Are there enough NHS hospital beds?

Are there enough NHS hospital beds?

Short answer is yes/no [“that’s helpful!” CKDEx Ed]. What we need is more protected surgical beds, so we can do more operations. Let’s explain why that is so.

The problem
As we all know there are over 6m people waiting for an operation (or procedure) in the NHS, some waiting over 2 years. We are very sorry. We know it is not good enough. Lets do some maths.

In England, there are about 120,000 NHS beds in our hospitals. Of those, about 20% are surgical, and ‘available’ for ops. In those beds, we (NHS) do about 10,000 operations a day, making 2.6m ops per year (presuming a 5 day working week).

But the beds are poorly used for 2 reasons:

1. As the beds are not ‘protected’ (i.e. only used for surgery), we put frail elderly ‘medical’ (non-surgical) patients in them – for example, an 87 year old lady confused with a UTI
2. Operating theatres are largely only used Mon-Fri (5 days).

So what’s the answer?
In COVID-19, the NHS took over the approximate 10,000 beds in private hospitals. They are very strict and only use them for planned ‘cold’ surgery.

And if they allowed us (the NHS) to use all ‘their’ beds all their beds the year round, it would have a significant effect leading to 1-1.5m more ops a year (depending on whether they can do 2 or 3 ops a week). But is unlikely that private providers will allow us to do that again, except in an emergency situation. The do let us use some of the beds at present, which helps.

For the NHS to get the type of capability we need, we need to build 100 (say 2 per Integrated Care Board, ICB*) ‘surgical treatment centres’, with say 100 beds each (4 wards). These would be NHS small hospitals, on or near an NHS site, run like private hospitals – i.e. with a 100% rule that they never ever take emergency patients.

Yes, it would be expensive, say £30m each = £3bn. But this is peanuts compared to the £50bn+ per year we spent in COVID-19, for 2 years. Obviously there would be ongoing staff (200 per centre at £50,000k each) costs (£1bn per year).

But as we all know, there are not the trained staff out there, hence all UK hospitals having unfilled posts. So, we need a huge recruitment drive, e.g. doctors, nurses and AHPs from the Far East and Indian subcontinent. Brexit didn’t help us, as we lost a lot of European staff and few come from Europe any more.

New hospitals?
We do NOT need new large general hospitals. We repeat, we do not need new hospitals. They will make no difference and may make things worse. They will fill up immediately with the confused frail elderly (someone’s Mum) and that will lead to social care backing off more. They would also lead to more operations being cancelled.

How have we got in this mess?
We are not sure. The NHS was hitting its targets from 2005 to 2015, then we hit a ‘Tipping Point’ in 2017 (nothing to do with COVID-19, that just finished us off). Brexit was probably a major factor with both the Tories and Labour taking their eyes off the ball, whilst squabbling about Brexit for years.

For the NHS to work it needs to constantly change, be tweaked, to keep up with population growth, frailty and public expectation (these are the three big drivers of healthcare need).

We all need to pull together and get it back on track. 100 surgical treatment centres will be part of the solution. Let’s get building and recruiting.

Summary

[*Note. An ICB is the new(ish) subregional organisational and funding entity in the NHS in England, that took over from Clinical Commissioning Groups (CCGs) in 2023. There are 42 of them, and about county-sized; each serving approximately 1 million people.]