New Report – The Kings Fund NHS hospital bed numbers past, present, future.

The number of general and acute beds has fallen by 43 per cent since 1987/8, the bulk of this fall due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.

The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 to 142,000, while the number of patients treated has increased significantly.

Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK currently has fewer acute beds relative to its population than almost any other comparable health system.

Since 1987/8, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community.

The number of general and acute beds has fallen by 43 per cent since 1987/8, the bulk of this fall due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.

While the rate of decrease in bed numbers has slowed in recent years, there are opportunities to make better use of existing bed stock by preventing avoidable admissions, reducing variations in length of stay and improving the discharge of patients. Efforts to make better use of the existing stock should focus on the relatively small number of mainly older patients who stay in hospital a long time.

There are promising signs that some initiatives are succeeding in this. Emerging evidence from vanguard sites suggests progress in slowing rates of increase in emergency admission.

However, research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care.

Today there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. In this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

In some areas, it may be possible to reduce the number of beds. However, at a national level, with hospitals under real strain from rising demand and a prolonged slowdown in funding, further significant reductions are both unachievable and undesirable.

How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity. It is essential that the national audit currently being undertaken by NHS England provides a transparent, accurate and comprehensive picture of bed capacity.