Leading Article: Intensive care needs more beds

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On Tuesday, an official inquiry catalogued how 10-year-old Nicholas Geldard, dying from a brain haemorrhage, was shunted between four hospitals because no paediatric intensive care beds could be found. That day Sir Roy Calne, one of Britain's most respected transplant surgeons, revealed that 11 of his patients had died in the past year waiting for liver transplants because of a shortage of intensive care beds. We have learnt to live with long waiting times for operations in the National Health Service. But deaths such as this we find hard to accept.

Yesterday, Stephen Dorrell, the politically astute Health Secretary, set about tackling a crisis in these emergency services. A few weeks ago he launched a potentially far-reaching review of community care policies. Mr Dorrell is busy putting in place his party's defences against charges that are bound to be made during the election campaign that the Government has neglected the NHS. Yet his planned measures will fail to assuage the genuine and warranted fears of those who rely on the NHS in times of emergency.

Mr Dorrell published a long list of guidance and advice requiring and requesting that hospital trusts and health authorities give these emergency and intensive care services higher priority. He focused his attention particularly on paediatric intensive care beds, accepting the conclusion of the Geldard report that the time for talking about improving bed availability was over. Mr Dorrell expects to be told by the end of April how the problem has been solved.

The Health Secretary wants greater emphasis on the creation of "high dependency units", a system for patients who need more than ordinary ward care but less than intensive care. The aim is to reduce costs and take the strain off adult intensive care beds He has also demanded greater co-ordination of the available beds, so a shortage in one area can be met by using surplus beds elsewhere. To improve casualty departments that are frequently logjammed he wants the workforce better organised and new guarantees for patients waiting for treatment.

All these organisational changes make good sense. Mr Dorrell is right to petition the various players in the NHS market - hospitals and health authorities - to make a better job of planning intensive care bed and casualty facilities.

But the Health Secretary must recognise that the problem goes beyond planning. Doctors do not find themselves jeopardising the lives of critically ill people simply because of poor organisation. The issue Mr Dorrell did not address yesterday was resources.

Changes in priorities and planning can make a difference, but with all hospitals concentrating on government targets to cut waiting times for operations, there is not that much room to shift resources within existing budgets.

New money will have to come from somewhere to address the shortages so clearly identified yesterday. Yet Mr Dorrell is not offering fresh financial help to struggling hospitals. Within the constraints of tight public sector finances, the poverty of his response is hardly surprising. But come the general election, Mr Dorrell should not be surprised if voters are unsympathetic with the Government's failure to meet popular expectations on such a critical issue.