Hospital bed occupancy

We analyse how NHS hospital bed occupancy has changed over time.

Qualitywatch

Indicator

Last updated: 27/06/2023

Background

High levels of hospital bed occupancy are an important indicator of a health system under pressure. Hospitals cannot operate at 100% occupancy, as spare bed capacity is needed to accommodate variations in demand and ensure that patients can flow through the system. Demand for hospital beds peaks at different times of the day, week and year and there must always be sufficient beds available to accommodate these peaks.

A lack of available beds can have widespread consequences in a health system. It can increase delays in emergency departments, cause patients to be placed in clinically inappropriate wards and increase the rate of hospital-acquired infections, while pressure on staff to free up beds can pose a risk to patient safety. Bed availability is also closely linked to staffing, as beds cannot be safely filled without appropriate staffing levels.

The data presented here do not include critical care beds.


General and acute hospital bed occupancy

The number of overnight general and acute beds fell by 8% between Q1 2010/11 and Q4 2019/20, from 110,568 to 102,194. Over the same period, the number of occupied general and acute beds decreased by 5%, from 95,430 to 90,309. Therefore, the rate of general and acute bed occupancy increased from 86% in Q1 2010/11 to 88% in Q4 2019/20.

In Q1 2020/21, the number of available general and acute beds decreased to 92,559 and the number of occupied general and acute beds fell to 58,420. This came after trusts were asked to urgently discharge hospital inpatients who were medically fit to leave. Non-urgent elective operations were also postponed to free up 30,000 or more general and acute beds across England for the response to the coronavirus (Covid-19) pandemic. It may also have been due to infection control measures, such as the need to create space to enable social distancing, and staff redeployment or absences.

The number of available general and acute beds has since increased to the level that it was before the pandemic. In Q3 2022/23 (October to December 2022), of the 103,521 available general and acute beds, 95,241 were occupied. The bed occupancy rate was 92% in Q3 2022/23 for overnight general and acute beds.


Hospital bed availability by bed type 

Over the last decade, the number of overnight NHS hospital beds has decreased for all bed types. Between Q1 2010/11 and Q3 2022/23, the number of mental health beds decreased by 23% from 23,515 to 18,152. Pressures on the availability of mental health beds could have occurred due to delayed discharges, which may reflect a lack of suitable community services. A consequence of pressure on these beds is that ‘out of area’ placements occur, where mental health patients are sent far away from their homes and support networks.

The NHS Long Term Plan includes a goal to reduce the number of beds for people with learning disabilities to less than half of 2015 levels by March 2023/24, taking population growth into account. This ambition is described in further detail in a published national plan aimed to reduce the need for inpatient care for people with a learning disability, autism and other mental health conditions. It involves ensuring specialist health and social care support in the community for many with complex behavioural difficulties, providing coordinated and person-centred care, and increasing support from and for families and caregivers. Between Q1 2015/16 and Q3 2022/23, the number of beds for people with learning disabilities decreased by 43% from 1,322 to 752, indicating progress towards the goal of reduced in-patient care.

The number of maternity beds decreased by 6% from 7,906 to 7,465 between Q1 2010/11 and Q3 2022/23. A decrease in the number of beds, in addition to staff shortages, contributed to maternity ward closures across England between 2014-2016, jeopardizing the safety of maternity services.

In contrast, the number of day-only beds increased slightly by 2%, from 11,783 in Q1 2010/11 to 12,070 in Q3 2022/23. Clinical improvements have led to reductions in the average length of stay and have enabled patients who once would have stayed in hospital overnight to undergo day surgery.

In Q1 2020/21 (April to June 2020), after the onset of the Covid-19 pandemic, the number of available beds decreased for all bed types, reflecting the reorganisation of services in response to the pandemic. Between Q1 2020/21 and Q3 2022/23, the number of available general and acute, mental health, and day-only beds increased, the number of maternity beds remained somewhat constant, and the number of beds for people with learning disabilities continued to decrease.


About this data

Quarterly bed availability and occupancy data has been collected since 1987/88 and has remained the same apart from slight changes in 1996/97.

For wards open overnight, an occupied bed day is defined as one which is occupied at midnight on the day in question. For wards open during the day only, an occupied bed day is defined as a bed in which at least one day case has taken place during the day. Bed occupancy cannot be more than 100%.

During the Covid-19 pandemic, hospital services were reorganised due to infection prevention and control measures, and the need to treat Covid and non-Covid patients separately. As a result, hospitals were likely to experience capacity pressures at lower overall occupancy rates than in previous years, so caution should be taken when comparing occupancy rates.

For more information, please see NHS England's Bed Availability and Occupancy Guidance.

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