NHS 'has enough beds to cope', minister says Some hospitals narrowly avoid "catastrophe" every weekend, one doctor told Sir Richard, because doctors" shifts were being limited by the European Working Time Directive, which prevents them working more than 48 hours a week. Many acute wards were "struggling to cope" with the volume of older patients, with people discharged in the middle of the night or shunted around "like parcels" to free beds for new arrivals. The College warned that if the problem was not tackled there would be more tragedies like the scandal at Mid Staffordshire NHS Foundation Trust, in which up to 1,200 mainly elderly patients died from substandard care. A radical reorganisation of the NHS was needed, according to the College. It may include shutting the worst-performing hospitals to expand care at better ones, with more staff coverage at nights and weekends. Sir Richard, who retired after 33 years as consultant physician and gastroenterologist at London St Thomas' Hospital, said there were parts of the NHS that were "having a great deal of difficulty in getting patients into the beds." He told the BBC Radio 4"s Today programme that many hospitals were "on the edge of having even more difficulty in coping with the large number of elderly patients ... coming into acute care services and hospitals." He said: "Yes there really are hospitals that are having a great deal of difficulty in getting patients into the beds they need and they are then pressurising the other services in hospital. My analogy is rather like a cuckoo in a nest - the acute services are growing because of the increasing elderly patients and therefore pressurising all the other services in the hospital. Certainly for the moment I believe we need more beds. If we believe that community and primary care could improve and allow the better discharge of patients to hospital and there are fewer admissions to hospital, then eventually we may be able to enjoy to have a reduced number of beds. He added: "For the moment, there are too few to cope with the increasing load year-on-year. It has an implication, particularly for staffing, because it is quite clear we need ... is looking at how we run the medical staffing to cope with the different flow of patients that we had 10 or 20 years ago. So it does have implications where we concentrate those staff and also the type of staff we have. He continued: "I think there will be reconfiguration and concentrating of clinical services to cope with the load and particularly the trainees [who] are enormously stretched." Dr Chris Roseveare, the president of the Society for Acute Medicine (SAM), said: "There is increasing evidence that a consultant-led, multi-professional acute medicine team provides better outcomes for patients. It is vital that acute hospitals work to provide this consistently, seven days per week. The NHS is being asked to deliver huge financial savings at a time when many hospitals are already buckling under pressure from the rising number of emergency admissions. He added: "A coordinated approach is urgently required between hospitals, general practitioners and social care agencies to address the challenges which this report has identified; without this, patients face the prospect of a very long, tough winter."