With hospitals full to capacity, NHS plans in some areas to cut hospital beds are undesirable and unachievable, warns The King’s Fund in a new report.
New analysis for the report finds that the total number of NHS hospital beds1 in England has more than halved over the past 30 years, from around 299,000 to 142,000, as more people with mental illness and learning disabilities are cared for in the community and medical advances have reduced the time many patients spend in hospital. Although it finds that most advanced nations have reduced hospital bed numbers in recent years, the report shows that the NHS now has fewer acute hospital beds per person than almost any other comparable health system2.
As the NHS braces itself for a difficult winter, the analysis highlights a growing shortage of beds as hospitals struggle to cope with increasing numbers of patients with more complex conditions. In 2016/17, overnight occupancy in acute hospitals averaged more than 90 per cent and regularly exceeded 95 per cent during the winter, well above the level widely thought to be safe.
Despite clear evidence that hospitals are overstretched, the report finds that in some parts of the country, sustainability and transformation plans (STPs) have put forward significant cuts in hospital beds3, in some cases proposing to reduce the number of beds at a faster rate than the national trend in recent years. The authors conclude that the scale of reductions in the number of beds proposed in these areas is unrealistic.
The report suggests that there are still some opportunities to make better use of existing beds, especially by focusing on older patients who stay in hospital for long periods of time, and highlights promising signs that ‘vanguard’ areas trialing new ways of delivering care have made some progress in slowing the rise in emergency hospital admissions. In the long term this may help moderate future increases in hospital bed use from a growing and ageing population.
Crucially, further progress depends on having adequate services in place to provide care closer to people’s homes. But the report also highlights evidence that capacity in intermediate care – services to support patients leaving, or at risk of going into, hospital – is only sufficient to meet around half of demand, while cuts in funding have led to significant reductions in publicly funded social care.
Helen McKenna, Senior Policy Adviser at The King’s Fund, says: "Over the years, medical advances and policies to care for more patients in the community have enabled hospitals to treat more patients using fewer beds. This has improved care for patients and resulted in significant reductions in the number of hospital beds.
"There are opportunities to make better use of existing beds and initiatives to capitalise on these should continue. But with many hospitals already stretched to breaking point, reductions on the scale we know have been proposed in some areas are neither desirable nor achievable. We welcome new requirements introduced by NHS England that local areas must meet before significant numbers of beds can be closed4.
"It is also important that the national audit NHS England is currently undertaking addresses gaps in data by providing a transparent, accurate and comprehensive picture of bed capacity."
Key messages
* The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients treated has increased significantly.
* Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK currently has fewer acute beds relative to its population than almost any other comparable health system.
* Since 1987/8, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community.
* The number of general and acute beds has fallen by 43% since 1987/8, the bulk of this fall due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.
* While the rate of decrease in bed numbers has slowed in recent years, there are opportunities to make better use of existing bed stock by preventing avoidable admissions, reducing variations in length of stay and improving the discharge of patients. Efforts to make better use of the existing stock should focus on the relatively small number of mainly older patients who stay in hospital a long time.
* There are promising signs that some initiatives are succeeding in this. Emerging evidence from vanguard sites suggests progress in slowing rates of increase in emergency admission. However, research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care.
* Today there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3%, and regularly exceeded 95% in winter, well above the level many consider safe. In this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.
* In some areas, it may be possible to reduce the number of beds. However, at a national level, with hospitals under real strain from rising demand and a prolonged slowdown in funding, further significant reductions are both unachievable and undesirable.
* How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity. It is essential that the national audit currently being undertaken by NHS England provides a transparent, accurate and comprehensive picture of bed capacity.
View the full report and more information/comment here:
https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers
Sources
1. Total hospital beds include five categories: general and acute, mental health, learning disability, maternity and day only.
2. The report uses OECD data on acute beds per 1,000 inhabitants in 2014 to compare EU-15 countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom.
3. https://www.kingsfund.org.uk/publications/sustainability-and-transformation-plans-london
4. In April 2017, NHS England Chief Executive Simon Stevens introduced a new test requiring local NHS organisations to demonstrate that ‘significant’ proposed bed closures meet one of three new conditions, one of these being that sufficient alternative provision, such as increased GP or community services, is put in place alongside or ahead of changes (https://www.england.nhs.uk/2017/03/new-patient-care-test).
