Show As we approach the planned end to most covid-19 restrictions in England on 19 July, our general hospitals remain under unprecedented midsummer pressures, even though admissions and beds occupied by people with covid-19 are still way below peak pandemic levels.12 Bed capacity was a glaring problem for the NHS well before covid, and even with no more surges in infections it will remain a huge limiting factor to our health system’s resilience and performance.3 Between 2010-11 and 2019-20 England’s overall number of NHS hospital beds fell by 11%, from 144 455 to 128 943. The number of available general and acute beds fell by 8%, from 110 568 to 102 194.4 Population growth, ageing, and the accompanying frailty, disability, and multiple long term conditions all drive activity and need in health and social care. Despite a pressing need to tackle health inequalities, socioeconomic deprivation, and wider determinants of preventable non-communicable disease, it’s fanciful to think that we’ll reverse the need for hospital care in the foreseeable future.567 Overnight bed occupancy was around 90% before the pandemic and exceeded that in serial pre-covid winters.8 We must be cautious in interpreting figures from the pandemic, because infection control measures and emergency discharge arrangements reduced the number of beds available, enabled faster clearance of beds, and led to elective work being cancelled and postponed so that occupancy fell below historical levels.9 In June 2021, however, emergency department attendances in England reached an all time high for that month, at over 2.1 million, with 407 000 emergency department admissions to beds (up 21% on June 2020 and 8% on June 2019), and waits for over 12 hours rose sharply.10 The NHS also faces the longest waiting list for elective appointments since 2007, of over five million people, growing by over 600 000 in the past three months.10 These waits are often for procedures requiring beds for overnight hospital stays or day case admission. Occupancy is back above 90% in many places,11 and some hospitals have declared formal capacity alerts.12 We could debate evidence about the optimal bed occupancy needed to avoid inefficiencies and overheads from empty beds and whether the 85% sometimes quoted is the right figure.13 We could discuss whether we have enough staff to look after any additional beds when we already face a workforce crisis.14 We could explore the UK’s wisdom in hosting both acute “hot” and elective “cold” care in the same facilities so that seasonal pandemics, outbreaks, and acute demand affect planned care.15 We could discuss the efficiencies of enabling a better flow of patients through beds, fewer internal delays in processes, and a greater focus on early discharge.16 We could also argue the case for more capacity in alternative services outside hospital and a greater focus on prevention. But remember that public health17 and social care budgets have suffered sustained funding cuts since 2010, and in that time the number of people receiving home support has fallen, with care home places flatlining.1819 During that period, GP numbers have remained static and district nursing numbers have fallen, all against a background of rising demand. The National Audit of Intermediate Care20 has shown that we have nowhere near enough capacity in community alternatives to hospital beds for adults recovering from acute illness or injury. In 2017 the Nuffield Trust’s Shifting the Balance of Care report predicted that demand for hospital beds would continue to rise and argued that ambitions to shift ever more care out of hospital beds were overstated without big additional capacity in other services.21 By 2020 Nigel Edwards, the trust’s chief executive, wrote that we were still failing to learn from the kind of over-optimistic assumptions that had led to ever fewer beds in the face of rising demand.22 I’m still not convinced that politicians or national NHS leaders are listening or learning from the history of successive cuts in bed numbers.
Research carried out by The Kings Fund has shown how the volume of hospital beds within the NHS have varied over time. The findings are that the total number of NHS hospital beds In England has more than halved between 1987/88 and 2019/20, going from 299,000 to 141,000. Whilst the beds have drastically decreased, the number of patients has increased significantly. This has been put down to more advanced medical care and therefore meaning less patients are having to stay in hospital overnight. Despite this fact, daytime beds have increased from two thousand to nearly thirteen thousand, a five hundred and thirty per cent increase. Other changes within the structure of the healthcare system, for example, mental health and care for those with learning disabilities has been made a community care responsibility rather than institutional. This change showed that overnight beds for mental health had a 73% decrease and learning disabilities had a 97% decrease.  The research also found that critical care beds have an additional 500 beds now than thirty years ago. The overall number of hospital beds within the NHS continues to fall as a result of the pandemic, social distancing and infection-control measures. Despite the number of hospital beds decreasing the general population has increased to approximately 56.6 million in 2020, meaning the number of beds per capita has decreased over time. The UK now has fewer hospital beds than most comparative health care systems. Figures gathered over the past 20 years have shown that the number of hospital beds has been slowly falling across many countries. Factors for this according to the research could be because patients are spending less time in hospital. Better patient care within the NHS and advances in anaesthetic and surgical techniques have resulted in the average length of stay in an NHS hospital falling more than forty per cent since 1988. Another factor for this is reducing the reliance on hospital care by dissolving certain areas of care into social and community care, such as mental health. This allows for people to be treated either at home or in a specialist unit, rather than in hospitals. Covid-19 and the effects of the pandemic has radically changed the current demand for beds and it is still not clear when and how hospitals will stabilise these numbers. This has put a halt to policies for the medium- to long-term management of beds until the demands on hospital beds from the pandemic alleviate themselves. .
NHE Sept/Oct 22 The Christie's Experimental Cancer Medicine Team
This issue highlights the latest innovative technologies to optimise the NHS estates, the journey to improving EDI at an NHS Trust, hybrid working, the HARMONIE study, and much more.
National Health Executive Presents NHE365 Virtual Events
NHE has created a full calendar of events to address the most important issues that influence the delivery of healthcare services. Over 365 days you'll have the opportunity to hear from a range of highly motivating, informative and inspirational speakers. These speakers will equip you with the knowledge and unique insight to enable you to overcome the challenges that you face. Finger on the Pulse Ep 14. Health messaging is a science, Professor Craig Jackson
On Episode 14 of NHE's Finger on the Pulse podcast, we're joined by Professor Craig Jackson, Professor of Occupational Health Psychology
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Why are the number of hospital beds decreasing?
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