#BTColumn – Another hospital is definitely not needed

Disclaimer: The views and opinions expressed by this author are their own and do not represent the official position of the Barbados Today.

by Professor Emeritus Sir Henry Fraser

The recent mention of “bed-blocking” at the QEH by elderly incapacitated patients has led to the media highlighting a view that “Another hospital is way overdue.”

– (Daily Nation, Tuesday, November 3rd.) Nothing could be further from the truth.

Barbados has a larger proportion of elderly citizens than most CARICOM countries. There are several reasons for this:

(1) The physically active lifestyle before independence promoted longevity,

(2) We probably have a healthier gene pool, for historical reasons linked to the slave trade, and

(3) The continuing emigration of younger people to North America.

Unfortunately, the epidemiological transition, with a largely inactive lifestyle since independence, has produced an epidemic of chronic diseases which greatly increases the morbidity of the elderly – a high prevalence of high blood pressure, heart disease, diabetes and their consequences such as strokes and amputations, and hence significant disability and dependence.

But this does not mean that hugely expensive tertiary care beds in a second or expanded hospital are needed. Our beds to population ratio is as good as most western countries. Incapacitated elderly do not need intensive and costly tertiary care. As the prime minister has pointed out, QEH beds cost five times as much as geriatric hospital beds.

What IS needed is a multi-faceted approach, with several key programmes, to prevent the “bed blocking” the Minister commented on, which has in fact been going on for decades, and shifts with fluctuations in staffing, operation of equipment such as X-Ray and lab services, morale and other causes of variable efficiency of overall care.

The first requirement to deal with the current problem is adequate residential accommodation – the geriatric hospital, infirmary and elderly care-home beds. The latter is a programme of private care that has been operating
for some years.

Infirmary beds were seriously reduced with the demolition of the Christ Church Infirmary at Oistins, and more recently, the closure of that in St. Lucy. The Geriatric Hospital has accommodated more than 500 patients for much of the past. Is it being efficiently utilised today to accommodate those described as “left” at the QEH and said to be “blocking beds”?

Day care centres

The medium-term solution is the provision of day care centres. I have written and spoken repeatedly for 40 years about the obvious benefits of such facilities – in conferences, columns and in the senate.

The example of the St. Barnabas Church Day Care Centre is a role model that can easily be followed both by many of our churches, which have church halls and similar out buildings, and by the government and the private sector. Such a centre not only maintains activity into old age for a longer period, delaying dependence, but solves the problem of day care for many elderly subjects and families.

The long-term solutions, of course, include both the broad public health and educational approaches advocated by the Chronic Non-Communicable Disease Commission led by Sir Trevor Hassell, and the expansion of the support health care services of rehabilitation therapy (occupational therapy and physical therapy), which help to delay invalidity, accelerate recovery from illness and hospitalisation, and help the disabled to function in their own homes.

We certainly do NOT need another hospital or a new hospital in order to improve our health services and the care of the elderly.

In fact, some 14 years ago the then Minister of Health commissioned an extensive study by the leading hospital consulting team, Capita, Norman and Dawbarn.

The better of their two options proposed, that of a complete rehab and improvement job and a state-of-the-art new multi-story wing to the north, was estimated to cost just under $600 million. They also suggested a new hospital, with fewer beds, at an estimated cost of just under $900 million – 50 per cent more. I am relieved that this government is not being misled into proposing a new hospital, as we simply do not need one and would not be able to afford it, anyway.

What we DO need, as shown in the study of health care human resources commissioned by the Faculty of Medical Sciences in 2007, are increases in several categories of health professionals.

Our problems are all solvable by an evidence-based, multi-faceted approach and improved efficiency at all levels; not by more bricks and mortar.

Professor Emeritus Sir Henry Fraser is a Professor of Medicine and Clinical Pharmacology.