David Oliver: Is Lord Prior right about scrapping beds?

On 5 October the Daily Mirror reported that the Conservative “NHS productivity minister,” Lord Prior, had told the management consultancy McKinsey that the English NHS should scrap half of its hospital beds.1 Prior had form: in his recent role as supposedly neutral chair of the Care Quality Commission (CQC) he courted media attention for personal views.

For instance, he told the Daily Telegraph that we needed to start closing beds quickly to prevent the NHS falling over as urgent activity increased.2 He called for more competition and learning from US organisations, comparing hospitals with refrigerators, and predicted that the CQC would find many to be failing.3 They might then be taken over by US hospital chains, he said.4

It’s unclear how Prior arrived at these conclusions. Surely a man chairing a public regulator wouldn’t allow political ideology to influence his “blue sky thinking”?

There is some sense buried beneath the soundbites. We don’t invest sufficiently in prevention and wellbeing (not helped by the government’s £200m (€274m; $308m) raid on public health budgets).5 We don’t support enough people to live with long term conditions and avoid crises (hampered by the workforce gaps in primary care and community nursing).6 Most patients with conditions sensitive to primary care admitted acutely to hospital have bypassed GP referral altogether.7

We don’t have sufficient capacity in community health services to support people outside hospital in subacute emergencies or to discharge them sooner.8 Since 2010 we’ve drastically cut capacity in social care services.9

Urgent activity through emergency departments and acute medical units has continued to rise10 despite a rapid loss of acute beds, as advocated by Prior. Emergency departments are accessible 24/7, greatly valued by the public, and remarkably they continue to assess and treat nine in 10 attendees within four hours.

The United Kingdom lies near the bottom of the Organisation for Economic Cooperation and Development’s list of nations regarding hospital beds per capita, and England is lower still.11 The Economist12 and the Commonwealth Fund13 (cited supportively by the chancellor in the 2015 spending review14) ranked our system already high for efficiency. The Nuffield Trust projects that, at current trends, we will need six million more hospital bed days a year by 2022.15

So yes, Lord Prior: hypothetically, many people in hospital could be cared for elsewhere. But that capacity doesn’t typically exist. The King’s Fund and the Health Foundation propose a “transformation fund” to create that capacity and keep already full hospitals afloat before removing more beds.16 Even Prior’s boss—the health secretary, Jeremy Hunt—has admitted the NHS’s parlous finances.17 Yet, on these points, Prior seems quiet, copying another US innovation and “pleading the fifth.”