The UK has been losing more beds than almost every other OECD country since 1979. John Appleby says that throughput could now compromise quality of care

Once upon a time, when chief executives of health authorities were known as district administrators, and district planning officers thought contracting meant getting smaller, there were such things as bed norms. But in the early 1980s, the reliance on national norms of provision by care groups was abandoned. Now, with health secretary Frank Dobson's announcement of a national inquiry into the number, mix and use of NHS beds, could we be going back to more centralised guidance?

Clearly, the Department of Health has registered difficulties the NHS has experienced in maintaining its ever-upward hospital throughput as its bed stock has dwindled. But if the waiting list reduction targets are to be met, hospital activity has got to rise more this year than at any time since the second world war. While the NHS has managed to do more and more with fewer and fewer beds, is it perhaps now close to reaching a floor?

In the UK, the decline in bed numbers started in the late 1950s, and since 1979 the UK inpatient bed stock has fallen by 190,000 - a drop of 41 per cent. Expressed as a rate per 1,000 population, the number of beds has fallen by 43 per cent. At this rate of decline, it will only take a further 10 years to halve the current bed stock.

Although other countries have experienced declines in hospital beds, apart from Sweden and Ireland, the UK has lost proportionally more beds than all other Organisation of Economic Co-operation and Development countries over the period 1979-95. By 1995 only Turkey, Spain, Portugal and the US had fewer inpatient beds per head of population than the UK.

However international comparisons are often confounded by differences in the nature of healthcare systems. And having fewer beds does not necessarily mean poorer healthcare (or outcomes). Hungary, for example, has many more beds per head of population, but the health of Hungarians is not noticeably better than their UK counterparts. In addition, how primary and secondary care services work together, and the degree of substitution between them, influence provision and resource needs of services in both sectors.

Nevertheless, the decline in the number of UK hospital beds is marked by international standards. And with acute care throughput per bed now the highest of all OECD countries, occupancy rates hovering around 80- 85 per cent and the average length of stay for acute care the lowest out of 24 OECD countries, indications are that parts of the hospital sector in the UK are under pressure, with a danger that the quality of care could be compromised.