Pressures on the NHS are a real threat to patient safety-Report

Patient safety at risk

Five entire hospitals’-worth of extra beds had to be opened every day last winter 

Pressure on beds in the NHS in England has become so acute that on any given day last winter, the equivalent of more than five extra hospitals’-worth of beds had to be brought into service to cope with surges in demand.  On the single busiest day last winter, an extra 4,390 beds had to be opened, equivalent to more than seven extra hospitals in one day.  And on average, over 95% of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy rates exceed 85%-90%, there is an increasing risk of infection (see note 1).  Given that pressures on the health service have not lessened over the last 12 months, Trusts will face similarly high bed occupancy rates this winter.

These are the findings of a new analysis by the Nuffield Trust health think tank (see note 2), the first of a new short series of briefings from the Trust examining the extra pressures on the NHS in winter (attached – see note 3).  Last week NHS England published the first of its weekly statistical bulletins for the current winter (see note 4), with the second week’s figures expected later today.

The report explains that high bed occupancy rates are a real problem for both patients and staff in the NHS:

·         Firstly, as occupancy levels rise, it gets harder and harder to find beds for emergency patients who need to be admitted from A&E – affecting a hospital’s ability to meet the standard that 95% of patients attending A&E should be treated, admitted or discharged within four hours. 

·         Secondly, high rates of occupancy lead to problems in maintaining cleanliness and infection control. 

·         Thirdly, high levels of bed use can make patients’ experience of hospital unpleasant and disruptive, as patients are moved around to accommodate others, or placed on inappropriate wards (elderly patients on obstetrics wards, for example) when there are no free beds on the right ward for them. 

·         Finally, hospitals need some slack in the system to be able to deal quickly and efficiently with outbreaks such as flu and norovirus, where numbers affected can rise very quickly. 

The report finds that:

·         The average number of extra beds brought into service on any given day last winter was 3,466, equivalent to at least five and half extra hospitals’-worth of beds (see note 5).

·         On the single busiest day last winter, Tuesday 26th January 2016, the number of extra beds hospitals had to make available to accommodate patients reached its highest level, when 4,390 extra beds were opened – equivalent to bringing onstream an extra seven entire hospitals on that one day.

·         The previous day, Monday 25th January, one in seven Trusts reported that all their acute beds were full, and nearly four out of 10 had bed occupancy levels of over 98%.  This was after opening nearly 4,200 extra beds that day.

·         Throughout that week, nine Trusts (see note 6) were all full every day with 100% of their acute beds – including extra escalation beds brought in temporarily – occupied.

·         The following Monday, 1st February, 72% of all Trusts recorded bed occupancy levels exceeding 95%.

·         On average across the whole of last winter, around 95% of the almost 100,000 available beds in England were occupied, even with all the extra escalation beds pressed into service.

The research analyses bed availability and occupancy numbers for each Trust from the daily situation reports (‘sit reps’) NHS England published last winter, as they have each winter since 2010/11.  These sit reps cover every weekday from Monday to Thursday during the period 1st December to the last day of February, with a combined figure for the period from Friday to Sunday each week.  The data provides figures for the number of core beds available each day (the number of beds a Trust has available under normal circumstances), the number of escalation beds available (the additional beds each Trust has to bring into service to cope with extra patients), and the number of beds occupied by patients. From these figures, we calculated the proportion of total occupied beds (the ‘bed occupancy rate’) each day last winter at each Trust, and the average for England as a whole on each day.

Commenting on the findings, Professor John Appleby, Chief Economist at the Nuffield Trust said:

“Our analysis shows just how acute the pressure on beds was last winter, with around 95% of the beds in all hospitals in England occupied every day.  With such high levels of bed occupancy linked to higher infection rates and longer waits in A&E, these pressures pose a real threat to the smooth running of hospitals and, ultimately, to patient safety.

“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”.


Notes for your reference reader.

1              See for example (  In  addition, a review of studies examining the association between high bed occupancy rates and increased rates of infection cited by our recent annual statement on care quality in the NHS also found evidence of a link (

2              The Nuffield Trust is an independent charityWe aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.

3              Nuffield Winter Insight is a new short series of briefings from the Trust examining the numbers behind the extra pressures on the health service in during the winter months.  Today’s report on bed occupancy is the first in the series.

4              The data for week 1 of the Winter Sit Reps was incomplete, and under-recorded the number of total beds occupied relative to the number of available beds – so any figure for average bed occupancy across England in week 1 will not be reliable. 

5              Based on an average number of 634 core beds in a Trust in England.  However, some Trusts comprise more than one hospital, so the figure for the number of extra beds as expressed as numbers of whole hospitals is necessarily an under-estimate – hence our wording ‘at least five and a half extra hospitals’-worth’.  (We have not been able to calculate a figure for the average number of core beds in a hospital, as opposed to a Trust). 

6              University Hospitals Birmingham NHS Foundation Trust, Bolton NHS Foundation Trust, Northampton General Hospital NHS Trust, North Middlesex University Hospital NHS Trust,  Isle of Wight NHS Trust, Great Western Hospitals NHS Foundation Trust in Swindon, Basildon and Thurrock University Hospitals NHS Foundation Trust, Kettering General Hospital NHS Trust and Epsom and St Helier University Hospitals NHS Trust


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