The decline of NHS beds

Could a trend in falling NHS bed numbers spell trouble for suppliers?

A report released by the King’s Fund has found that NHS bed numbers have fallen significantly over the last three decades and worryingly for suppliers to the Health Service, looks continue to fall in the coming years.

In 1987/88, NHS bed stock totalled 299,364 stated the new report but had fallen to 142,568 in 2016/2017, with the largest drops occurring in overnight mental health and learning disability beds, falling by 72.1 and 96.4 percent respectively in the 30-year period.

The ‘NHS hospital bed numbers: past, present, future’ report by the King’s Fund states that most other advanced health care systems have also reduced bed numbers in recent years, however, highlights that England currently has fewer acute beds relative to its population than almost any other comparable health system.

Mental illness & learning disability beds were found to have the largest percentage reductions in bed numbers, with the number of general and acute beds also falling sharply, with a 43 percent drop since 1987/8 according to the research.

In contrast to the other categories, however, the number of day-only beds has grown by more than 520 percent, from around 2,000 in 1987/8 to 12,463 in 2016/17.

The numbers reveal a shift in the way healthcare is provided in the UK, with changing policies such as the moving of mentally ill and learning disability patient care into the community, as well as the increase in day-case operations.

These changing policies have reshaped the NHS’ priorities in regard to which beds it requires, with general and acute beds making up a much larger share of the total.

The report reveals that in 1987/8, 60.4 percent of the total stock was general and acute beds, whereas by 2016/17, it made up 71.8 percent. Day-only beds have also grown as a proportion of the total bed stock, accounting for less than 1 percent in 1987/8 and growing to around 8.7 percent in 2016/17.

The success of policies to move more care into the community relies on the availability of these services within the community. Many community services, however, are struggling to cope under reduced funding, a growing population and a rising number of older people in England, with the Office of National Statistics stating the number of people aged 65 and over has increased by approximately 33.6 percent over the 30-year period.

Combined, these factors have led to large numbers of delayed transfers into socio-care environments and increasing bed shortages. The report emphasised that in 2016/17, overnight general and acute bed occupancy averaged 90.3 percent and regularly exceeded 95 percent in winter, whilst the National Audit Office has noted that hospitals with average bed-occupancy levels above 85 percent can expect to have regular bed shortages, periodic bed crises and increased numbers of healthcare-acquired infections.

Angus Long, Owner of Impression Marketing, discussed how officialdom and bureaucracy in the NHS and country councils was a decisive factor causing delays transferring patients in socio-care environments, leading to bed-blocking and longer discharge times.

"Current procurement practice does not allow for cost efficiencies to be taken into account when buying or evaluating supply contracts and tenders if the beneficiary is another department or healthcare organisation, other than that of the purchasing budget holder,” commented Angus.

"This was illustrated a couple of years ago when Durham County Council chose not to award a regional community care contract to a local company. The reason being that it felt the cost benefits to the NHS of being able to discharge patients back into the community three weeks earlier than previously wasn’t a consideration the council could take into account, as the cost savings would not be reflected in their budget and to do so would contradict procurement rules.”

Aware of the need for closer collaboration, 44 NHS ‘Sustainability and Transformation Plans’ (STPs) have been created to address the issues, bringing together the NHS and local councils to find ways of improving efficiency and reducing costs.

Worryingly for manufacturers and patients, many of the local blueprints drawn up are targeting further reductions in beds, such as Lancashire & South Cumbria and Cheshire & Merseyside, with the report acknowledging demanding financial control totals playing a large role.

Some STPs are plan on reducing beds more than the recent trend. Leicester, Leicestershire and Rutland set out in their Sustainability and Transformation Plan, released on the 21st November 2016, to reduce acute beds from 1940 in 2016/17 to 1697 in 2020/21 beds, whilst also reducing community hospital beds from 233 in 2016/17 to 195 in 2020/21 beds.

For suppliers of beds to the NHS, this evidence suggests that demand from the Health Service will continue to fall in the coming years, however, the report argues that realism is required about what can be achieved.

With bed shortages and blocking already at high levels, continued population growth combined with an increasing proportion of elderly people more likely in need of health care and a prolonged slowing of NHS funding, the report concludes that whilst "in some areas, it may be possible to reduce the number of beds further, at a national level, further significant reductions are both unachievable and undesirable” and ambitious aims set out "in some STPs to reduce beds by 2020/21 look unrealistic.”

What about the independent sector and social care?

This trend in the reduction of beds does not seem to apply solely to the NHS, with the number of acute beds in the independent sector – which partly caters for self-paying patients, those with insurance and some planned care for NHS patients – also seeing a drop.

According to figures from market intelligence agency LaingBuisson, the number of acute beds in the independent sector fell from approximately 9,500 in 2006 to approximately 8,900 in 2016, after peaking in the mid-19990s at just under 11,700.

The number of beds in the social care sector has seen an increase in the past six years as the NHS continues to reduce the number of beds available for the long-term care of the elderly, however, is still less than the number of beds available in the mid-1990s.

LaingBuisson estimates that in 1988, there were slightly fewer than 363,000 social care beds in the UK, with those numbers peaking to more than 525,000 in the mid-90s. However, a decline in the subsequent years now estimates the numbers to be around 458,000, with a modest increase in purchasing occurring since 2010.