Dozens of hospitals hit dangerous bed occupancy levels

At one point in May, 49 general acute trusts out of 145 — the most since before covid — operated at occupancy of 95 per cent or more in adult acute beds. Up to eight trusts at a time were operating at 99 or 100 per cent occupancy during May, according to analysis of published data. 

NHS England, prior to covid, told trusts to keep occupancy below 92 per cent, and others believe even this is dangerously high, although trusts do often exceed it during winter.

Trusts are seeing the largest numbers of non-covid emergency patients since at least winter 2019-20; and are also trying to return as many planned operations as possible.

They are doing so with thousands fewer beds than normal, due to measures to deal with ongoing covid patients without further outbreaks of the virus in hospital. 

Figures seen by HSJ show that, through May, the average daily number of general and acute beds open in acute trusts was 92,232 (see chart right). The average once further beds reserved for confirmed or suspected covid patients are discounted was just 89,339. At the same time of year from 2015-2019, the figure ranged between 101,500 and 104,000 — meaning this year there is an effective reduction of around 12 per cent.

The figures, seen by HSJ, are all based on daily reports from NHS trusts.

At a minority of hospitals — those most hit by the current fourth wave — the situation is now compounded by small but not tiny numbers of covid-positive patients. This can further disrupt other care, particularly when it relies on intensive care (see chart below).

As of Friday, 11 trusts had 20 or more covid-positive patients. At three, this represented 4 or 5 per cent of their total bed base: Croydon with 24 patients (5 per cent), Bolton with 37 patients (5 per cent); and East Lancashire with 32 patients (4 per cent).

A senior manager at one of those affected said their covid occupancy was “not at all insignificant”. The person added: “The big problem we have is we are as busy as we’ve ever been with non-covid activity… Admissions are so high, even with escalation beds open bed occupancy is virtually 100 per cent.

“With bed occupancy so very high, we are not in a resilient position should we have an outbreak or see a sudden increase in activity.”

A hospital trust director in a different region said: ”Emergency demand is higher than pre-covid for the time of year… It’s a mix of ‘worried well’ who are telling us they can’t get access to their GP… and really sick people who have sat on things for too long.

“The back door is definitely stickier now and we are finding it difficult to discharge what are complex patients out into non-acute care.”