False localizing signs

Mark Newbold, the Chief Executive of the Heart of England NHS Trust, once introduced me to what doctors call "false localizing" signs. These are signs that reflect dysfunction distant or remote from the expected anatomical location of pathology. So you get false localising signs when a problem manifests itself in a place other than where the source of the problem is.

The hospital behind the foliage is the Royal Northern Infirmary. It's the community hospital that serves Inverness, it has about 30 beds, and - at any one time - several - perhaps as many as fifteen - of these beds might be occupied by patients who really needn't be there. These are patients who are ready for discharge but they can't be discharged because they're waiting for "something else" to happen before they can go home - for example, a package of social care that might need to be organised, provided and funded by the local authority.

Delayed discharges are a massive problem for the NHS. And one of the reasons this problem hasn't been solved is to do with the false localizing sign thing. Patients needlessly occupying beds in hospitals like this means that patients in the general hospital three miles up the road can;t be transferred here. So they end up blocking beds in the acute hospital. And because their beds are needed by patients who are waiting in A&E to be admitted, we end up with ridiculously long delays in emergency departments - elderly patients waiting on trolleys for beds to become available.

False localizing signs make it harder for NHS managers to "see" the true cause of the problem. And because managers hardly ever look at the right data to help them make sense of the problem, we continue to limp along from one bed crisis to another.