SIR: I am writing in response to Mr Crausby's letter (Viewpoint, May 21). Mr Crausby raises a number of points about hospital services for elderly patients and the closure of Bolton Royal Infirmary which require comment and clarification.

While respiratory illnesses are more prevalent during the winter months, we are experiencing increased demand for emergency admissions of patients in medical, elderly and surgical wards throughout the year. The number of in-patients and day cases admitted to our hospitals increased by 14 per cent during 1995/96 and this places great pressure upon bed availability and the staffing and financial resources of the Trust. The increase in admissions of elderly patients has been particularly high, but we would reassure all our patients, including the elderly, that we will continue to make every effort to meet their clinical needs within the resources available to us.

I should like to clarify the measures taken last year to increase bed availability in the medical and elderly specialities. In October 1995 we opened an additional ward for medical admissions at Bolton General Hospital. This represents a permanent increase of 18 beds and was funded mainly by Wigan and Bolton Health Authority but also through efficiency savings within the Trust. We also allocated staff to enable 11, previously orthopaedic beds at Bolton Royal Infirmary, to be re-designed temporarily for the admission of medical/elderly patients.

No beds will be lost through the relocation of services from Bolton Royal Infirmary to Bolton General Hospital. The new development provides a small increase in beds with further potential for increased theatre and intensive care services. The benefits of integrating acute services onto the Bolton General Hospital site include a greater flexibility in admission arrangements and speedier and more effective diagnosis and treatment; these, together with the new Medical Assessment ward, will help clinical staff to deal with the increasing activity. If these trends continue, it is inevitable that further resources will be required to meet the growing demand for medical specialities, particularly for the elderly. We have made many improvements in recent years and will continue to enhance our facilities and to extend the range of services available locally and to sustain progress made in reducing waiting time and improving performance in Patient Charter standards.

The burden of increased activity affects all departments, including those who provide supporting services as well as front-line areas. We recognise the tremendous efforts made by the staff in all our hospitals in these difficult circumstances and praise them for their dedication, professionalism and commitment.

J E Brunt, Chief Executive

Bolton Hospitals NHS Trust

Converted for the new archive on 14 July 2000. Some images and formatting may have been lost in the conversion.