NHS is “full” owing to rise in emergency admissions and poor discharge procedures, report says

BMJ 2012; 345 doi: (Published 04 December 2012) Cite this as: BMJ 2012;345:e8245
  1. Gareth Iacobucci
  1. 1BMJ

NHS hospitals are being stretched to “bursting point” by a combination of soaring emergency admissions and an inability to discharge patients effectively, a comprehensive new audit has found.

The Dr Foster Hospital Guide 2012, which examined capacity at acute trusts in England, found that most hospitals were more than 90% occupied for 48 weeks of the year, with many hospitals more than 95% full in winter.1

The report said that high levels of bed occupancy were endangering patient safety and making it more difficult to run the health service effectively and that the NHS should ideally operate at 85% bed occupancy.

It said that the latest figures also disguised the highs and lows of bed occupancy throughout the year, with many hospitals functioning even when 95-100% of their beds were taken.

A rapid 15% increase in admissions among frail elderly patients over the past five years was cited as a key reason for the pressure on capacity, with this alone creating a bed demand “equivalent to two large hospitals.” Half of all avoidable bed days were occupied by those over 75 years old.

Problems were compounded by almost 29% of hospital beds being occupied by patients whose hospital stay could have been avoided, with a lack of integration with social and community care often the problem.

The report pointed out that, although the total number of beds in the NHS had decreased by a third in the past 25 years, bed occupancy could be brought back “within safe limits” without creating additional capacity, by reducing “avoidable admissions” and improving the integration of health and social care.

Almost 12% of beds in 2011-12 were occupied by people with conditions that could be treated outside hospital, such as those with diabetes, asthma, and hypertension.

Capacity could also be eased, the report said, by reducing the 5% of annual bed days relating to patients who have left hospital and are then readmitted as an emergency within a week; the 3% relating to patients with dementia; and the 2% relating to patients who are kept in overnight when they should have been treated as day cases.

Roger Taylor, director of research at Dr Foster Intelligence, said: “The NHS is full; the solution is not to increase bed numbers, but rather to ensure that people who do not need to be in hospital are treated in a more appropriate setting.

“Not only will this give the health service the flexibility it needs to cope with unexpected jumps in demand, but it will also save the vast amount of money currently being wasted on expensive and entirely avoidable admissions.”

Andrew Goddard, director of the Royal College of Physicians’ medical workforce unit, said, “The staggeringly high bed occupancy rates show that hospitals are at bursting point. This prevents hospitals from being able to deliver non-urgent care—such as hip replacements—and puts staff under increasing pressure as they are constantly fire fighting.”

Mike Farrar, the chief executive of the NHS Confederation, said, “These figures give further weight to calls that NHS leaders have been making about the need to change the way we deliver services to improve the care people receive. In order to take the pressure off our hospitals, we need to move resources to improve community and primary services and ensure people can be treated safely in their own home.”


Cite this as: BMJ 2012;345:e8245