NHS England chief reveals new restrictions on bed closures

In a speech due to be given at a Nuffield Trust summit today, Mr Stevens is due to announce there will be three additional tests for it to approve any consultation involving the removal of hospital beds.

The announcement comes ahead of next week’s Budget, from which NHS England has been seeking additional funds for social care and extra capital spending to implement sustainability and transformation plans. It also follows recent controversy about STPs, proposals for hospital reconfiguration, and about acute care capacity over winter. 

NHS England said plans must:

• “Demonstrate sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver”, and/or
• ”Show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions” and/or
• ”Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme)”

The new tests, to be judged by NHS England, will be in addition to four existing national “tests for reconfiguration”, which were put in place in 2010, requiring changes to have the support of GP commissioners, strengthened public and patient engagement, clear clinical evidence and be consistent with patient choice. 

However, the statement said: “Hospitals would still have the freedom to flex their number of beds throughout the year, and the responsibility to determine how many beds they can safely staff.”

From 1 April, these conditions must be satisfied before NHS England will clear a proposal to go to formal public consultation.

The move seems to go against the grain of long-held national policies of moving more care out of hospitals and into the community, and avoiding overnight hospital stays where possible.

Data released last month, for the three months to the end of December, showed NHS bed occupancy at its highest rate since the data collection began in 2010.

The total number of beds available overnight has fallen 10.6 per cent from quarter one 2010-11 to quarter three 2016-17, from 144,000 to 129,000.

A source in the NHS provider sector told HSJ some trusts had concerns about the introduction of new rules from the centre seemingly without consultation with providers, and about how the rules will operate in practice.

Mr Stevens was expected to say: ”Hospitals are facing contradictory pressures. On the one hand, there’s a huge opportunity to take advantage of new medicines and treatments that increasingly mean you can be looked after without ever needing hospitalisation. So of course there shouldn’t be a reflex reaction opposing each and every change in local hospital services.

“But on the other hand, more older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places. So there can no longer be an automatic assumption that it’s OK to slash many thousands of extra hospital beds - unless and until there really are better alternatives in place for patients.

“That’s why before major service changes are given the green light, they’ll now need to prove there are still going to be sufficient hospital beds to provide safe, modern and efficient care locally.”

Mr Stevens’ announcement was welcomed by one of the large health unions.

Unison’s head of health Christina McAnea said: “This announcement will reassure patients that hospital beds will be available when they need them. But it’s important the NHS has the right staff to provide a high quality service, at a time when the health service faces immense pressure.”

However, Don Redding, policy director at National Voices, the coalition of health and care charities, suggested the NHS should go further. He said: “There should be no further cuts in hospital beds until there is a new funding settlement for the NHS and social care…

“NHS England rightly proposes that we need stronger primary and community care before beds are closed. But this would require significant new money to ‘double run’ services. That money is not available – paradoxically, transformation funds have been sucked up to plug hospital deficits.

“Neither is there an immediately available workforce for primary and community care. The numbers of GPs and qualified district nurses continue to fall.

“To set this test at a meaningful and credible level will in fact mean no acute beds can be closed.”