RCEM view on NHS England proposals of test for hospital bed closures

3 March 2017

While NHS England’s proposed criteria to mitigate the closure of beds is well intentioned, it should be redundant; the College remains sceptical of any initiative that could further erode the bed base.

With attendances and admissions ever increasing, patients presenting at a later stage of life with more acute symptoms, and bed occupancy currently over 95% - way above the safe limit of 85%, all the evidence points to the need for more beds. This is not to mention the impact cuts to social care have had.

We already have the lowest number of acute beds per capita in Europe, along with a poor ratio of doctors to patients, yet we appear to be on a downward trend. If we are to get back to safe levels of bed occupancy it should be obvious that we need more beds.

There are now so few beds that departments are having to ask patients to sleep in corridors. This cannot continue. The frail and vulnerable should not have to be subjected to such undignified conditions. 

Analysis from The Nuffield Trust found that during the winter of 2015/15 five entire hospitals’-worth of extra beds had to be opened every day, and we would echo the call from the Royal College of Surgeons for NHS England to review bed capacity.

However, where there is an airtight case for service reconfiguration, having guidance around bed closures in place could be considered a step forward. 

In such a case, conditions for bed closures must be clearly demonstrated, recorded and proven to be sustainable with ongoing funding, with embedded service changes prior to any implementation of reductions. This must be coupled with future proofed capacity planning and funding over a suitable period of years. 

We await with interest to see how these rules are interpreted.