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Bed cut plans ‘undesirable and unachievable', warns think tank

Doctors support the findings in new King’s Fund report

Jo Carlowe

Friday, 29 September 2017

The total number of NHS hospital beds in England, has more than halved over the past 30 years, according to a major new report, published today.

The King’s Fund report NHS hospital bed numbers: past, present, future notes that while most other advanced health care systems have also reduced bed numbers, the UK has fewer acute beds relative to its population than almost any other comparable health system. 

With hospitals full to capacity, the report describes NHS plans in some areas to cut hospital beds as ‘undesirable and unachievable’. 

Since 1987/8 the largest percentage of reductions has been in mental illness and learning disability beds, as a result of long-term policies to move patients into the community. 

The number of general and acute beds has fallen by 43%, the bulk due to closures of beds for the long-term care of older people.

The report states that there are “signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3%, and regularly exceeded 95% 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”.

Helen McKenna, senior policy adviser at The King’s Fund, said: “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 nor achievable. We welcome new requirements introduced by NHS England that local areas must meet before significant numbers of beds can be closed. 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.”

Commenting on today’s report, Dr Chaand Nagpaul, British Medical Association council chair, said the BMA’s own analysis has shown that overnight hospital beds in England have decreased by a fifth in a decade.

“The UK already has the second lowest number of hospital beds per head to comparable European nations, a key factor in explaining the extreme pressure on the NHS. With many cuts coming from so-called ‘transformation plans’, serious questions need to be asked about whether these plans are realistic and evidence-based given it defies logic to cut bed numbers when we already don’t have enough.”

He added: “High bed occupancy routinely above the recommended limit of 85% is compromising patient safety and is a symptom of wider pressure and demand on an overstretched and underfunded system. It causes further delays in admissions, operations being cancelled and patients being unfairly and sometimes repeatedly let down.

“Staff across the NHS faced the worst winter on record last year and we don’t want to see a repeat of that again this year. In the short term, we need to see bed plans that are workable and focused on the quality of care and patient experiences, rather than financial targets. But in the long term, we need politicians to take their heads of out the sand and provide a sustainable solution to the funding and capacity challenges that are overwhelming the health service.”

Dr Taj Hassan, president of the Royal College of Emergency Medicine, also commented. He said: “This important report echoes what we have been saying for some time: we do not have enough beds.

“We have fewer acute beds relative to population than almost any other comparable health system, and yet we are still seeking to cut our bed base. Continuing on this course puts both patients at risk and the long-term sustainability of the NHS at risk.

“We know that some sustainability and transformation plans (STPs) suggest cutting hospital beds by up to a third. We believe that these STPs will require a radical rethink to their approach – cutting more beds without realistic or viable alternatives is not deliverable in the present environment.”

An NHSE spokesperson told OnMedica: “Hospitals have said that they are planning to open up more than 3,000 extra beds this winter and, in addition, work is underway to free up to 3,000 more by improving the availability of community health and social care.

“We have also introduced an explicit test to prevent inappropriate bed closures while recognising that the right number of beds in any geography will partly depend on the age and number of patients in that area, the availability of alternative community services and also the level of the NHS budget that parliament requires local areas to operate within.”

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