Stephen Black challenges NHS untruths in the first in a new series

Many widely believed stories about the NHS actually hinder improvement. This series will challenge some of these myths in the hope of improving the debate about healthcare policy.

Myth one is that we need more beds and fewer targets to control infections. This myth is based on the argument that pressure of waiting-time targets has pushed hospitals to use beds too intensively leaving them without space to deal with outbreaks of infection.

The myth was bolstered last year when a leaked Department of Health report suggested a correlation between bed use and MRSA rates, the implication being that we should have more beds and fewer targets.

A naive observer might assume hospitals discharge patients on the day they are ready to leave. But half or more of patients are not.

Booked arrivals, however, are often told to arrive early and are admitted to a bed first thing in the morning. That makes two groups of people occupying beds most of whom do not need to be there.

Statistics on bed use are based on beds occupied at midnight each Thursday. A hospital with a disciplined approach to admission and discharge could free up beds every morning and would know where every patient was; when they were due for discharge; and when elective patients were due to arrive. It would be able to respond quickly in large emergencies or outbreaks of infection and reschedule arrivals or expedite discharges to create space.

A hospital not in control will keep occupancy low, but will not have the management levers to reduce occupancy.

The data behind the leaked report shows a weak but noticeable correlation between bed use and MRSA rates. This is not caused by uncontrollable pressures or lack of beds, but because inability to control flows through beds causes high use and inability to control infections. Management is the problem, not lack of beds. The myth distracts us from the reality.

Stephen Black is a consultant at PA Consulting. The next Myth-buster will published on 21 June.