We have put extra funding in. There are more beds available across the system, we’ve reduced the number of delayed discharges of elderly people who would otherwise have been in NHS beds rather than in social care.
British prime minister, Theresa May, in comments to the BBC on January 3.
According to NHS statistics, there were on average 139,935 beds available in NHS hospitals in England between July and September 2017. This is actually 2,526 fewer beds than in the same period in the previous year, when there were on average 142,461 beds available. The drop was the highest in the acute sector, where there were 1,736 fewer beds. However, there was a reduction across all settings, including mental health, learning disabilities and maternity.
This drop follows a long-term trend of decreasing hospital beds – not only in the NHS but in most developed countries. This is expected and on its own not necessarily a concern. Models of care are changing and the average length of stay in hospital has decreased substantially in recent years, from just over six days in 2006-7 to just under five days in 2016-17. Many operations such as hernia or gallbladder stones removal used to involve several days of stay in hospital and are now performed as day cases.
Drop in bed-blocking
While May did say there are more beds available, the Department of Health told The Conversation she was referring to a reduction in bed blocking. This is when patients stay in hospital even though they are medically fit to be discharged, commonly because of a lack of nursing home places or other suitable discharge arrangements. The number of beds occupied because of this – called delayed transfer of care (DToC) – decreased from 6,455 in October 2016 to 5,487 in October 2017, creating an overall gain of 968 beds. Despite this, DToC remains a big problem: it is still much higher than the long-term average, and in October 2017 there were 1,834 more beds blocked than there were in October 2010.
Also very relevant is the bed occupancy rate – the percentage of all beds that are not occupied and available for patients to use. The NHS recommends the occupancy rate to be no more than 85% – this is considered the safety threshold. According to the latest statistics for overnight bed use for the period between July and September 2017, this rate was surpassed, standing at 87.1% for all settings and 88.9% for acute care. This is only a small improvement on the rates from the same period the previous year.
In the 2017 autumn budget, an additional £337m of emergency winter funding was announced for the NHS, which a Department of Health spokesperson said would be used to open up 2,800 additional acute and non-acute beds. But even if the number of beds increases following the implementation of the recent ad-hoc solutions including cancelling planned operations, this is not enough to stop NHS hospitals breaking under the winter pressure. Particularly so as staff shortages are bigger than ever and most hospitals are under severe financial pressure.
The current winter crisis does not come as a surprise, but it’s a consequence of years of shrinking services. Anything the government does now to relieve the crisis is most likely to be too little too late for the current winter.
May’s statement is not supported by the currently available data. The total number of available beds actually reduced compared to the same period in 2016. While there was indeed a reduction in bed blocking, this remains well above the long-term trends.
Mireia Jofre-Bonet, professor in economics, City University of London
The verdict of this fact check is correct. The number of beds in the NHS in England has not increased from 2016-2017 but rather gone down slightly. This, combined with a reduction in the number of delayed discharges, could allow for the prime minister’s claim of “more beds available across the system”. But the very small improvement in the speed of patient discharges plus the increased demand faced by the NHS means that the shortage of beds has got worse, not better. A growing and an ageing population have translated into a larger and more complex mix of patients and an increased need for healthcare resources.
May’s statement that “we have put extra funding in” can also be scrutinised. Although there have been nominal increases of funding in health in recent years, NHS spending per person is set to fall by 0.3% in 2018-19 compared to the year before, according to the joint report of the King’s Fund, Nuffield Trust and Health Foundation. This is currently complicated by an extreme shortage of personnel in the NHS.
About the Author
Katja Grasic, Research Fellow, Centre for Health Economics, University of York. She joined the team in October 2012. Katja holds a diploma [MsC] in Mathemathics from University of Ljubljana and has previously worked in Slovenia on several projects in the areas of care pathways and investigation of anomalies in the reported DRG data.
Picture (c) Toby Melville / PA Wire.