The bedless hospital is at the centre of Birmingham Health Authority's plan for a health revolution across the city. A £20 million building is under construction at the Central Middlesex Hospital in London. The building will stretch across 75,000 square metres, the size of three football pitches.
Birmingham Health Authority proposes to build two of these centres, one at Good Hope Hospital, Sutton Coldfield, and the second at City Hospital, Birmingham.
It is claimed that they could ultimately care for 85% of all waiting-list surgery. There are no beds, only "recovery positions".
From the moment they enter the building, patients are to be moved smoothly from point to point - rather than spending the day sitted in crowded waiting rooms or hospital wards. Most of what happens to them will be determined by a prearranged schedule rather than by the ad hoc arrangements that characterise much of traditional hospital treatment.
The concept sounds radical but in many ways is no more so than an extension of what has happened already. Sixty percent of operations are already done as day surgery and new techniques are arriving daily. Patients once needed a perilous heart by-pass procedure now see a cardiologist who pokes around inside them and may install a reinforcing structure within their arteries. It can be less painful than going to the dentist.(but see (34))
Hospitals have been talking about setting up air-line style booking systems for patients. In an ACAD everybody is scheduled by computer. Nurses are retrained so that instead of specialising in, say, theatre work they stay with a patient from beginning to end.
All this takes less space than a traditional hospital, it is argued, enabling money to be spent on diagnostic equipment rather than bricks and mortar.
The behind the scenes architect of the Birmingham health plan was Mr Peter Spilsbury, its acute services commissioning manager.
He said: "In hospitals quite a lot of spaces are designed with only one function in mind. By moving away from that, with a relatively small investment, you can build something in which you can treat a very large proportion of your elective workload in absolutely first rate facilities."
In Birmingham the concept of a bedless hospital is provocative. It is not the first time planners have sought to play down the significance of beds. But Dr Jacky Chambers, Birmingham director of public health, insisted the benefits of being in a hospital bed were over estimated.
"Putting people into a bed is not always the best thing to do because bed rest leads to clots and muscle wastage," she said.
"It is what happens to you in the bed that is important. Nowadays you don't need to be in a hospital bed to get good diagnosis and treatment since medicine has changed such a lot. It's not just about doing things to people but also about helping people to understand how they can help themselves to recover."
The argument about beds will rage particularly fiercely around City Hospital, Dudley Road, proposed for a shot gun marriage with Sandwell Hospital, West Bromwich. City Hospital runs one of Britain's busiest front line services with 100,000 casualty patients in a year, tens of thousands more than any other local hospital.
It also has more casualty consultants than other Birmingham hospitals and pioneered the idea of a consultant led accident and emergency department - now a centrepiece of the health authority's considerations.
There is a distinction between emergency services - which treat people in crisis - and waiting list surgery which to a large extent seeks to prevent critical illness. But in both cases hospital staff raise the same objection to bed cuts: "If beds are being poorly used how come we believe we are having to discharge many patients days before they are truly ready?"
The health authority argues that there is a difference between nursing and medical care. It proposes establishing nursing home style "intermediate care centres" which, it says, could provide nursing care for patients before they go home. These new centres along with the ACADs, may well represent a long needed revamp of hospital services but will they genuinely reduce the need for mainstream beds and wards?
Dr Barrie Smith, a consultant physician at Sandwell Hospital, said they would not.
"I believe the current level of acute beds in West Birmingham and Sandwell will need to be largely maintained - given the rise in public expectation, the increasing intolerance of symptoms and the demographic changes," he said.
Major forms of surgery, such as joint replacements, would continue to develop, he argued, and there were no grounds for running down either City or Sandwell hospitals.
"It seems that the plan was formulated and then the facts and philosophy were adapted and massaged to support the argument," he said.
See also Birmingham Health Authority
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