• Trusts told to reduce bed occupancy below 92 per cent
  • Told to keep around 3,000 beds open
  • Planning guidance says A&E performance must improve against “2019-20 benchmark”
  • NHS also aims to reduce waiting list year-on-year
  • New gram-negative infection reduction target

Hospitals must reduce bed occupancy to below 92 per cent and improve their A&E performance against a benchmark based on how they have fared this year, according to planning guidance published today.

The annual orders from system leaders also underline the need to increase bed capacity across the NHS and says “the peak of open bed capacity achieved through the winter…will be at least maintained through 2020/21”.

Trusts and local systems have also been told that they must cut their waiting lists, so they have less waiters in January 2021 than in January 2020.

There is no mention of the four-hour A&E standard in the entire document, again indicating system leaders want it scrapped, or to at least begin phasing it out from April. Previous planning rounds have included specific commitments to meet the target, or specific improvement trajectories, which have routinely been missed.

Yet until a new target regime is given the green light, the 95 per cent benchmark remains one of the NHS’ most important targets.

The document says: “In 2020-21 A&E performance must improve, and all providers should plan to deliver a material improvement against a 2019-20 benchmark.

“To achieve this, systems and organisations will be expected to reduce general and acute bed occupancy levels to a maximum of 92 per cent.”

It does not specify what the “2019-20 benchmark” used to judge progress will be based on.

The document adds: “The long period of reducing the number of beds across the NHS should not be expected to continue…The default operational assumption is that the peak of open bed capacity achieved through the winter of 2019-20 will be at least maintained through 2020/21, including the 3,000 increase from October 2019 already planned for.”

General and acute bed occupancy for the second quarter of 2019-20, the last available full quarter on record, was 90 per cent. But the system has been breaching the target over winter, according to the weekly winter SitRep data, which runs from December to February. Bed occupancy over the eight weeks so far this winter averaged 94 per cent, according to data collected by the Nuffield Trust.

Moreover, the royal colleges view 85 per cent bed occupancy as the quality benchmark, an issue which has been a bone of contention between senior clinical and managerial leaders in recent years.

Cut your waiting lists, trusts told

Trusts have also been told elective waiting lists should reduce in 2020-21, while waits of more than a year must be eradicated. These aims have been stated in previous years, without being achieved.

The guidance says: “The waiting list on 31 January 2021 should be lower than that at 31 January 2020. Delivery of this requirement may be managed at STP/ICS level, in agreement with the regional team, with every provider expected to make a significant contribution.”

All providers and systems must also implement supplementary choice at 26 weeks with reference to the relevant guidance and the best practice models emerging from a pilot programme.

Infection control

Providers have been set a new target to halve the rates of healthcare-associated gram-negative infection rates by 2024, in the new planning guidance. Infections included in the target include E.Coli, P. aeruginosa and klebsiella species. In 2020-21, trusts will be given reduction targets of between 3 and 5 per cent, which will be agreed with regions. Targets for future years will be set later in 2020-21.