Research carried out by the Health Foundation’s REAL Centre finds that the next decade will see increases in demand for services from rising levels of chronic disease and a rapidly ageing population – putting pressure on hospital services that are already stretched with bed occupancy rates of close to 90%.
The analysis finds that even if the NHS continues to reduce the length of time people stay in hospital, 23,000 to 39,000 extra beds could be needed in 2030/31 to maintain pre-pandemic standards of care – a 20–35% increase. The Health Foundation indicates that the build cost could be between £17bn and £29bn, but cautions that this depends on a range of factors, with recent rises in inflation significantly increasing construction costs.
Over this decade, more hospital capacity will almost certainly be required to meet people’s health needs. The NHS has fewer beds per 100,000 population and shorter hospital stays compared to other health systems in comparable countries. While this is a sign of efficiency, increasing demand is now causing critical pressures in hospitals.
But more beds are only part of the answer, and policymakers have choices about how to best meet demand for care: investments outside of hospital, particularly primary care and adult social care, are also needed to improve people’s health and reduce avoidable demand for hospital care.
There is no avoiding the need to expand health system capacity to meet people's health needs in future, the Health Foundation argues.
Anita Charlesworth, Director of Research and the REAL Centre at the Health Foundation, said: "Our projections show meeting the future demand for hospital care could require a far larger increase in bed supply than we would expect under the government’s current hospital plan, and significant additional funding for the DHSC capital budget.
"At the moment, there is no national assessment of the amount of capacity the NHS needs. Hospitals are full, and long waits for ambulances and A&E are a reflection of the pressures on hospital capacity. How quickly patients can safely be discharged plays a major role in the number of extra beds the NHS will need.
"The pressures hospitals face are linked to a lack of capacity in social and community care, making it hard to discharge patients. Policymakers need to look at capacity in the round, inside and outside of hospital, and set out a realistic plan for how the NHS will meet rising demand over the long-term. But whatever choices are made to meet rising demand, doing nothing isn’t an option."
Responding to Health Foundation analysis suggesting the NHS may need up to 39,000 more beds by 2030, the director of policy and strategy and interim deputy chief executive of NHS Providers, Miriam Deakin, said: "It is a real wake-up call to hear that the NHS could need an extra 39,000 beds just to stand still, but the Health Foundation's analysis based on pre-pandemic figures underlines what trust leaders have been saying for far too long.
"The data shows an efficient health service and reflects efforts in recent years to reduce length of stay in hospital and to offer more support to patients in community settings and at home. However, we have fewer beds per head of population compared to other countries – just one bed for every 500 people in England according to this report, one of the lowest rates among OECD nations.
"Given continuously high levels of demand on NHS services, the need to boost capacity right across the health and care system is urgent. Funding and capital investment have not kept pace with rising demand over the last 10 years. It is important to remember that when we talk about more beds that also means more staff to provide the care people need. We have more than 100,000 vacancies in the NHS currently, the number one concern for trust leaders.
"Bed occupancy in the NHS tends to run 'hotter' than in other comparable countries. Right now the level of occupied hospital beds is very high as we see more people admitted with COVID-19. This has a serious knock-on effect on other parts of the NHS including mental health and ambulance services. Strains on social care mean that hospital patients can't be discharged as soon as they could be to recover closer to home. The NHS was already under severe pressure, and the current heatwave is only compounding the pressure-cooker environment for overstretched staff and services as they work flat out to bring down waiting lists and to look after patients as quickly as they can."