The King’s Fund warns against further hospital bed cuts

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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, said: ‘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 not 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 are currently undertaking addresses gaps in data by providing a transparent, accurate and comprehensive picture of bed capacity.'

  • 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).

Notes to editors

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The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.