Last winter In distressing scenes across the country patients waited in vain for ambulances, in hospital corridors and queued in hospital car parks. In total 23,003 excess patient deaths in England in 2022 were associated with long waits in the Emergency Department. A lack of available hospital beds was one of the key factors, so what are the plans to increase the number?
After a decade of watching hospital bed numbers decline by over 10% while hospital activity has been consistently rising, the government’s announcement of a specific target to raise bed numbers by 5000 could be seen as a desperately late u turn.
The announcement was first made by the PM back in January along with funding of £1 billion to pay for the additional capacity,”as part of the permanent bed base for next winter. (2023/24)”, and has been included in NHS England’s recent plan for winter 2023/4.
In response NHS leaders have welcomed aspects of the wider winter plan, but were clear about how the plan would fail without extra support on funding and staffing and urgent action to resolve ongoing industrial disputes.
Matthew Taylor, chief executive of the NHS Confederation, said:
”..the financial settlement provided for the NHS and required to effectively fund this plan, is not enough. We should be honest about this”
Progress with bed numbers so far?
Since April 2022 the number of NHS hospital beds has risen by 1284, largely due to a rise in general and acute beds – only a third of the way to the government’s target.
Will 5000 be enough?
Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), believes the extra 5000 pledged by the Prime Minister is less than half of the 11,000 additional staffed beds that are necessary to get a grip on the overcrowding crisis in the NHS.
Achieving the target would mean only an extra 20 beds in each of the 150 hospitals with large A&E departments, according to the RCEM.
Estimates about the bed capacity that is needed are based on the safe levels of bed occupancy. The RECM, BMA, NHS providers and the National Audit Office are amongst the commentators that have concluded that 85% occupancy is an effective safe limit. Spare capacity is needed to avoid compromising care during busier periods and for effective infection control.
Bed occupancy rates in the NHS have been rising since 2010, when they averaged around 85% and are currently around 92% for general and acute beds. However, many trusts experience rates of around 95 during busy periods.
NICE acknowledges the research supporting the 85% limit, but suggests a “pragmatic compromise” of 90% occupancy on the basis that appropriate levels can vary according to factors like the type of hospital department and the proportion of complex cases.
NHS England accommodates an even greater level of risk though, aiming for 92% occupancy in its winter plan. The risk is the normalisation of the proven impact upon patients and staff from working close to the limit of capacity on a day to day basis.
What are the long term trends?
The total number of hospital beds fell in most years in the decade before the pandemic.
The current level of hospital beds is 13,592 lower than the number of beds in the NHS in 2010/11.
There are also 6000 fewer general and acute beds, a lack of capacity that has heavily contributed towards A&E delays.
For much of the last decade the NHS has been doing more inpatient work with less available beds.
Hospital activity rose by 21% 2010/11-19/20 16.1 -2010/11 – 25 million (2019/20), despite a two year dip during the pandemic (measured by the number of finished consultant episodes). In fact the NHS is still struggling to reach pre pandemic levels of activity. A&E attendances have risen by 55%.
Impact upon other services
Excessive A&E workloads press GPs and ambulance services to also work too close to their safe limits. The consequences are damaging and without a quick fix..
UK GPs experience the highest stress and lowest job satisfaction compared to GPs in 9 other high-income countries. The workload on ambulance staff is having dangerous impacts upon patients and staff. 85 per cent of ambulance workers have witnessed delays, which have seriously affected a patient’s recovery 82 per cent feel the current pressure on ambulance workers puts them at an unacceptable level of stress.
The situation in social care is no less pressured, as a survey of councils finds that they are not confident they can meet minimum social care support.
Much focus is on workflows and the communication between services which undoubtedly can produce improvement, but for too long long term planning in the NHS has not responded to fundamental shortages in staff and resources, and yet it remains by far the most influential factor to achieve sustainable services that can respond to our communities health needs.
Short term over long term
The successive failure of governments to adequately plan around NHS workforce needs means that even a relatively modest increase of 5000 beds is proving hard to deliver.
Record numbers of staff are leaving the NHS, up 13% in the last year. Whilst 8% of all medical posts are vacant and 10% of nursing posts, and consequently the NHS is struggling to expand capacity in the short term.
Over the last decade NHS staff numbers have consistently not kept pace with the rising numbers of hospital patients. Action has been painfully slow, funding inadequate and the policy focus has been on managing demand and not increasing supply. The recently published NHS workforce plan was first promised in 2017, and despite pressure from NHS leaders was delayed several times, and for NHS leaders the funding for adequate staffing levels still remains absent.
As training staff in the NHS takes time, retention and overseas recruitment are the main short term options for raising staff numbers. Again funding, policy alignment and a long term thinking is crucial. It seems that these plans to raise NHS bed capacity have arrived too late and are again not adequate to meet the depth of the hole the NHS is now in.
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