“The NHS is not crowded – on average, there are around 20,000 of its beds available. Of course this goes up and down, but the NHS has practice and experience in managing peaks in demand.”
Jeremy Hunt, health secretary, 3 December 2012
For the last few years, around this time of year, Dr Foster has been publishing a hospital guide.
Dr Foster isn’t a real doctor. It’s a private company set up by two journalists which crunches NHS data and produces a number of reports into the state of the NHS. It’s part-owned by the government.
This year, the Dr Foster Hospital Guide 2012 highlighted that “occupancy rates at some hospitals can reach 100 per cent…the average mid-week occupancy in the NHS is 88 per cent…for most of the year most NHS hospitals are experiencing occupancy rates above 90%”.
That led to numerous headlines that nearly all hospital beds were full, and a counter-claim from Mr Hunt that “the NHS is not crowded – on average, there are around 20,000 of its beds available”.
So who’s right?
Both Dr Foster and the Department of Health use figures from the NHS to make their claims.
The Department of Health told us that it considers 85 per cent occupancy to be a “healthy level”.
Figures for the number and occupancy of beds from 2010-11 onwards show that on average, from the first quarter 2010/11 to the second quarter of 2012/13, overnight occupancy rates hovered around the 85 per cent mark, from 84.3 per cent at its lowest to 86.9 per cent.
For general and acute beds over the same period, the lowest overnight occupancy rate was 85.3 per cent, and the highest 89 per cent.
It’s also clear that Mr Hunt isn’t that far wrong either, with his average total figures (click on the image below to see a readable version).
On average, they show, there are around 20,000 spare beds – in the first quarter of 2010/11, there were 144,455 beds in total, 122,551 of which were occupied – ie 21,904 free beds. In the second quarter of 2012/13, there were 20,015 beds unoccupied.
But it’s more detailed data from the NHS Information Centre which shows how Dr Foster is able to make the claims it makes.
That shows that occupancy rates vary by a considerable margin nationwide. If you needed a bed from the Imperial College Healthcare NHS Trust in 2011/12, they had occupancy rates of 62.7 per cent, but if you were in need of a hospital bed from Aintree University Hospital NHS Trust over the same period, occupancy rates were 96.9 per cent.
That’s of the trusts which had the data available – some didn’t submit any data, namely Rotherham, Sheffield Teaching Hospitals and Kings College Hospital NHS Foundation trusts.
Dr Foster’s report said that “when occupancy rates rise above 85 per cent it can start to affect the quality of care provided to patients and the orderly running of the hospital”.
It then goes on to quote Michelle Mitchell, charity director general of Age UK, who said: “the chances of older people receiving high quality care are often stacked against them…left with nowhere else to go, older people frequently arrive at hospital, not necessarily inappropriately, but often avoidably.”
Indeed, the figures show that geriatric wards have been consistently over-occupied, according to the Department of Health’s “healthy level” benchmark – their occupancy rates have been above 90 per cent from 2000 to 2010.
After that, the specialities are changed and geriatric beds are included as part of general and acute medicine.
Mr Hunt is right when he says that on average, there are around 20,000 beds within the NHS which are not occupied.
But for elderly patients, the NHS is “overcrowded”. They have fewer spare beds than anyone else in the population.
Clearly, residence also affects the chances of a patient getting a bed. It wouldn’t matter to a young patient in Aintree as to whether there are spare beds 200 miles away.
Dr Foster’s conclusion is that the problem has been exacerbated by the decline in the number of beds overall in the NHS. The NHS’s own figures show this to be the case – in 1995 to 96, there were 206,136 beds across England, but by 2009-10, there were 158,461.
The company says that as the elderly population grows, problems with occupancy are only likely to get worse.
We asked the Department for Health to comment on the figures. We were told that the department agrees with the need for better community care which would take care of elderly patients who don’t need to be in hospital beds.
“We agree that by community and social care services working better with hospitals, patients can leave hospital more quickly and return home with the support that they need – or even avoid going into hospital altogether,” Mr Hunt said.
By Fariha Karim