Hospital bed squeeze is being miscounted and causing congestion

With performance falling below targets and winter approaching, a Nuffield Trust briefing today warns the NHS can no longer find enough bed space to move patients through hospitals quickly and meet key A&E targets – and that its practice of counting patients at midnight means we are missing the true scale of the squeeze.

Understanding patient flow in hospitals, a briefing for NHS managers, estimates that 5.5% of beds need to be free for cleaning and preparation if patients are to be moved through quickly enough to meet the high-profile commitment to admit or transfer emergency patients within four hours. Yet many hospitals are unable to provide this much of the time, making target breaches inevitable. With a growing number of patients coming and going during the day, counting bed occupancy at midnight means that crunch times are often invisible.

The authors, Sasha Karakusevic and Nigel Edwards, show how space has been squeezed over the last five years as the number of hospital beds has flatlined even as thousands more have been needed. The NHS is now so far from the 85% occupancy rate once considered ideal that 12,000 extra beds would be needed to return to it. They expect pressure to continue due to rising number of patients with multiple conditions, and a predicted rise in the death rate from 600,000 each year to 800,000 by 2050.

The report finds that the 10% of patients who stay for more than a week account for 65% of bed use, and concludes that a strong focus on earlier discharge for these people may help to free up space.

It tracks how bed use changes through the day, with the most beds full in the morning, and the highest rate of patient movements seen in the afternoon. The authors argue that IT systems and management must adapt to tracking how beds are used on a minute by minute basis, so that hospitals can react when staff and space are under most pressure.