John Womersley
It’s to be all single rooms here at the Southern General
I want help to save at least £30 million building costs (and considerable savings in nursing and cleaning) for the proposed new Dumfries and Galloway Royal Infirmary (DGRI). These, and similar savings in all new hospitals, can be achieved without detriment to anyone if together we can reverse a senseless Scottish Government policy, made without public or parliamentary debate, that all rooms in new hospitals must be single except for ‘clinical reasons’.
This new policy has been accepted with little comment in Glasgow (all rooms in the new Southern General hospital are to be single), but many people in Dumfries and Galloway are not happy. NHS Dumfries and Galloway ignores their views, not wishing to deprive itself of the fun of planning and kudos of having a new hospital. The Scottish Health Council does likewise – its responsibility now being only to ensure that ‘consultations’ take place, not that any account is taken of views expressed.
Many people are concerned at depriving about 50% of the population of their choice of accommodation and worry that isolation in a single room will deprive them of companionship, diversion from their own problems, and the opportunity to ‘watch out’ for one another. Having 100% single rooms adds some 15% to the £200m cost of a 50/50 mix of single rooms and four-bedded wards.
Nicola Sturgeon, when cabinet secretary for health and wellbeing, explained in a letter that the decision in favour of 100% single rooms was based on ‘available literature and evidence, a public attitude survey, a nursing staffing report, a financial impact study, a three-stage Expert (Delphi) Consultation, the views of specialty advisors, and a review by the Chief Medical Officer – taking into account the impact of increasing multidisciplinary team-working and anticipated new ways of delivering care’.
However the ‘available literature’ was from selected parts of selected sources, omitting for example a survey of patients in DGRI that showed that 70% of patients in four-bedded bays and 40% of patients in single rooms would prefer shared accommodation if re-admitted, and a survey of 990 patients across Scotland in which only 41% expressed a preference for a single room.
A consultant at the hospital states ‘there is no evidence base for the policy. Single rooms are what upper middle class professionals would want if admitted for elective surgery but will amount to sensory deprivation in solitary confinement for the middle aged/elderly emergency medical admission. Around 50% single rooms is sufficient to isolate patients during outbreaks of hospital acquired infections’. The only flexibility may be for consultants to make the case for some four-bedded wards on the basis of preventing sensory deprivation – surely an extreme measure to secure companionship and safety whilst in hospital.
A health board member comments: ‘For many elderly patients even a day in hospital is a long time to be on your own, let alone a week or more. More staff are needed for nursing and cleaning single rooms. There is also evidence of more falls in single rooms, and increased capital and running costs’.
‘Increasing multidisciplinary team working and anticipated new ways of delivering care’ are also questionable reasons in favour of the single-room policy. A multidisciplinary team seriously failed Kane Gorny who died of dehydration in St George’s Hospital, London; and a similar case occurred in Glasgow Royal Infirmary. Both cases resulted from failures in communication and continuity of care – nothing to do with the availability of single rooms. Communication with nurses and others is likely to diminish with single rooms, particularly if video screens become a substitute for personal contact.
At least three senior NHS Dumfries and Galloway staff and health board members have expressed concern about the single room policy to politicians and senior officers of NHS Scotland. Members of the public had their turn on 25 September at the NHS Dumfries and Galloway annual review with the Scottish Government, represented by Michael Matheson (minister for public health) and Derek Feeley (director general health and chief executive of the NHS in Scotland). But every argument put to the minister was firmly dismissed.
The Scottish Health Council website states ‘our aim is to improve how the NHS listens to you, values your views and experience, and ensures that patients, carers and the public are able to influence the planning and delivery of NHS services’. However its director, Richard Norris, writes ‘expressed public preferences cannot be used to support variance from the stated policy’ and that ‘in our view NHS boards should be clear to the public that there is no opportunity to influence a move away from single-bedded rooms’. What is the point of holding public consultations if public preferences are not to influence ‘stated policy?’. And what is the purpose of the Health Council if not to ensure that government policy takes account of the public’s reasonable wishes and concerns?
Rather than responding to well-evidenced needs for service improvement and waste reduction, NHS policy-makers dream up ideas for their own adulation – the single room policy being just one example. Evidence in support of each new idea is sought, surveys conducted and ‘inconvenient’ findings ignored. ‘Experts’ are then invited to give their views before ‘consultations’ are held to allow members of the public to comment on – but not influence – decisions already made.
The editor of the British Medical Journal writes: ‘Policy decisions that go against good evidence must be acknowledged to be ideological rather than rational’. The NHS abhors evidence that is not of its own making. There are numerous reports on lack of accountability and wasteful activity in the NHS from medical, academic and media commentators but their evidence continues to be ignored. When are taxpayers going to say that enough is enough?
John Womersley was a consultant in public health, NHS Greater Glasgow and Clyde, 1978-2006
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