NHS hospitals suffer from chronic bed shortage, surgeons say

Royal College of Surgeons calls for rethink after figures show 89% of beds are full overnight for fourth quarter in a row

The Royal College of Surgeons has warned of a chronic shortage of NHS hospital beds in England, after occupancy rates for overnight stays topped 89% for a fourth successive quarter.

The maximum occupancy rate for ensuring patients are well looked after and not exposed to health risks is considered to be 85%, a figure that has not been achieved since NHS England began publishing statistics in 2010.

From July to September this year the percentage of beds occupied in wards open overnight was 89.1%, compared with 87% in the same period last year. That was the last time it was below 89%.

The RCS said the figures, published on Thursday, made for alarming reading and indicated a failure to cope with the increasing number of older patients in hospital.

Ian Eardley, a consultant urological surgeon and vice-president of the RCS, said: “The NHS has been able to reduce bed numbers as medical advances mean more modern surgery can take place without an overnight stay. However, these figures suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives.

“We are now seeing increasing numbers of frail older patients in hospital because they have nowhere else to go. The lack of additional money in the autumn statement for social care and the NHS is only going to make this even harder.”

The chancellor, Philip Hammond, had been urged to increase funding for social care in the autumn statement, amid warnings that it was in a critical condition, and to help plug shortfalls at NHS trusts, but health providers were left disappointed. NHS Confederation, which represents 85% of providers and commissioners, described it a “missed opportunity to ease the strain on the NHS”.

The high occupancy rates have coincided with record delayed transfers of care, whereby patients are medically fit to leave hospital but unable to be safely discharged, costing the NHS £800m a year. There were 6,777 patients delayed from being transferred out of hospital on the last Thursday of September, up 29% on the equivalent figure a year ago and the sixth month in a row in which a new high was recorded.

The number of delayed days in September – 196,246 – was also the highest number since monthly data was first collected in August 2010, and up one-third on a year ago. Four in five UK local authorities have insufficient care for older people in their area, according to research published on Monday.

The occupancy situation is forecast to deteriorate further with more beds expected to disappear under local sustainability and transformation plans designed to improve NHS services and ensure their viability.  [Many campaign groups, including ours, dispute this claim by NHS directors]

Among the acute service beds at general hospitals in line to be cut are 535 in Derbyshire, 400 each in Devon and West Yorkshire, and 30% of all beds in hospitals in Bristol, North Somerset and South Gloucestershire.

Eardley said: “NHS leaders need to think carefully about whether this is a good idea without first putting in place better care in the community.”

Last month the Nuffield trust warned that the statistics underestimated the problem because they took a snapshot of occupancy at midnight, so did not capture squeezes in availability of beds during the day.

Eardley said: “I and too many of my colleagues all around the country are regularly having to cancel patients’ operations due to a lack of beds and delays in transferring patients back into the community.”

Caroline Abrahams, Age UK’s charity director, said: “The professional consensus, based on experience across the country, is that the shortage of social care for frail elderly people is a big part of the problem. This is what Age UK hears from older people and families too, through our advice line and local Age UKs too.

“Unless and until there is additional government investment in social care we can only see these difficulties getting worse.”

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