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STPs must pass new ‘care test’ before closing hospital beds, says Stevens

Hospital bed closures proposed in major service reconfigurations will only be supported in STPs if they meet a new ‘patient care test’ to ensure the move will not jeopardise high-quality care, NHS England has announced today.

The news, revealed by CEO Simon Stevens at the Nuffield Trust Health Policy Summit today, has been welcomed by a number of national health bodies as a move in the right direction for the NHS.

The policy will be implemented from April and has been brought in to combat the serious issue of bed losses, which has seen bed places in England decline by 20% over the past 10 years – despite growing demand leading to hospital and community care struggling to cope.

In his speech, Stevens said: “More older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places.

“There can no longer be an automatic assumption that it’s OK to slash many thousands of extra hospital beds, unless and until there really are better alternatives in place for patients.”

From April, local NHS organisations will have to demonstrate that significant hospital bed closures, subject to public consultation, can meet one of three conditions before NHS England gives plans the green light. These include:

• Demonstrating that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new staff will be there to deliver it;
• Showing that specific new treatments or therapies will reduce specific categories of admissions; and/or
• Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (such as in line with the ‘Getting it Right First Time’ programme)

Responding to the news, Nuffield Trust chief executive Nigel Edwards said: “As our research published earlier this week found, there are many excellent initiatives that seek to move care out of hospital. But they often cost money, require new staffing and take time to develop.

“Meanwhile GP shortages are rife and many community services have been cut. The truth is that many non-hospital services simply don’t have the capacity to care for the sheer numbers of patients that need it.  

“Patients and staff alike will be reassured by Simon Stevens’ announcement today that hospital beds won’t close unless there are alternative services and the staff in place to run them.”

The Royal College of Physicians (RCP) also welcomed the announcement, emphasising the importance of prioritising patient safety and care.

Its president, Prof Jane Dacre, added: “The quality of patient care must be the top priority for any transformation. Today’s announcement by NHS England is a step in the right direction and recognises that certain conditions must be met before significant bed closures can take place.”

The RCP also called for STPs to plan ahead to prevent bed reductions having to be considered and have extra capacity in place before any closures occur. Prof Dacre argued it “remains critical that STPs involve their clinical workforce” in the development and implementation of these plans, with frontline workers being “best placed to advise on the potential impact of bed closured and other STP measures”.

More money needed

The coalition of health and care charities National Voices also said that Stevens’ announcement was the right move from NHS England, but reignited calls for extra cash ahead of next week’s Spring Budget to ensure today’s plans can be supported in practice.

Don Redding, its director of policy, explained: “There should be no further cuts in hospital beds until there is a new funding settlement for the NHS and social care.

“NHS England rightly proposes that we need stronger primary and community care before beds are closed. But this would require significant new money to ‘double run’ services. That money is not available – paradoxically, transformation funds have been sucked up to plug hospital deficits.”

Neither is there an immediately available workforce for primary and community care, added Redding, who claimed the numbers of GPs and qualified district nurses continue to plummet.

“To set this test at a meaningful and credible level will in fact mean no acute beds can be closed,” he concluded.

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