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. There must be a sufficient number of beds to accommodate these peaks.
A lack of available beds can have widespread consequences in a health system. For example, delays in emergency departments increase, patients are placed on clinically inappropriate wards, there is an increased rate of hospital acquired infections, and pressure on staff to free up beds could 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 most recent data presented here are from Q4 2019/20 (January to March 2020). Data from March 2020 will be affected by the coronavirus (Covid-19) outbreak. In March, trusts were asked to urgently discharge all hospital inpatients who were medically fit to leave to free up capacity for the response to the outbreak.
Between Q1 2010/11 and Q4 2019/20, the total number of NHS hospital beds decreased by 11%, from 144,455 to 128,935. But the number of occupied beds only decreased by 9%, from 122,551 to 111,324. Therefore, the bed occupancy rate increased from 85% in Q1 2010/11 to 86% in Q4 2019/20.
Bed occupancy tends to peak in Q4 (January to March) of each year. However, in 2019/20 the bed occupancy rate reached a peak of 89% in Q3 (October to December). The decrease in bed occupancy in Q4 2019/20 to 86% may reflect trusts being asked to urgently discharge all inpatients who were medically fit to leave, in order to free up capacity during the Covid-19 outbreak.
The number of overnight general and acute beds fell by 8% between Q1 2010/11 and Q4 2019/20, from 110,568 to 102,186. Over the same time period, the number of occupied general and acute beds decreased by 5%, from 95,430 to 90,312. Therefore, the rate of general and acute bed occupancy increased from 86% in Q1 2010/11 to 88% in Q4 2019/20. This is concerning as rising general and acute bed occupancy rates are associated with worsening A&E performance.
As with overall bed occupancy, the general and acute bed occupancy rate tends to peak in Q4 (January to March) of each year. However, in 2019/20 the bed occupancy rate reached a peak of 92% in Q3 (October to December) before falling to 88% in Q4, which came alongside trusts being told to free up capacity in response to the Covid-19 outbreak.
The number of overnight NHS hospital beds has decreased over time for all bed types. Between Q1 2010/11 and Q4 2019/20, the number of general and acute beds decreased from 110,568 to 102,186 (an 8% decrease) and the number of mental health beds decreased from 23,515 to 18,139 (a 23% decrease). Pressures on the availability of mental health beds can occur because of delayed discharges, which may reflect a lack of suitable community services. A consequence of pressures on these beds is that out of area placements occur, where mental health patients are sent far away from their home and support network.
Between Q1 2010/11 and Q4 2019/20, the number of beds for people with learning disabilities decreased from 2,465 to 921 (a 63% decrease) and maternity beds decreased from 7,906 to 7,689 (a 3% decrease). A shortage of maternity beds can lead to closures of maternity wards.
In contrast, the number of day-only beds increased by 8%, from 11,783 in Q1 2010/11 to 12,716 in Q4 2019/20. Clinical improvements have led to reductions in the average length of stay and have enabled many 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.
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 can't be more than 100%.
For more information, please see NHS England's Bed Availability and Occupancy Guidance.