• Four per cent “modest” increase would help address mounting flow and infection issues
  • Call comes with NHS England carrying out major audit of declining bed stock
  • Royal College of Emergency Medicine study underlines pressure on trust

The NHS needs at least 5,000 more beds to achieve safe bed occupancy levels and hit the four hour waiting time target, according to a report by senior medics shared exclusively with HSJ.

The Royal College of Emergency Medicine winter flow project said the NHS needed to add to its 130,000 beds to “combat exit block, overcrowding in emergency departments [and to] maintain flow through the system”.

The college’s report tracked performance of 50 trusts running 60 sites across the UK between October 2016 and March 2017 on a weekly basis. It also found some trusts saw their four hour waiting performance drop to under 50 per cent over winter, against the 95 per cent target.

The vast majority of the sites were in England (50), with two from Scotland, five from Wales and three in Northern Ireland. The trusts, which the RCEM said were representative of the sector, provided the data on the condition of anonymity.

The 4 per cent bed base boost would equate to an average hospital with a type one accident and emergency department, of which there are 184 in England, adding only around 20 beds, although there would be significant variation across the system.

The suggested increase is based on an aim of achieving bed occupancy rates of 85 per cent, a level at which RCEM says the system can be run safely, but not a benchmark endorsed by NHS England.

The report comes with NHS England currently understood to be carrying out a major assessment of the current bed base, which has been declining since 2010, with a view to preparing for this winter.

It is not yet clear whether system leaders will push for more beds to be opened. Most recent efforts have focused on attempting to free up existing capacity and reducing attendances and admissions, which are also both policies supported by the college.

Ministers this week ramped up efforts to try to free up around 2,500 hospital beds by cutting social care related delayed discharges – an ambition which will be very difficult to achieve.

The total NHS bed base dropped from 142,319 in the last quarter of 2010 to 131,060 in the same period in 2016-17. This is around 500 beds less than the same period in the previous year (see table below).

RCEM vice president Chris Moulton told HSJ: “We are not asking for bed ratios to be raised to meet European countries, like Germany and France. It would be a modest increase, but it would significantly help flow and reduce healthcare acquired infections.

“As well as raising numbers we also need to address staffing at all levels, [and] improve access to community and social care.”

The college’s call follows the Nuffield Trust raising concerns about occupancy levels in December. It said trusts were forced to open an extra 4,390 beds, equivalent to seven extra hospitals, on a single day last winter. Its report added: “On average, over 95 per cent of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy exceeds 85 to 90 per cent, there is increasing risk of infection.”

The RCEM project underlined the stress emergency departments are under. Only four of the 60 sites achieved an average of 95 per four hour performance over the period, although a further 14 sites averaged over 90 per cent. Average performance slumped to 74 per cent in the second week of January and peaked at 86 per cent in the third week of March.

The overall proportion of beds occupied by delayed discharges of care patients averaged 6.6 per cent across winter flow contributors, an increase from 6.1 per cent in 2015-16. This underlines the challenge the system faces in reducing this to 3.5 per cent by September, a commitment set out in the NHS 2017-18 Mandate.

Total NHS bed base

YearPeriodTotal General and acuteLearning disabilitiesMaternityMental illness
2010-11 Q4 142,319 108,890 1,974 7,848 23,607
2011-12 Q4 140,454 107,449 1,937 7,948 23,121
2012-13 Q4 138,178 106,374 1,697 7,839 22,268
2013-14 Q4 136,811 105,581 1,671 7,829 21,731
2014-15 Q4 136,946 106,250 1,455 7,868 21,374
2015-16 Q4 131,561 103,422 1,306 7,746 19,086
2016-17 Q4 131,060 103,666 1,190 7,782 18,422

Source: NHS England data

An NHS England spokesman said: “The most recent figures - for January to March 2017 - show that NHS hospitals actually had 582 more general and acute beds open than a year ago. So it is misleading to claim that A&E performance is somehow affected by closures of other types of hospital bed, for example old and outmoded learning disabilities beds which are deliberately being replaced following the Winterbourne View scandal.

“Going into next winter, the single biggest opportunity lies in reducing by 2000 to 3000 the number of older people stuck in hospital at any one time who are waiting for home care or care home places. Action set out by the Government this week is intended to help with that.”

UPDATED: This story was updated on 7 July at 6:15pm with a quote from NHS England