Acute Trusts Encouraged to Reduce Bed Occupancy

Acute trusts must reduce bed occupancy, according to orders delivered ahead of the Christmas period.

Trusts have been informed that they must “cease most inpatient elective activity”, in order to free up capacity.

It is hoped that this will help avoid further deterioration in emergency care.

A letter has been issued from NHS Improvement requiring all acute providers to aim to cut their general and acute bed occupancy to 85 per cent over the key Christmas period.


It is thought that this could be a reaction to a Nuffield Trust report which suggests that patient safety is being compromised.

Nuffield Trust chief economist John Appleby had argued that bed occupancy rates of 95% were “linked to higher infection rates and longer waits in A&E”.

“In preparing for managing winter pressures, it is recommended that all providers ‘pace’ their elective work by introducing elective breaks where trusts cease most in patient elective activity and focus on treating emergency activity and non-admitted patients.Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements,” the letter comments.

NHS Providers chief executive, Chris Hopson, commented on the issue, outlining the reasons for this specific guidance.

“This guidance does go further than before – for example in specifying a target bed occupancy level as the holiday period starts – but it’s in line with direction of travel over the last few years, prioritising emergency over elective work for the holiday period. Many trust chief executives tell us they were already planning along these lines but this is a helpful prompt to ensure the work is completed to time and quality”.

Hopson also argued, though, that trusts are being placed in a difficult situation.

“It is, though, another classic illustration of how trusts are now caught between a rock and a hard place. The rock of coping with ever rising emergency demand and the hard place of meeting the referral to treatment elective surgery target and financial control totals where elective income is key. Trusts chief executives tell us it’s increasingly difficult to deliver both”.

Hopson ultimately concluded that the picture for the NHS this winter is rather bleak.

“What’s more, the NHS is going into this winter in an even worse position than it was a year ago, with record deficits, worse performance against the A&E target, far more trolley waits, record delayed discharges from hospital, and fewer people getting the help they need with social care. When you add into that mix the sort of intense pressure on beds we’ve demonstrated hospitals experienced last winter, patients’ care is bound to suffer,” he said.

However, an NHS Improvement spokesman defended the initiative and claimed that the NHS will function successfully over the Christmas period.

”NHS providers will be doing all they can to make sure their patients are able to receive quality care during the busy Christmas period. A reduction of elective hospital activity in the run up to Christmas is standard practice, and well-rehearsed by NHS providers. Many hospital trusts also routinely wind down elective activities in the run up to the Christmas and New Year period, as patients do not wish to be in hospital over the festive period and those who are medically fit for discharge want to return home. This also frees additional capacity”.


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