The number of hospital beds

A shift in national policy towards providing care outside of hospital has seen a reduction in the number of hospital beds. However, more recently there has been growing concern that this trend has gone too far and now there aren’t enough hospital beds.

How has the number and type of hospital beds in England changed over time and how does this compare to other countries?

Total number of beds

Over the past 30 years the number of hospital beds in England has halved. Medical advances meaning patients don’t have to stay in hospital as long and a shift in policy towards providing treatment and care outside hospital have been the main drivers of the reduction in bed numbers.

Types of bed

There has also been a change in the type of beds available in England, with fewer overnight beds and more for day cases. Between 1987/88 and 2023/24 the total number of overnight beds decreased by 56% while the number of day-only beds increased by 531% as medical innovations have led to an increase in same-day procedures. There are four types of overnight hospital beds (general and acute, mental illness, learning disability and maternity), and the largest falls have been for beds for learning disability and mental health patients. There is now also a move towards providing more care in the community through ‘virtual wards’ (where people receive hospital care from home). As of August 2024 there were 12,400 virtual ward beds in the community.

Bed numbers internationally

Bed numbers have also gone down in other countries. However, the UK has a low number of hospital beds: 2.35 per 1,000 population versus 3.51 in Portugal and 5.41 in Belgium in 2021. Low bed numbers can indicate good patient care – with patients being treated and able to return home more quickly – and can demonstrate resources are being used efficiently. However, not having enough beds can lead to high bed occupancy rates.

Bed occupancy

While there is no agreed standard for bed occupancy rates, the 2023/24 NHS operational planning guidance stated bed occupancy should be a maximum of 92%. High bed occupancy can make it difficult to find beds for patients, impacting on patient flow, operational performance and waiting times, and has been linked to increased infection rates. Before the Covid-19 pandemic bed occupancy was frequently above 90%. During the pandemic bed occupancy fell substantially but NHS England noted that hospitals will have experienced pressure on beds at lower occupancy levels due to infection control measures and other changes to how beds and staff were deployed during Covid-19. At the end of 2022, bed occupancy levels returned to pre-pandemic levels and by the end of 2023/34 bed occupancy had risen to a record high of 93%. In contrast, virtual beds, are potentially being under-utilised as occupancy levels averaged only 71% so far in 2024 (January to August).

Winter pressure on beds

Hospital beds are under intense pressure during winter when more people tend to be admitted from A&E, particularly as a result of respiratory diseases and the challenges in discharging patients. At the peak of the pressure during winter 2023/24, 2% of all beds were occupied by flu patients, 4% by Covid-19 patients and 14% by patients waiting to be discharged. In response, each year trusts open large numbers of winter escalation beds to cope with rising demand.

In summary

There has been a long-term trend in reducing the number of hospital beds and providing more care in the community. However, before the pandemic there were signs of a shortage of beds, and in June 2019 the then Chief Executive of NHS England Sir Simon Stevens said bed numbers were ‘overly pressurised’ and likely to need to be increased. The pandemic has only increased pressure on beds as Covid-19 continues to create additional demand and as the NHS is now confronting the longest waiting list since the 1990s. The NHS is now expanding the number of core hospital beds in an attempt to recover urgent and emergency services.