"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Tuesday, 12 January 2010

Conservative Draft Manifesto 2010: Dissection Part 8

An analysis of the Conservative Draft Manifesto 2010.

"We will end the scandal of mixed-sex accommodation and increase the number of single rooms in hospitals, as resources allow."

First note the emotive language, the implication is that Labour has changed hospitals to a "scandalous" state where sexes have to mix. You get an image of vulnerable old women being leered at by dirty old men in raincoats, and all of this been forced on patients from an uncaring Labour government. This is arrant nonsense, of course, mixed wards go back far longer than the current Labour administration and existed when the Conservatives were in office and running down the health service. It is Labour government policy to change over to single-sex accommodation, and two thirds of hospitals now have single sex accommodation. It is also Labour policy for hospitals to supply more single rooms: in 2001 the government issued guidance that all new hospitals should have at least 50% single room capacity.

Labour has always wanted hospitals to have single sex wards and, if possible, single room accommodation. However, the big problem, as always, is cost. The Conservatives recognise this with that weasel phrase as resources allow. Changing to single sex accommodation requires capital spending on existing wards, and changing to single room accommodation often means complete rebuilds. Labour has supplied capital funding to upgrade hospitals to these new standards, but they recognise the immensity of the task. The Conservatives do not appear to understand the size of the problem. They are simply promising jam tomorrow.

Let's examine the problem. The old style wards in the UK are often known as Nightingale wards: they are large rooms with rows of beds along the two long walls and typically a nurses' station at one end for monitoring the patients. Toilet and washing facilities are typically at one end or other of the ward and so to use these facilities a patient has to walk past other beds. In a mixed-sex ward such a patient will have to walk past patients of either sex. When patients need privacy curtains are drawn around the bed. Such curtains do not block sound, and often gaps appear between the curtains. They are simply no solution to dignity.

A more up to date solution is bays where the ward is sectioned off enclosing six or eight beds. Again, curtains are used to provide some privacy from other patients in the bay. It can be argued that each patient gets more privacy because patients from other bays (nor hospital workers visiting other bays) will not need to be in another bay. Since each bay has fewer patients it is more possible to make them single sex. Converting a Nightingale ward to a ward with bays reduces the number of beds because the partitions take up space. In addition, to prevent patients walking past patients of the opposite sex when visiting the toilet or bathroom, there has to be provision of extra toilets and bathrooms (preferably these facilities should be for the use of a specific bay) and this takes up more space.

For single room accommodation, it makes no sense for patients to share bathrooms since the idea is to keep the patients separated. This means rooms have to be en suite and so for single room accommodation even more space is taken up. It is easy to imagine that each bed in single room accommodation will take up at least twice the space as a bed in a Nightingale ward.

Therefore, a provision to provide single-sex or single room accommodation will reduce capacity significantly, and this will mean building more wards and more hospitals. The cost of this will be billions. There is no costing in the Conservatives' proposal, so one can only assume that this policy, from an austerity government, is an unobtainable aspiration. David Cameron was pressed on this issue on the 7 January on the BBC's Today programme and he agreed that he would "have to be tough and pull back" from the Conservative "guarantee" of 45,000 single rooms. He then said that it couldn't be a "pledge", instead he said "it is an aspiration". I think we will find that a lot of the Tory promises will become "aspirations".

The Conservative 2009 health policy acknowledges that the Labour government has provided capital funding to upgrade accommodation, but they do not pledge any extra funding and David Cameron has admitted that their promises are unobtainable. In other words, the Conservatives will carry on exactly the same as the Labour government in this policy.

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