The number of hospital 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, particularly for mental health and learning disability patients, have been the main drivers of the reduction.

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 2019/20 the total number of overnight beds decreased by 57 per cent whilst the number of day-only beds, increased more than five-fold as medical innovations have led to an increase in same-day procedures.

Bed numbers have also gone down in other countries. However, the UK has a low number of hospital beds: 2.45 per 1,000 population versus 5.84 in France and 7.91 in Germany. 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.

While there is no agreed standard for bed occupancy rates, in 2018 the National Institute for Clinical Excellence (NICE) recommended a ‘pragmatic maximum’ of 90 per cent, and the 2020/21 NHS national planning guidance stated bed occupancy should be reduced to a maximum of 92 per cent. 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 the rise in bed occupancy had started to level off but still remained above the NICE recommended level. During the pandemic bed occupancy has fallen substantially but NHS England have 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.

The Covid-19 pandemic has changed demand for hospital beds. There has been a need for more critical care capacity, which led to staff and resources being reallocated to these areas, and fewer routine operations being carried out. The number of adult critical care beds increased from around 4,000 before the pandemic to almost 6,000 in the peaks of the first and second wave.

There was also a need to quickly free up as many hospital beds as possible, which led the government to introduce NHS funding for the first few weeks of social care after a hospital stay to speed up discharges. However, as part of the measures to reduce the burden on frontline staff the publication of data relating to delayed transfers of care was paused and has not yet resumed, so we don’t yet know how big the impact was and whether numbers have returned to pre-pandemic levels.

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 increasing. Although Covid-19 has led to beds being freed up and lower occupancy levels, the long term impact will be to increase the pressure on beds, as the NHS confronts the longest waiting list since the 1990s and demand for hospital care increases again.