Editorial

A senior colleague once told me that his life would be ‘dull’ if all a consultant ever did was treat patients. There have been plenty of occasions this winter when I would willingly have traded my yearly salary for a ‘dull life’. Amidst the daily crowd control of Acute Medicine it is easy to immerse oneself in clinical challenges; however it is equally important not to lose touch with management responsibilities during these difficult times. The Economic gloom of the past 12 months will soon have a significant impact on the financial health of the NHS. While Government ministers strive to reassure the Public that the cuts in funding will not impact on patient care, those working in the Service are casting nervous glances over their shoulders, wondering where the axe will fall. It is tempting to believe that the value of the Acute Medical Unit in maintaining patient f low will afford protection from the Chief Executive’s best Hatchet Man. As illustrated in the paper in this edition by Khadjooi and colleagues from Scarborough, early review by an acute medical consultant can be highly effective in preventing unnecessary hospital admission and shortening length of stay. Many readers may be able to produce similar data from local developments within their own units. However, the paper on p 123 shows how changes in funding arrangements might threaten such developments. Alam et al have shown how the lower ‘short stay’ tariff through Payment by Results is far from offset by financial savings from reduced bed numbers. Indeed, hospitals may find themselves losing revenue, discouraging the additional effort which is often required to get patients home sooner. Of course there are other arguments which must not be forgotten – a bed which can be used more than once in 24 hours can attract multiple ‘short stay’ tariffs for the same staff cost; fewer ‘outliers’ in surgical beds mean more ‘high tariff’surgical procedures; the four-hour target would disappear over the horizon if bed occupancy rose any higher; and of course we should not forget the patient, who would surely prefer to sleep in their own bed… Same Sex accommodation has been another hot topic in UK healthcare over recent months. The rapid patient turnover within Acute Medical Units might previously have led acute physicians to consider that they would be excluded from this additional burden. However, recent Department of Health documents make it clear that these ‘rules’ should apply equally on an AMU. Whether this is achievable within our high levels of occupancy will probably depend on the relative levels of priority afforded to each of the targets with which we are faced: is it acceptable to leave a patient on an Emergency Department trolley simply because the appropriate sex bed is not available? Hayley Bonner’s paper on p119 suggests that some patients would probably disagree. Her findings indicate that most AMU patients do not consider this issue as important as some would have us believe; predictably men were less bothered than women, and most would choose a shorter hospital stay above same-sex accommodation if given the choice. Correspondence from readers who have found solutions to these challenges, or on any other issue raised in this edition would be welcomed for future publication.