Electronic Letters to:

Original papers:
Guy Dodgson, Kathleen Crebbin, Caroline Pickering, Emma Mitford, Alison Brabban, and Roger Paxton
Early intervention in psychosis service and psychiatric admissions
Psychiatr Bull 2008; 32: 413-416 [Abstract] [Full text] [PDF]
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[Read eLetter] Not quite as simple as this
LS Choong   (19 December 2008)

Not quite as simple as this 19 December 2008
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LS Choong,
Medical director
MRCPsych

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Re: Not quite as simple as this

steve.choong{at}worcsmhp.nhs.uk LS Choong

The cash saved following a reduction of bed days claimed by Dodgson et al needs to be understood in the context of benefits realisation and clinical service realities. The average bed reduction was just over four. Therefore it would not reduce costs of the admission ward if the beds were filled up by others. Further, keeping the beds empty would not allow the full savings to be achieved as the corresponding reduction in staff would not usually possible in practice; the overheads would also, by and large, remain the same.

Savings near this level, apart from central organisational overheads, can however be achieved if whole wards can be closed. This requires the right critical mass in terms of reduction in bed usage through services providing for bigger populations or being part of a raft of other interventions such as assertive outreach, day service provisions, crisis reslution and home treatment.