Only nine out of England’s more than 130 hospital trusts were operating within a ‘safe’ limit of occupancy last week, with 20 trusts running out of beds completely on at least one occasion.
It comes as a damning report published by the House of Lords declared a “national emergency” in healthcare, warning “low capacity in hospitals and social care has left the emergency health services gridlocked and overwhelmed, unable to provide safe care”.
Analysis of weekly NHS England data on hospital bed availability shows an average of 95.7% of beds on adult general and acute wards were occupied on any given day in the week ending 15 January. That is far higher than the 85% threshold widely considered to be a safe level of busyness. The data is based on snapshots taken at 8am each day throughout winter. The busiest day last week was 11 January, when occupancy hit 96.3%.
The overall performance across England last week was a slight improvement on the week before, when occupancy levels were at an average of 96%. It was significantly higher than for the same week last year however, when it was at 93.3%. It is not possible to compare with earlier years, as previously figures were combined for adult and paediatric beds.
After 85%, evidence shows that patients can suffer adverse impacts, such as longer hospital stays or hospital-acquired infections. Hospitals may also be forced to place patients on inappropriate wards, and struggle to move people through A&E, contributing to increased waiting times.
It is a threshold that has been endorsed by the British Medical Association (BMA), National Audit Office (NAO), NHS Providers and Royal College of Emergency Medicine (RCEM). NHS England and NHS Improvement have previously suggested 92% should be considered the recommended safe limit for bed occupancy in winter, while the National Institute for Clinical Excellence (NICE) recommends maximum occupancy should be 90%.
Hospitals “cannot operate at 100% occupancy”, according to the Nuffield Trust think tank – but that was just what 20 hospital trusts were forced to do last week, having run out of beds completely on at least one occasion. These were:
- East and North Hertfordshire NHS Trust - 100% on three days
- The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust - 100% on one day
- Kingston Hospital NHS Foundation Trust - 100% on four days
- North Middlesex University Hospital NHS Trust - 100% on three days
- Birmingham Women’s and Children’s NHS Foundation Trust - 100% on 1 day
- George Eliot Hospital NHS Trust - 100% on all seven days
- Kettering General Hospital NHS Foundation Trust - 100% on three days
- South Warwickshire NHS Foundation Trust - 100% on one day
- Walsall Healthcare NHS Trust - 100% on one days
- Leeds Teaching Hospitals NHS Trust - 100% on six days
- Countess of Chester Hospital NHS Foundation Trust - 100% on one day
- Mid Cheshire Hospitals NHS Foundation Trust - 100% on two days
- Southport and Ormskirk Hospital NHS Trust - 100% on four days
- Stockport NHS Foundation Trust - 100% on one day
- Wrightington, Wigan and Leigh NHS Foundation Trust - 100% on six days
- Frimley Health NHS Foundation Trust - 100% on one day
- Dorset County Hospital NHS Foundation Trust - 100% on one day
- Great Western Hospitals NHS Foundation Trust - 100% on one day
- Salisbury NHS Foundation Trust - 100% on one day
- Yeovil District Hospital NHS Foundation Trust - 100% on four days
Out of 134 hospital trusts, 125 (93%) were operating above 85% occupancy across the week, while 119 were above 90%. More than half – 83 trusts – were above 95%. All of the nine trusts within the 85% limit were smaller or more specialist hospitals without a general-purpose, 24-hour A&E for adults, including Moorfields Eye Hospital, Liverpool Women’s NHS Trust, and the Royal Orthopaedic Hospital NHS Foundation Trust.
On Thursday (19 January) the House of Lords’ public services committee published a report on emergency care in England, concluding “emergency healthcare, a key component in the national health service, has been allowed to degenerate, and it is likely to get worse […] there is no sign that the government is adequately addressing the problem”.
Among the wide range of crises identified by the peers was a shortage of beds, which prevents patients from flowing through hospital and leads to A&E backlogs and queues of ambulances unable to offload patients. The RCEM told the committee that 29,000 hospital beds had been lost since 2010 “despite no reduction in demand”, leaving the UK with one of the lowest numbers of beds per head of the population among similar developed countries.
The Nuffield Trust think tank however warned there was not enough staff to keep more beds open, even if physical capacity was added. The Lords report urged the government to “continue working to increase the number of physical beds in hospitals” and “ensure that additional beds are sufficiently staffed”.
The report was published as nursing staff in England walked out for the second day in a row in their dispute over pay and staffing levels. The Royal College of Nursing said it was campaigning for a fair pay rise to tackle record levels of staff vacancies. “People aren’t dying because nurses are striking – nurses are striking because people are dying,” said RCN general secretary and chief executive Pat Cullen.
NationalWorld was speaking to nurses at a picket line in London yesterday (19 January) – you can find out why the staff we spoke to say they believe striking is the only way to protect their patients and the NHS in our full report here.
A Department of Health and Social Care spokesperson said: “We recognise the pressures the NHS is facing following the impact of the pandemic and are working tirelessly to ensure people get the care they need, backed by up to £14.1 billion funding for health and social care over the next two years.
“We have announced up to £250 million of additional funding to immediately help reduce hospital bed occupancy, alleviate pressures on A&E and speed up much-needed ambulance handovers, and are boosting call handler numbers for NHS 111 and 999 to reduce answer times.
“This is on top of the £500 million Discharge Fund to speed up the safe discharge of patients who are medically fit to leave hospital, and the NHS creating the equivalent of 7,000 more beds as well as establishing 24/7 data driven system control centres in every local area to manage demand and capacity.”
The Lords report noted that even with 7,000 extra beds this winter – a figure which includes 2,500 ‘virtual beds’ which allow hospital doctors to monitor patients at home remotely – the NHS would still be 22,000 beds short of 2010 levels, and without a longer-term boost to capacity.
This article originally said 12 hospital trusts were within the 85% limit, but this included three children’s trusts not relevant to the analysis. It has been amended to remove them.