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 2021/22 the total number of overnight beds decreased by 58 per cent while the number of day-only beds, increased by nearly 500 per cent as medical innovations have led to an increase in same-day procedures. There is now a move towards providing more care in the community through ‘virtual wards’ – at the start of 2023 there were 7,000 virtual ward beds in the community.

Bed numbers have also gone down in other countries. However, the UK has a low number of hospital beds: 2.43 per 1,000 population versus 5.73 in France and 7.82 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 2023/24 NHS operational planning guidance stated bed occupancy should be. 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 the NICE recommended level. During the pandemic bed occupancy fell 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. At the end of 2022, bed occupancy levels returned to pre-pandemic levels.

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 in discharging patients. At the peak of the pressure during winter 2022/23, 6 per cent of all beds were occupied by flu patients, 10 per cent by Covid-19 patients and 15 per cent by patients waiting to be discharged. In response, each year trusts open large numbers of winter escalation beds to cope with rising demand.

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. NHS England is now planning to increase the number of permanent hospital beds by 5,000 in the next two years in an attempt to recover urgent and emergency services.