The NHS has a shortage of hospital beds, with occupancy rates consistently exceeding safe levels. As the health system faces unprecedented pressures due to rising demand and the burden of COVID-19, bed capacity will remain a critical limiting factor in the ability of the NHS to recover.
This page provides analysis on the availability and occupancy of beds in the English NHS and is updated regularly with new data. [Online article contains more graphics.]
Last updated: 20 December 2022
COVID-19 has had a significant impact on service delivery. A number of factors impact the usage and availability of beds:
- infection control measures placing limits on ward space
- reduced elective capacity
- staffing redeployment.
This is why data shows a sharp fall in the number of available hospital beds in 2020/21.
To fairly illustrate long-term trends this analysis therefore uses the pre-pandemic year of 2019/20 as the comparator.
The UK has fewer hospital beds than comparable nations
Compared to other nations, the UK has a very low total number of hospital beds relative to its population. The average number of beds per 1,000 people in OECD EU nations is 5, but the UK has just 2.4. Germany, by contrast, has 7.8.
Combined with staffing shortages, an insufficient core bed stock means that hospitals are less able to cope with large influxes of patients, for example during winter or periods of high demand.
This has ultimately impacted hospitals’ ability to provide safe and timely care and remains a major factor in growing backlogs.
NHS hospital bed stocks have changed over time
Overall bed stock has declined
Prior to the pandemic, the total English NHS hospital bed stock reduced by 8.3% between 2010/11 and 2019/20 as the average daily total of available beds fell from 153,725 to 140,978.
The ratio of beds that are overnight versus day-only has also undergone change. Between 2010/11 and 2019/20 the overnight bed stock shrunk by 10% while the number of day-only beds increased by 13.4%.
The extent to which overnight bed numbers have fallen varies across different settings. Learning disability and mental illness beds have seen the largest reduction of 56% and 22.5% respectively since 2010/11. This reflects policies to move care for these patient groups out of hospitals and into the community.
A reduction has also occurred in the available number of general and acute overnight beds which have decreased by 6.9%, from 108,958 average daily beds in 2010/11 to 101,432 in 2019/20.
The rise in general and acute day-only beds reflects an increase in day-case surgeries reducing the need for overnight stays, following clinical innovations that have lowered the time patients generally need to spend in hospital.
COVID-19 has impacted bed availability
As NHS England has noted, capacity has had to be organised differently during the pandemic. This is to comply with enhanced infection control measures and to treat COVID and non-COVID patients separately.
As a result of this reorganisation, the number of general and acute beds available for use dropped to a low of 92,559 in the first quarter of 2020/21.
Latest data for the second quarter of 2021 showed this has now increased to 98,000, but remains well below pre-pandemic levels.
Safe limits are routinely breached
While overall bed numbers have declined, occupancy rates have been rising.
Since 2010, average bed occupancy has consistently surpassed 85%, the level generally considered to be the point beyond which safety and efficiency are at risk.
Coming into the pandemic, England had an average occupancy of 90.2% in 2019/20. However, local variation in supply and demand have seen many trusts regularly exceeding 95% capacity in the winter months.
Bed shortages alongside high occupancy rates are unsafe for patients and staff. It can:
- increase delays in emergency departments
- delay patients transfer from intensive care units and between wards
- add stress to staff and patients.
Impact of COVID-19 on occupancy levels
The pandemic has seen a drastic fall in bed occupancy rates as a result of infection control procedures and rapid discharge arrangements. However, occupancy levels go hand in hand with the availability of beds.
Low occupancy with a low bed stock and low throughput is neither good for patients nor staff, who are facing long waits for treatment, a mounting backlog and capacity pressures.
Data for the second quarter of 2022/23 indicates that bed occupancy levels in England have risen substantially and have passed the recommended safe threshold again.
Pressures in social care are causing delayed discharges from hospital
Issues surrounding bed capacity are compounded further by discharge delays caused by pressures in social care. Up to one in three English hospital beds are occupied by patients who are medically fit to be discharged, but remain in hospital as there is no space for them in social care. This issue highlights the importance of properly funding both health and social care systems so that they can effectively work together.
Critical care capacity remains low despite increases in beds
National data on critical care beds is collected via monthly situation reports. Until February 2020 this consisted of a snapshot taken at midnight on the last Thursday of the month.
In March 2020 reporting adjustments due to COVID-19 changed this to an average across the month.
NHS England paused the regular publication of complete critical care bed capacity in February 2020 due to the COVID-19 pandemic.
The UK entered the pandemic with a low number of critical care beds relative to its population, with just 7.3 critical care beds per 100,000 people, more than half the average in OECD EU nations (15.9).
This is despite the total number of adult acute critical care beds actually having risen over the years.
In placing new demands on critical care services, COVID-19 laid bare that England does not have enough critical care beds.
When the NHS was asked in early 2020 to free up critical care capacity to prepare for a surge in patients, it achieved this through reorganising existing resources to:
- reduce demand by postponing non-urgent planned operations
- increase the amount of beds and physical spaces dedicated to critical care by reducing capacity elsewhere, including repurposing recovery rooms
- redeploy staff from elsewhere in the NHS.
As a result of these measures the number of available critical care beds saw a sharp increase between March and April 2020.
However, the need for rapid expansion of critical care capacity has come at a large cost to the NHS, which now faces extensive backlogs in other parts of the system. See our secondary care capacity analysis.
What the BMA is calling for
With bed capacity pressures mounting, the BMA is calling for action to be taken to ensure that the core bed stock grows to reach a level that will cope with year-round demand.
Increasing the total number of available beds is a sensible and achievable step towards addressing bed shortages in the NHS.
Expanding bed numbers will only be meaningful if there is sufficient workforce to staff them safely.
Funding for the adequate staffing of these beds – alongside long-term investment in increasing the NHS workforce – must therefore be provided by the Government.
This must be accompanied by a workforce strategy to ensure that the appropriate number of future staff are being recruited and trained. This is likely to save costs in the long run – through, for example, a reduction in locum costs.