So English hospital beds have halved since 1997....

[Kokeshi123]

And the number of hospital beds per 1000 people in the UK, is around half the EU's average figure.

Spending on the NHS in real terms and cash terms has increased over this period, though I don't doubt that the NHS is still poorly funded compared with many other countries.

So the NHS struggles every winter and falls over when there is a new disease in town.

Hmmm.

Fun fact: Several health-related bodies, in the UK and elsewhere, have adopted "closing hospital beds" as a very deliberate policy on numerous occasions over the past 30 years. This has included holding discussions about how to deal with the unpopularity of this decision, and ways of convincing the public that actually it's a brilliant idea and they should be happy with it.

www.euro.who.int/__data/assets/pdf_file/0003/98436/E86722.pdf

This is one of the reasons my father took early retirement from the nhs over 10 years ago. It was the final nail in the coffin, he felt the nhs was being run for the benefit of nhs management and not patients.

The thinking behind closing wards was to push care back to the community.

Yeah - dumb-ass move. Care in the community is not necessarily a bad thing but needs to be done on top of keeping beds in hospital - given the winter surges and growing population.

It was astonishing that one of the shiny new (v expensive) PFI hospitals in my region has LESS beds than the hospitals it was replacing. PFI is another scandalous waste of money - it is waaaay more expensive in the long term as the contracts tie you into purchasing services etc via the private company.

The Physical space for beds isn’t necessarily the only problem. There was a hospital that had some redundant unused wards because it was not deemed necessary to make use of them. Staffing with nurses, hca’s and docs is going to be the main limiting factor I think.

I worked for the NHS years ago at the time when our local hospital which consisted of lots of individual buildings on multiple sites was being replaced by a much smaller single site via PFI.

The new build had far fewer beds as the assumption was there would be less bed blockers as care in the community would be bolstered. Far more day case surgery would be carried out so fewer overnight stays and a walk in centre would be created to ease pressure on the smaller A&E.

None of the assumptions happened so now we have a 440 bed hospital serving a population of some 300k residents. It’s completely insufficient.

nhs was being run for the benefit of nhs management and not patients

That - with bells on.

The hospital where I work is COVERED with 'informative' signs on all the corridor walls about the new building works etc. So many 'exciting' plans. And yet all services are on their knees as there aren't the staff to run it all.

People don't need to stay at in hospital for as long as they needed before.

Who would want 2 weeks standard after childbirth? Or a week or more even after very routine surgery?

There were more beds, but there wasn't necessarily more capacity, because the throughput was different.

Yea herein lies the main problem with where we are in managing a pandemic. Our hospitals are just not adequate. Our trust is shifting down wards right now as the staff are not there. Carehomes are preparing to take a large number of patients who are not yet able to return to their own homes. Hope to God they somehow have the staff to look after them. My own Mum is being moved from the nursing floor as her health needs are stable but I'm very worried.

I hate the Tories (and the previous Labour Gov) FWIW but fewer beds isn't necessarily a bad thing.

Eg postnatal- women used to stay in for a week or two now you can be out in 6 hours.

We have strict bed blocking timescales eg discharged 14 days after being fit to leave. I'd imagine since we have more elderly people in care homes we can discharge them quicker from hospital than in other countries where they are going home to relatives.

Encouraging day surgery is a good thing. Remember the constant news about MRSA infections in hospitals a few years ago? Keeping people out of hospital is good.

How many people who have died of covid caught it in hospital? We never hear that stat.

Yes - long hospital stays for childbirth/day surgery etc are not necessarily good, but with a growing and aging population, this would also increase the demand for beds. Complex and frailer patients may take longer to recover - and the bed crises over the past few years should have flagged this as an issue.

We have strict bed blocking timescales eg discharged 14 days after being fit to leave. I'd imagine since we have more elderly people in care homes we can discharge them quicker from hospital than in other countries where they are going home to relatives

I'm not sure you're in the UK as this so definitely doesn't happen. So many beds are blocked as there's nowhere for people who still need nursing care to go to...

It's correct to have fewer beds than 1997. Overnight Hospital stays have become less common. Things which would require admission before are now treated as day cases and maternity stays are no longer at long as previously.

These are good things.

It is true also that the number of beds are fewer than required and this is as a direct result of actions by Tory govts.

But just saying 'hospital beds have halved' and implying that is only because of the govts since 1997 is wrong.

The NHS is screwed until social care funding stops being screwed. Local government funding has been slashed while NHS funding has gone up and up. You could keep tipping more and more money into the NHS and it would never be enough because there is not adequate social care available for people to get them back out of hospital, or adequate public health, early intervention etc to help prevent them needing to go into hospital in the first place.

As an NHS nurse I agree with most of this, apart from the 14 days after being medically ready for discharge, these patients are still sitting in beds on my ward weeks to months after being ready. This is a huge issue as why alot of elective work on my ward is currently being cancelled. We don't have the beds or even the staff.

We keep opening up 'other' areas as wards but as there is no staff they pinch from everywhere, making all wards dangerously short. Alot of the time these elderly patients require so much nursing time to wash, feed and mobilise, this in turn means we cannot properly care for everyone.

It is a nightmare, I don't know what the outcome will be but it won't be good.

The idea is that you get your life saved or your acute condition treated in hospital, then most of the recovery is done at home, with support. Generally recovery is supposed to be more active nowadays rather than lying in a hospital bed.

@RobinPenguins

The NHS is screwed until social care funding stops being screwed. Local government funding has been slashed while NHS funding has gone up and up. You could keep tipping more and more money into the NHS and it would never be enough because there is not adequate social care available for people to get them back out of hospital, or adequate public health, early intervention etc to help prevent them needing to go into hospital in the first place.

"Care in the community" is often cover for "cuts in the community."

It's politically difficult to close a visible institution like a hospital.

It's politically very easy to just fail to provide a care package to Mrs Smith of 23 Acacia Avenue.

It's politically even easier to provide no direct care at all but instead have a system where people can apply for money to organise their own care. Then you can get the population actively applauding the cuts, by promoting a narrative that Mrs Smith is a scrounger applying fraudulently and getting free money. 'Cos everyone can feel jealous of getting money, whereas getting the service of having your bum wiped by a stranger, not so much.

General Statistics hide the wider picture though. Overall hospital beds have decreased, but many of those beds are now in the community. Mental health and geriatric beds have been moved into the community, so those beds didn't disappear they just got moved outside of the hospital environment.

Did we lose total number, yes, could we do with more, absolutely yes. Do they have to be in a hospital setting, not necessarily. Depends on the patient need. An elderly patient is best treated in a care home, and a mental health patient best in a dedicated unit. Hospitals should be for acute care, and routine surgery. As pp's noted, routine surgery is often now a day case, which has meant many hospitals setting up day units. Fewer beds, but more patients treated.

Times in hospital have reduced dramatically post op, post childbirth etc. unfortunately we have an issue with mostly older patients needing care for discharge which causes most the issues

@RancidOldHag

People don't need to stay at in hospital for as long as they needed before.

Who would want 2 weeks standard after childbirth? Or a week or more even after very routine surgery?

There were more beds, but there wasn't necessarily more capacity, because the throughput was different.

That would be true if we were talking about the difference between 1970 and now.

We are talking about cuts over the last 10-15 years. There hasn’t been a big difference in LOS since then.

We are talking about cuts over the last 10-15 years. There hasn’t been a big difference in LOS since then

Not as big no, but still falling year on year:

The graphs start in the 80s, and yes hospital says were much longer then. Keyhole surgery and day cases barely existed, and standard recuperation times (including after childbirth) were considerable longer. Even in the 90s it was still routinely over a week

Agree with @PerkingFaintly. Easier to obscure problems in the community - lack of care home places, lack of District nurse’s, lack of mental health provision. Early discharge and re admission also causes inefficiencies and problems. The problems have been going on for a long time and no one wants to tackle them. They just want high profile - build hospitals with PFI or re-organise the pcts into ccgs or abcs or whatever.

I had my first baby in 1971, as he was born before lunch time we could leave 7 days later, if he'd been a couple of hours later I'd have had to stay an extra day. When it came to discharge the doctor had forgotten to sign the form and as it was a Saturday they were sure they could find a doctor to sign my discharge. I said I'd discharge myself, Sister went mad, how irresponsible I was, the danger of something happening to the baby. Considering the doctor had said on the Friday night that I was fine to go I couldn't see what difference his signature made to our safety. They were so worried they managed to find a doctor to sign.

A few years later my son needed surgery, he had to be in hospital 24 hrs before the surgery. A year later he need the same op on the opposite side, I was told that as they trusted me he could come in on the morning of surgery if I promised to make sure he didn't eat or drink. He was then in for 3 days, his op is now done as day surgery.

We did used to have much longer stays in hospital and I wonder how many were needed.

I've just found a post I made 6 years ago (with different nickname) during Osborne's austerity.

I wish I'd been wrong.

[PerkingFaintly] Tue 24-Nov-15 16:17:13
There's this huge sleight of hand going on at the moment, where responsibility for the "social care" end of healthcare gets shunted around.

It did belong to councils, who used some central govt funds. Then Osborne cut funds to councils, who in turn cut social care. Things are in train to make social care the NHS's responsibility (funded from where?), but last week Osborne announced local councils can raise local taxes for social care.

So it's a dog's dinner.

I would expect to see a large "increase" in the NHS budget, as social care is transferred. And I would expect this to be trumpeted as increased support for the NHS. I would also expect the total budget for healthcare and social care to have decreased or failed to keep pace with the rise in elderly population, when compared with pre-cuts.

The cuts to social care may be what kills the NHS. Hospitals simply can't discharge.

Oh halved in number not size. I thought maybe only little people could go to hospital now.