Daily Insight: Beds progress takes a nap

Numbers of “permanent” acute beds have either reduced or stayed about the same at around a third of systems since the summer – amid NHS England promises to increase the bed base ahead of winter.

Analysis by HSJ has found numbers of available “core” permanent general and acute beds have dropped in seven systems since August, and increased by less than 1 per cent in a further six integrated care systems.

NHSE has promised to increase the number of “core” general and acute beds in England to 99,000 by the end of December as part of its winter planning. The average number of available core beds in all acute trusts was 98,291 in the week to 10 December – up from an average of 96,731 in August.

NHSE’s promise of more core beds aimed to address “high levels of bed occupancy all year round”. However, at the 13 systems which have either seen a drop or increase under 1 per cent in core beds since August, eight have total bed occupancies above the latest national average of 94.7 per cent. All were above the 85 per cent level advocated as a safe bed occupancy by the Royal College of Emergency Medicine and others.

NHS Confederation said it is “sensible” that ICSs organise care differently due to the varying needs of their populations, but were “concerned” that bed occupancy remains “very high” despite having more beds open than last year.

NHSE said it is “still on track to have 99,000 core beds in place” by the end of December.

Last thoughts

A major government funding settlement will be needed to take community services to the “next stage”, according to the national clinical director for older people.

Adrian Hayter – who will leave the role in the new year to join the Royal College of GPs as medical director for clinical policy – said community services were now much more prominent at NHSE, and in its asks of the service, than they were four years ago.

He has been clinical lead for several major community services which have launched and been rapidly expanded since then, including urgent community response; enhanced health in care homes; and virtual wards. A national “proactive care” service for people with frailty, a development of previously delayed proposals for “anticipatory care”, is expected to roll out shortly.

He said: “When I first came in, there wasn’t very much in planning guidance about what was happening in the community at all. Now that is different and we are expecting a range of initiatives in 2024.”

Dr Hayter warned that, as well as moving those services closer together, there needed to be a future government spending review settlement aimed at growing community services, to meet the needs of the rapidly ageing population.