Acute care in hospitals cannot be sustained in its present form, the Royal College of Physicians has warned in a new report.1 An ageing population with multiple and complex needs is producing greater demands, but these have to be met by a hospital system that has a third fewer beds than there were 25 years ago.

Emergency admissions have risen by 37% in the past decade, the report says. While hospitals have so far dealt with this rise by reducing patients’ length of stay, this cannot be sustained indefinitely. Lengths of stay have stopped declining and in the past three years have started to rise among patients aged over 85.

Patients are increasingly frail, with 65% aged over 65, and an increasing proportion have dementia. But hospitals, services, and staff are ill suited to dealing with patients who have these complex needs.

Within hospitals, continuity of care …