NHS reforms

STPs planning further bed cuts at ‘unrealistic’ scales

The King’s Fund has issued a major report warning of the effects of cutting hospital bed numbers as suggested by some sustainability and transformation partnerships (STPs) across the country.  

The report has revealed that the number of NHS hospital beds in England has halved in the past 30 years, dropping from 299,000 to 142,000 – corroborating the BMA’s finding that bed numbers have reduced by a fifth in a decade.

A reduction in bed numbers is consistent with other developed countries, who have also seen a reduction in recent years, but the UK has less acute beds per 1,000 people than almost every other comparable health system.

As winter draws in, the NHS is preparing for its most difficult time of year, caring for patients with increasingly complex conditions with fewer available beds. In 2016-17 average overnight occupancy in acute hospitals was over 90%, frequently increasing to 95% during the winter months, well above recommended safe levels of 85%.

The report found that despite these difficulties, STPs in some parts of the country are proposing further significant bed cuts, with some suggesting reducing beds even faster than the trend over recent years.

The think tank has warned that cuts of this magnitude are “unrealistic” and had already argued that similar proposals in London are not credible even if these partnerships receive extra cash or boost investment in community services.

The King’s Fund’s senior policy advisor, Helen McKenna, 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 not achievable. We welcome new requirements introduced by NHS England that local areas must meet before significant numbers of beds can be closed.”

Instead of focusing on bed cutting, its report highlighted opportunities for improvement, such as reducing the length of stay for older patients who are often in hospital for long periods and are unable to be discharged.

It also suggests that vanguards are off to a positive start, having made some progress in slowing the rise in the number of emergency hospital admissions. In the future, the think tank hopes that this slow-down may help to compensate for increasing admissions from an ageing population.

Those with mental illnesses and learning disabilities are increasingly being cared for in the community, and medical advances have led to a reduction in the average number of bed days. The King’s Fund has advised that this should be built upon, with intermediate services supporting those who are leaving or are at risk of admission to hospital being key. However, currently there are only sufficient services to meet around half of the demand.

Jane Dacre, president of the Royal College of Physicians, was not surprised by the findings of the report, arguing: “Every day the chronic shortage of hospital beds frustrates and delays much of the care we provide as physicians.”

NHS Providers’ director of policy and strategy, Saffron Cordery, called the report “timely and important.”

“NHS trusts recognise the need to transform services and deliver more integrated care for patients, working more effectively with GPs, councils and other local services,” she noted. “Trusts are playing a lead role in adopting new care models as we move to accountable care approaches.

“However, it is clear that some areas are making far more progress than others. We have expressed concerns over how achievable many of the plans are within the available timescales and funding levels.”

Cordery went on to emphasise the importance of avoiding unsafe levels of bed occupancy, and called bed cuts a concern.

“While there is some evidence that new approaches to integrate care for patients in the vanguard programme may ease growing pressure on hospitals, these are often small in scale and taking time to bed in,” she argued.

“One of the key lessons from last winter was the importance of avoiding unsafe levels of bed occupancy. It is vital that plans for the future reflect the reality of increasing demand from a growing and ageing population. Central to this is the need to ensure there are adequate services to provide care closer to people’s homes.

“We have warned consistently that far from strengthening community-based services, as outlined in the Five Year Forward View, we are seeing cuts to staff and beds in the community. This must be addressed as a matter of urgency.”