Across the healthcare system, hospital beds are under increasing pressure. But have you noticed that, since the pandemic, the level of strain seems exceptionally high, perhaps even greater than the rise in demand. Why is that?

• A less visible explanation lies in the long-term trends that have shaped hospital care for decades. Over the past 30 years, hospital beds have been falling slowly, by about 1.4% per year.
• This has been happening despite growth in admissions of around 2.1% per year.
• The reason beds have been able to fall is a huge reduction in average length of stay, from around 8.5 days in 1994 to 2.6 days today.

This ~ 3% annual improvement in length of stay is an incredible feat of medicine. It’s been driven less by policy than by clinical decision making and innovation. But we have a problem. This improvement in length of stay is levelling off, and clinicians are worried it might be reaching its limit. The better we become at helping people recover at home, the patients who remain in hospital are, on average, more seriously ill and more complex. Further reductions in their length of stay become progressively harder to achieve.

At the same time, admissions continue to rise, influenced by population ageing and other factors that we have explored in our wider work on hospital demand, here.

If we are going to avoid expanding the number of beds, the mechanism (if not the delivery) is quite simple - reduce admissions or reduce length of stay. There is one other option, to increase occupancy, but this too has a limit, considering the impact on flow and efficiency, and the need to manage surges and winter pressures.

To help explore these dynamics, we have developed a simple interactive toy model, Do we need more hospital beds?, to help shine a light on these challenging dynamics of history.

The tool allows you to:

• explore historic trends in admissions, length of stay and occupancy,
• test different future assumptions, for the future, and
• see the implications for the number of hospital beds that may be required. .

Have a look for yourself - what do you think is possible? What does that mean for the future? And what does it mean for the plans we make now?

Explore the tool: https://connect.strategyunitwm.nhs.uk/hospital_admissions_tool/

The conclusion is hard to avoid. Dramatic reductions in length of stay have masked the impact of increasing demand over the past 30 years but won’t continue to do so. If hospital capacity cannot be expanded significantly, keeping beds available for those who most need them will require us - urgently - to reduce the growth in the number of people being admitted in the first place.

For many reasons, this is easier said than done. But, through our Intelligence Centre functions for Neighbourhood Health and Strategic Commissioning programmes, we will be supporting systems and partners to rise to this challenge, with data, evidence, and analytical tools to support high quality decisions-making and better planning for the future.