Senior medical leaders 'reject' results of rapid bed review

Independent review found adding beds will not solve wider issues

An organisation that represents doctors on the Isle of Man has described the recent rapid review into bed capacity at Noble's Hospital as 'fundamentally flawed'.

The Medical Staff Committee disputes its conclusion that 'opening additional beds without root-cause improvements would most likely result in these beds being filled almost immediately, providing a one-off benefit, beyond which the current position would continue'.

The review came as a result of a call from the MSC earlier this year for Manx Care to provide an additional 50 inpatient beds at Noble's Hospital to tackle what it called a 'critical shortfall'.

You can read more on that background here and a full report on the review here.

As a result Health and Social Care Minister Claire Christian announced a rapid review would be undertaken to assess their concerns, with Ms Christian insisting her department was 'taking charge' of the capacity issues.

That review was published this week.

The independent reviewer found 'a range of other underlying issues', beyond just a lack of beds, that the reviewer 'believes are influencing service cohesion and delivery'.

In his closing comments Peter Gent, from PSG Health Limited, said: "Complex issues such as trust, discretionary behaviours, questionable consultant job plans, silo-planning and circumvention of normal governance systems appear evident.

"These are deep rooted behavioural and cultural issues which may also be distracting from delivering responsive and efficient services. 

"My concern for the current executive leadership team and future appointees is that Manx Care becomes ungovernable and, for key groups of the workforce, there are ulterior motives to building services comparable with modern and more efficient healthcare organisations."

INPATIENT BEDS

The review also found that 'whilst there may be a case at some point to expand inpatient capacity linked directly to demographic or population-based growth demand, more beds without addressing current inefficiencies would offer no ongoing solution'.

Instead, it recommends 'first optimising the potential of the current capacity, skills and transformation opportunities'.

It states that 'adding additional beds without embedding changes to current practices will not deliver improved flow but will significantly increase costs and introduce additional risks'.

But that position has been rejected by the Medical Staff Committee.

In a statement it said: "While welcoming the focus on operational efficiency, clinicians warn that the report’s primary conclusion—that Noble's Hospital does not require additional physical beds—is fundamentally flawed and poses a long-term risk to patient safety.

"The rapid review, completed within a highly restricted 10-day timeframe, attributes the hospital’s operational challenges to internal processes and 'behavioural issues' rather than a structural shortage of resources. 

"Senior medical leaders reject this assessment, citing extensive evidence from the Royal College of Emergency Medicine and NHS England, which proves that a baseline deficit in physical beds cannot be corrected by administrative or organisational adjustments alone. 

"When a hospital's bed occupancy consistently breaches the internationally recognised safe threshold of 85 percent, the entire care pathway experiences gridlock, directly increasing emergency department crowding, ambulance offload times, and patient mortality."

It adds: "Clinicians are calling on the DHSC and Manx Care leadership to look past short-term administrative audits and instead collaborate on a sustained, evidence-based expansion of the hospital's baseline bed capacity to safeguard the Manx public."

NEXT STEPS

The health minister faced questions in Tynwald this week about the report and its results.

After the sitting, Ms Christian spoke to Manx Radio's Political Correspondent Phil Gawne:

She says the department and Manx Care will now be looking at 'flow and efficiencies' not just within the hospital but 'all the way through from the GPs to discharge'.

She also confirmed plans to implement a Clinical Decision Unit - a 12-space unit within the emergency department - are proceeding. 

Other examples given in the review for what could help tackle issues at Noble's Hospital include switching to seven-day working.

Ms Christian explained: "So for example, right now, we work on a five-day discharge, that's during the week.

"And what the recommendation is, that we move to a seven-day discharge so that there's discharges happening on the weekend as well, so that we don't have that backup on Monday and Tuesday morning. And that's quite a simple thing, 

"But Manx Care now have to look at implementing that, working with the frontline staff, seeing if they'll be willing to work with working plans to be able to achieve that. 

"And then obviously there might be a cost to that as well, so we've got to look at that within our framework and within our budget."

Minister Christian has confirmed that Manx Care and DHSC officers will develop a draft action plan in response to the review by 24 June for discussion at the DHSC department meeting.