A recent report from the Kings Fund discusses the factors which influence the provision of NHS beds in England within the current political, social and economic climate.
The report states that, like most other advanced healthcare systems, the number of NHS hospital beds has reduced significantly in the last 30 years from around 299,000 to 142,000 whilst, conversely, the number of patients treated has risen significantly. However, these changes have left the UK with significantly fewer beds per head of population than comparable healthcare systems. This is explained by an increase in the population as a whole from 47.3 million in 1987 to 55.2 million in 2016, coupled with a 33.6% increase in the number of people aged 65+.
Changing policies such as moving the care of mentally ill and learning disability patients into the community, and the increase in day-case operations account for some of this decrease in bed numbers, however, the success of these policies relies on the availability of services within the community, many of which are struggling to cope. Indeed, there are signs today of a growing shortage of beds with occupancy rates regularly exceeding 95% during the winter months.
In response to this shortage of beds, 44 sustainability and transformation plans (STPs), have been established and charged with changing how acute and community services are currently provided, with the provision of hospital beds a central theme in all of these plans. This provision is determined by the following factors:
- Patient demand – determined by geographic, demographic and socio-economic factors
- National polices – funding, workforce availability etc influences how demand is met
- Local factors – such as availability of services and internal hospital processes influence how demand is managed at a local level
So how can STPs determine the optimum number of beds for their local population?
One area to explore is the variations in hospital bed provision which occur across England, and which cannot be explained by patient preference, case-mix or population need;
- Avoidable hospital admissions still account for one in five emergency admissions – these are potentially preventable by access to better care and management within the community
- Delayed transfers of care due to problems arranging ongoing community care
- Variation in care and services for older people with lower hospital bed use in areas able to demonstrate better integration of services for older, complex patients
So what is being done to support STPs in their quest for bed optimisation?
The NHS currently has a number of initiatives to identify and support the STPs. These include:
- Identifying and reducing variation through:
- Getting It Right First Time (GIRFT) – a clinically led programme to improve quality and reduce the cost of hospital care through identifying and tackling unwarranted variations in services and practices.
- RightCare – a national programme to reduce unwarranted variation in the commissioning of services
- Improving patient flow
- Setting a national target for the reduction of delayed transfers of care to no more than 3.5 % of all hospital beds by September 2017. This aims to free up 2,500–3,000 beds
- Primary care streaming in A&E departments to enable A&E staff to focus on complex needs patients thereby reducing wait times and improving patient flow.
- The Emergency Care Improvement Programme – a national scheme to improve the performance of emergency care.
- The provision of flow management tools to assist trusts in managing patient flow, e.g., the SAFER bundle and the good practice guide
- Early winter planning
- Moderating Demand
- the NHS is currently using 50 Vanguard areas to test new models of care aimed at reducing demand through focussing on prevention, early intervention, admission avoidance and care within the community.
- An audit of bed stock is currently being undertaken by NHS England
- Introduction of a new test in April 2017 requiring local NHS organisations to demonstrate that ‘significant’ proposed bed closures meet one of three new conditions, one of which is that sufficient alternative provision, such as increased GP or community services, is put in place alongside or ahead of changes.
- Trusts have been advised to reduce bed-occupancy levels in preparation for winter.
It therefore appears that whilst the number of hospital beds has fallen over the last 30 years in response to changes in care delivery, it has now reached a level were NHS England has fewer beds per head of population that any other comparable health economy. Although there are still some opportunities to continue this reduction in the number of beds, there is also a need to ensure an injection of realism is administered into the process. The population is both increasing and ageing, which in turn will lead to increased demand for acute care whether it be A&E, diagnostics, outpatient services or elective admissions, whilst simultaneously the NHS is subject to a prolonged slowdown in funding.
Investment in terms of both time and money are needed to ensure implementation of plans to reduce the need for hospital care – both of which are luxury items in the current NHS climate.
To read the full, detailed, report from the Kings Fund please click here