John Lister

During the election Labour challenged the Conservative Party’s record of cutting back hospital beds, pointing out that the number of beds had fallen to the lowest-ever level, 127,225 – a 10% drop from the figure for the same quarter in 2010.

Out of this total 100,406 are in general and acute hospitals, down from 108,349 in in 2010 – a fall of 7%.

Over the same period mental health beds have been cut by 21% — from 22,929 to just 18,179.

Of course these reductions help explain the chronic bed shortages, delays and congestion of NHS A&E departments at peak times (not just winter any more) and underline the extent of the unpreparedness to tackle the challenges of the Covid-19 epidemic, which is stretching even better-resourced health systems in Europe.

In the scale of things the recent cutbacks have been relatively small-scale and slow.

1982 figures

Almost 30 years ago, in 1982, the book of Department of Health statistics on Bed availability for England, which was only published once a year rather than the current quarterly figures, shows the total number of beds was a massive 348,104, with 199,181 general and acute beds, 83,831 mental health beds and 46,983 Learning Disability beds.

Over the decade to 1992 those numbers plunged – the total  fell over 30% to 242,356, general and acute bed numbers fell 21% to 157,201, mental health beds were slashed by 40% to 50,278, and LD bed numbers were more than halved to just 21,107.

Underlying these and subsequent changes were a number of factors including:

– the first moves towards closing the large mental health asylums and hospitals for LD patients – with some less than positive results in the early-mid 1980s;

– a rising proportion of operations performed as day surgery (negligible in 1982);

– improved drugs to relieve or treat some problems that previously required surgery;

– and, reduced length of stay for surgical patients as a result of improving techniques and anaesthetics with fewer side effects.

However the extent to which these factors apply to current day bed closures is questionable and limited.

Of course we must remember that in the 1980s the NHS was run by the hard-line Thatcher government, under-funding the NHS in their attempts to force through “efficiency” measures and closures of beds and hospitals.

Natural limit

Eventually a natural limit was found, and from 1997 to 2005 the rate of closure of general and acute beds virtually came to a halt, before a sudden step down, and then three more relatively stable years before 2010.

There have been brief pauses in the decline that has generally continued since 2010 as NHS chiefs tried to ensure sufficient beds were open to address periods of peak demand.

But now the HSJ has reported that NHS general and acute bed capacity at a lower number than these official figures have yet reached:

“NHSE announcing a drive to free up around 30,000 of the service’s overall 98,000 acute and general beds by a range of measures including postponing non-urgent operations and speeding up discharges.”

NHS boss Sir Simon Stevens gave the same figure when he spoke to the Commons Health Committee on March 17 – 3,500 fewer than the latest quarter’s NHS statistics would suggest.

It appears that the figures is based on the total number of “core” front line beds available, and any additional “escalation beds” in use to address increased pressures as published in “winter sit rep” reports each winter since 2012.

These are daily figures and fluctuate considerably, but they have been taken seriously as working figures on which the NHS actually bases its decisions.

Core bed puzzle

But as the 98,000 figure shows, these numbers are also a puzzle: because at no point does the number of core beds provided, or the grand total of core beds plus escalation beds, add up to the published numbers of general and acute beds in Quarters 3 and 4 covering the winter period, when we know more beds tend to be opened up.

The graph opposite (compiled from Sitrep reports, taking the figures from December 1 and February 1 of each year, compared with the quarterly reports of availability of beds open overnight  to admit potential emergencies) shows the size of the discrepancy.

The thing is, if these figures are at such variance, which set of figures gives a true picture? If NHS England reverts to the sit rep figures, what is the value of the Department of Health’s figures, which are consistently different?

What factors might explain the gap? As the hunt goes on for ways of opening up more NHS capacity to deal with the Covid-19 crisis, it would help if the NHS at least knew with any consistency how many beds it has available, as a benchmark for how many more it requires.

NB in Quarter 3 2016 sit rep figures there appears to have been a meltdown of NHS calculations, since not only does their appear to be an abrupt plunge in beds, but the numbers of core beds plus escalation beds do not add up to the stated total. Four years on, it is surprising nobody seems to have sorted out that confusion.

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