Where are all the beds?

The decline in the number of beds in the NHS in England since the end of the 1970s reflects a number of different changes which are also apparent in other countries of the UK.

The number of beds for people with learning disabilities and to a lesser extent for people with mental illness decreased as a result of the closure of small hospitals and people with learning disabilities moving into residential care, along with an increase in community care for people with mental illness.

The number of maternity beds decreased as smaller maternity units closed and care was concentrated into ever larger units. The number of acute beds decreased up to the early 1990s in response to shorter lengths of stay after acute admissions and the shift of elective procedures to day case and outpatient care.

Despite this it was apparent that capacity was inadequate leaving little potential to reduce the numbers on waiting lists. The National Beds Enquiry report in 2000 concluded that more beds were needed and that a ‘whole systems approach’ was needed to provide them, but the increase since then has been minimal, as the graph shows.

These data are publicly available from the Department of Health web site. Data on the private sector are harder to come by and are expensive. The right hand chart shows those which have been gleaned from various sources. It indicates that the private acute sector which grew in the 1980s and early 1990s has declined since then, and therefore has less spare capacity to offer the NHS. It has also shifted from the charitable and not-for-profit sector towards the more commercial national chains.