A combination of medical and managerial skills is needed to solve the problem

The NHS is under sustained pressure to cope with rising numbers of hospital admissions. Public concern over waiting on trolleys and delays in access to care has never been greater. The NHS has responded by using its most expensive resource—inpatient beds—more efficiently. Over the past 20 years the average length of stay for each admission has fallen year on year from 11.7 days in 1980 to 6.8 in 1999-2000. Factors have included increased use of day surgery and the recognition that earlier discharge in many conditions was not dangerous and may often be better for the patient.

After nearly 20 years of consistent reductions, the average length of stay has unexpectedly risen from 6.8 days in 1999-2000 to 6.95 days in 2000-1. The rise shown in the national hospital episode statistics for England may seem small in absolute terms, but a 2.5% rise has huge potential costs at all levels of the service. A recent workshop attended by professionals and department of health officers examined the figures and noted that the …