'Silly' bed closures made winter pressures worse, says NHSI chief

Many acute trusts reported capacity problems over the winter after being unable to discharge patients to community beds or care homes. This also put extra pressure on their finances, as trusts were unable to carry out planned levels of elective work.

Jim Mackey, chief executive of NHS Improvement, said local organisations must work better to understand the implications of reducing capacity in one part of the system, and a new approach would be introduced this year to ensure this.

He told HSJ: “The data on these things is terrible but our estimate on it was about 8 per cent of out of hospital capacity was closed [compared to the previous winter]. Which is a material number isn’t it? Even if it wasn’t 8 per cent and it was 5 per cent, it’s going to hurt.

“Birmingham really suffered with it, some intermediate beds closed just at the peak time and then social care closed some capacity and their performance got really hammered. And they are things we have to get our heads around better as a group, and say there’s no point in squeezing this balloon over here and creating this huge bulge over there.

“So frankly that just felt really silly, that we didn’t really see all of that and we didn’t have a grip of it. I don’t think anyone’s particularly to blame, everyone’s just in their own ‘I’ve got my QIPP or cost reduction or contract to deliver or whatever’ [bubble].”

Regarding in-hospital bed capacity, Mr Mackey said a national bed audit being conducted by Pauline Philip, the national urgent and emergency care improvement director, should help determine which areas can proceed with planned bed reductions.

Referring to new rules that mean local areas have to meet new conditions before they can close hospital beds, as set out by NHS England, Mr Mackey said: “That doesn’t mean you can’t close a bed but it does mean you can’t close a bed without thinking about it and without talking about it, and thinking about the impact assessment.

“Most people do it anyway, but the idea that you’d shut beds without thinking about the impact is really hard to understand. If it’s really predicated on some kind community resource then get that in place first and prove it works, wean yourself off the beds rather than trying to force it by saying ‘I’ll shut the capacity first and see what happens’.”

“What Pauline has to do as part of the emergency care plan is do this bed audit over the next few weeks that’ll flush out the plans across the country that are there or thereabouts. If people have proposals to reduce bed capacity the tires will get kicked on it.”

Mr Mackey also warned that trusts may struggle to reap the benefits of the increased funding for social care services, as some councils are saying the money “stops them having to do further bad things”, rather than provide more services that enable quicker hospital discharges.

He said: “Our council colleagues have shown over the last few weeks that they don’t see it in the way we see it. There’s going to be somewhere between where we are and where they are where we’ll find a sweet spot.

“Where they can do what they need to do, but frankly we’ve got a lot of old people who need social care packages who shouldn’t be in an acute hospital. If I’m honest that’s not going to magic all those beds up very quickly.”

He said the success of these discussions will also depend on the NHS being able to reduce the delayed discharges for which it is responsible.