A high level of hospital bed occupancy is 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. There must be enough beds to accommodate these peaks.
A lack of available beds can have widespread consequences in a health system. For example, it can increase delays in emergency departments, cause patients to be placed on 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.
In March 2020, NHS England wrote to trusts asking them to urgently discharge all hospital inpatients who were medically fit to leave and postpone non-urgent elective operations to free up capacity for the response to the coronavirus (Covid-19) pandemic. Because enhanced infection prevention and control measures have been in place, to treat Covid and non-Covid patients separately, caution should be taken when comparing bed occupancy rates with previous years as hospitals faced capacity pressures at lower occupancy rates than before the pandemic.
The data presented here does not include critical care beds.
Around four in five NHS hospital beds are general and acute beds. Over the nine years preceding the pandemic, the number of overnight general and acute beds had been steadily declining, while the proportion of beds that were occupied increased. Between Q3 2010/11 and Q3 2019/20, available general and acute beds fell by 6,425 (a 6% decrease), and the occupancy rate increased from 88% to 92%.
At the start of the pandemic NHS trusts were asked to increase inpatient and critical care capacity through freeing up 30,000 or more general and acute beds across England. In Q1 2020/21 (April to June 2020), the number of occupied general and acute beds fell by 35%, from 90,309 to 58,420, compared to the previous quarter.
In addition, enhanced infection prevention and control measures were put in place that reorganised hospitals into Covid and non-Covid wards in an attempt to limit cross infection. As a result, hospitals were experiencing capacity pressures at lower occupancy rates than before. In Q4 2021/22, there was a total of 101,970 general and acute beds (224 less than in Q4 2019/20) and the bed occupancy rate was 89% (88% in Q4 2019/20).
Over the last decade, the number of overnight NHS hospital beds has decreased for all bed types.
The number of available mental health beds decreased by 23% between Q1 2010/11 and Q4 2021/22. Part of the NHS Long Term Plan is to increase intensive home treatment and community care to provide more alternatives to inpatient admission. However, charities have raised concerns that the mental health bed shortage is leading to patients being discharged too early or treated out of area, far from their homes and support network.
The NHS Long Term Plan includes a goal to reduce the number of beds (accounting for population growth) for people with learning disabilities to less than half of 2015 levels by March 2023/24, and instead provide care at home or in a community setting. Between Q4 2014/15 and Q4 2021/22, the number of beds for people with learning disabilities decreased from 1,445 to 778 (a 47% decrease).
The number of maternity beds decreased from 7,906 to 7,668 (a 3% decrease) between Q1 2010/11 and Q4 2021/22. A shortage of maternity beds can lead to closures of maternity wards.
The number of day-only beds has increased by 1%, from 11,783 in Q1 2010/11 to 11,911 in Q4 2021/22. 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.
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. Please note, this dataset does not include critical care beds, beds occupied by private patients and residential care beds.
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 be experiencing 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.