Hospital wards

This one, as they say, will run and run. The government has just announced that hospitals will not be paid if they put people into mixed-sex wards, unless there is clinical need (BBC, Guardian, Times).

First, one wonders why we should never have mixed-sex wards. Clearly it is more efficient to have some mixed-sex wards. If all wards are single-sex then a new patient will have to wait for a bed in the correct ward, even if there are lots of beds available in another ward. It’s ridiculous to have two permanent wards dedicated to a particular treatment or technology, if there are never enough people to fill one. In the parts of the health service where proper research has been done (mental health) it seems many patients are happy with mixed-sex wards anyway, especially when there are always staff around to increase security.

However, various incidents in mixed-sex wards, hyped by the tabloids, have made the public believe that single-sex wards are the answer. Unfortunately, the government have made it a pledge again and again (despite understanding that it makes for inefficiencies). This has meant that it can be a stick to beat the government with when any mixed-sex wards remain.

Now if you are to read the current press, you’d think that this was a recent issue, and in some ways it is. The amount of news articles about it tripled from 2004 to 2005. Is this because there are more mixed-sex wards? No, there seem to be fewer each year. Is this story newly discovered? Certainly not.

The earliest reference I find is from August 1979:

In other respects Mr Jenkin and Dr Vaughan seem to be deliberately ignoring their own protestations about the need for decisions to be taken locally. For instance, about mixed sex wards. The wards of a modern hospital are designed to take patients of both sexes — in separate bays and with separate sanitary arrangements; they can thus be used more efficiently because they can allow for a temporary excess of one sex’s numbers over the other’s. In the Nightingale wards of older hospitals — with a row of beds down each wall separated only by curtains ruthlessly drawn back for most of the time and no segregated lavatories — unisex beds cause more trouble; many women are embarrassed enough by the prospect of a man in the next bed to prefer a longer waiting time for admission to a single-sex ward. But not all patients complain. Some prefer mixed sex wards even in older hospitals; others are not bothered either way. Very clearly, mixed sex wards should be a matter for local health service managers, guided by local opinion and community health councils. Hitherto they have always been regarded as such. Now Dr Vaughan has announced flatly that mixed sex admissions into an old-type ward, are to cease. (The Economist, found on Lexis Nexis)

So when one sees the press saying the government failed in its pledge after so many years, it should be noted that these pledges have been made since at least 1979.Virginia Bottomley was making this pledge in 1994…

But let’s accept the absolute need for ‘dignity and privacy’*. The important question to ask next is ‘what does single-sex ward mean anyway?’. Total isolation of a single-sex wards behind locked doors? single-sex rooms with single-sex bathrooms down the corridor? Floor to ceiling partitions that can be moved to make each half bigger or smaller, dependent on demand?

If, as I suspect, the government has painted itself into a corner by saying ‘there will be no mixed-sex wards’ as opposed to saying people will be allowed to choose single-sex wards, and everything will be done to ensure privacy, then we’re going to have to accept a less efficient service. Pound for pound, fewer patients will be treated, as sometimes the correct space won’t be available. Either money will go into new facilities, with no corresponding increase in healthcare, or money will be shifted from healthcare to new facilities. £100 million, so far, is being put into a ‘dignity and privacy fund’. So some people will get worse care than they would otherwise have done. At least they’ll be ill with dignity.

*Although I personally don’t see why single-sex wards increase privacy. I don’t want anyone, male or female, overhearing my medical issues, or glancing up my dressing gown. However, if I was ill and told we can offer you an appointment in a week, but you’ll be on a mixed ward, or in two months and you’ll have your own room, I’d be choosing the first.

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Londoncentric

This week I had reason to read through last summer’s Communities white paper, and it just reminded me quite how Londoncentric our government can be.

In its more serious guise, the inability to see beyond the M25 has serious policy implications. As an example, the idea of choice in schooling makes more sense in the metropolis where it is at least possible to commute to school. Obviously this is impossible in rural areas, and even in big cities it can be difficult because public transport is so sparse.

The white paper does state that ‘power still remains too centralised and too concentrated in government’. And it is true that throughout the document there are examples from around the country.

However, if you look carefully you’ll see just how far the hired photographers are prepared to go. Each chapter begins with a photo of a model citizen holding up a placard. Some settings looked a little familiar. First I recognised Chapter 3’s picture, Russell Square station, then Chapter 6 looks suspiciously like a pub I used to drink in, the Museum Tavern in Bloomsbury. Checking the others, Chapter 2’s photo was at the Brunswick shopping centre, Bloomsbury, Chapter 8’s is outside Ruskin’s cafe, next to the Museum Tavern. Two are indoors and two I can’t tell where they are.

All of these staged photos, it seems, were taken with a mile or so of Russell Square station. So it’s Londoncentric to the core.