Acute bed numbers could be increased by 35,000 in the next 20 years - or cut by 23,000 - according to a longawaited report by the government's national beds inquiry.
Officials indicated that three options put forward by the report were 'broadly in the same cost envelope', a bracket set before prime minister Tony Blair outlined his 'aspiration' to bring health spending up to European levels.
This suggests that any change could be quickened by extra funding. But officials were unable to provide costings for the different options, which vary in the amount of reliance placed on primary care.
The inquiry shows that a 30year trend for falling bed numbers - which peaked at 250,000 in 1960 - has stabilised over the past decade at around 147,000.
Making the 'central assumption' that elective admissions will continue to increase at a rapid rate while nothing else changes, the report says a 1 per cent rise in bed numbers could be required by 2003-04.
This would mean an extra 4,000 -5,000 beds, of which 2,000 would be likely to be acute.
It then sets out three options based on varying predictions of future demand in 2020. All include a focus on intermediate care - with an iden tical package of 15,000 residential beds and 7,000 nursing beds in all cases.
The first - the 'maintenance' - option backs this with a steady increase in primary care and 8,000 additional acute beds.
The second suggests a 35,000 increase in acute beds coupled with a sharp reduction in primary care that would see the number of GPs, district nurse visits and home-help hours reduced.
The third - the 'closer to home' model - sees a dramatic boost for primary care, with a doubling in the number of district nurse visits, 10,000 more GPs and up to 131 million more home-help hours. Under this option, acute bed numbers would come down by 12,000, based on assumptions that 20 per cent of bed days are 'avoidable'.
But the report suggests that if 30 per cent of bed days were avoidable, total acute bed numbers could drop by a further 11,000 'provided there was a sufficient build up of intermediate and community services'.
The inquiry says higher bed availability is not associated with better response to emergency pressures.
NHS Confederation policy director Nigel Edwards said: 'If they were to go down the acute beds option it would provide them with very major problems in terms of how they would cash up the capital charges.'
See news focus, pages 13-15.