• NHS England and NHS Improvement have told CCGs and NHS trusts to reduce excess bed days in acute trusts
  • In a letter sent to providers national bodies asked organisations to agree baseline levels of excess bed days and a target to reduce this 
  • Any savings made by commissioners through the reductions should be transferred to community providers
  • Reductions in bed days are to be used to free up elective capacity

NHS trusts and commissioners have been told to introduce new schemes to reduce the number of patients waiting too long in hospital beds, to increase elective capacity ahead of winter and save money.

In a letter, sent on 3 August, NHS Improvement and NHS England said NHS trusts and clinical commissioning groups should adopt local funding schemes to reduce “excess bed days” in acute trusts.

Excess bed days refer to an additional fee paid by CCGs to NHS trusts when a patient stays in hospital for longer than a pre-determined length of time - this varies by each speciality.

In the letter, seen by HSJ, the national bodies said: “local areas are expected to adopt an excess bed day incentive scheme…this is particularly important for CCGs with the highest excess bed day spend per head of weighted population.”

“Community and acute providers [should] agree a baseline level of excess bed days for their local CCGs and a plan to reduce them below that level. All savings to the CCG from this reduction should be transferred to the community provider, unless the local partners agree to share savings in a different way,” the letter added. 

In order to monitor the reduction NHS England and NHS Improvement  said they will ”regularly” publish new data on the number of excess bed days for each CCG and NHS trust. City and Hackney and Trafford CCGs had the highest rates of excess bed days over 2017, according to NHS England and NHS Improvement’s data. A full list can be seen here.  

In a guidance document attached to the letter, regulators said the reduction in excess bed days should be achieved by “targeted management within community services”. Any additional investment in staff needed for this would be funded through the anticipated savings.

The document said any reduction in excess bed days would also free up capacity within acute trusts to provide more elective services. 

“More parts of the country are currently not meeting waiting time standards or reducing their emergency bed occupancy to the required levels to confidently prepare for winter…

”Where acute providers are able to over-perform on their elective contract the provider and commissioner should discuss the affordability of using any freed capacity to further increase activity levels,” the document said.

Excess bed days

The national tariff payment system requires CCGs to pay providers when a patient stays longer in hospital than expected.

As part of this CCGs will pay a trust, per day, for each patient who remains in hospital beyond a predetermined length.

This is called a “trim point” and is different for each Human Resource Group (HRG)

NHS England and NHS Improvement have listed key reasons for an excess bed day payment to be triggered, this includes: ”Cases where patients can could be discharged sooner “with more consistent clinical practice and organisation in hospital”