by Pippa Morris December 14, 2018 4 min read

It is important that when preparing for your medical school interview that you are knowledgeable about the issues facing the National Health Service (NHS). Through our NHS Hot Topic series of blogs, we are aiming to prepare students for all types of interview questions. Our aim is to give you expert interview preparation that will help you secure your place at a UK medical school. We will be discussing issues such as mental health, the junior doctor contract, strains on A&E departments and much more. 

In this blog post, we look at the impact a lack of funding is having on bed occupancy in hospitals. It comes at a time when winter is looming and the pressures on the NHS amount to their seasonal high. The media is only too quick to display images of patients waiting on trolleys in hospital corridors because of the total number of occupied beds, but is this justified? Here we analyse the facts and figures available and the attempts being made to ameliorate the situation.

THE REALITY

Over the past 30 years, the number of beds in NHS hospitals has more than halved, whilst the number of patients being treated has increased dramatically. The UK has fewer acute beds available as a proportion of its population than any other similar health system. As winter looms, bed shortages become much more of an issue. In April, NHS leaders anticipated a shortage of 4,000 beds for the winter. This is despite the announcement of an additional £145million to aid the NHS over the harsh winter. It is thought this extra budget will only be able to provide 900 more beds, and thus there will still be long waiting times and unnecessary deaths. Some claims suggest that the bed shortage could be as high as 15,000 beds, which is over 10% of the total number of beds in the NHS. It is when this is taken into consideration that the sheer magnitude of this NHS topic must be explored. 

A report documenting occupancy during the 2017-18 winter showed that highest occupancy was on 20th February 2018. In order to meet the targets, an additional 4,809 beds were required. If the 85% target that has been calculated were to be met, more than 13,000 extra beds would be needed. In fact, the problem is likely to only get worse. Patient numbers are increasing and bed numbers continue to be slashed following cuts to the healthcare budget. Winter pressures shine a spotlight on this. 

WHAT DOES THIS MEAN?

In order to ensure patients are safely cared for and beds are available during emergencies, the NHS has set bed occupancy targets of 92%. Evidence suggests that it should really be about 85% to avoid increased risk of infection. Either way, neither of these targets are being met. High bed occupancy can result in discordancy across trusts and may lead to the cancellation of operations, posing a risk to patient safety. Doctors and their colleagues feel stressed out by the situation, with one report claiming over 60% feel worse prepared for this winter than before. Stress may result in mistakes, so it is evident something needs to be done.
 
Maybe the targets are unrealistic, or maybe the approach is incorrect. Last winter, only 5 hospital trusts (out of 137) never exceeded the 92% occupancy target. It is frequently the case that the people being moved out of beds are those suffering from learning difficulties or mental difficulties. In addition, there have been significant actions to decrease the length of stay of older patients. Fortunately, there has been an increase in the popularity and usage of care homes, minimising the devastating effect that these bed shortages could have had. Still, these intermediate care centres are reported to only meet half the demand. 

nhs-improvement


WHAT ARE WE GOING TO DO ABOUT THIS?

The general consensus is that healthcare workers need to focus on optimising the beds available. Analysis by the BMA suggests the worst winter ever is about to occur, and thus they are calling for 10,000 extra beds. 

Adding to the bed stock is easier said than done. Even if the funding were available, which it seems the government is unable to provide, other problems arise. Many trusts face staff shortages and space constraints. A freedom of information request by the BMA suggests that although some trusts have planned to increase the number of beds, the increases are modest and will certainly not dent the shocking occupancy statistics mentioned earlier. Certainly, there are other ways to deal with the national bed shortage other than simply purchasing more beds. This includes reducing the length of patient stay, improving patient flow, cutting delayed discharges, reducing unnecessary admissions and preventing admission in the first place, e.g. through the winter flu vaccine.

In addition, we can shift the style of care to community-based approaches. This can be through the admission of patients to intermediate care centres, or through care at the patient's home itself. NHS England and the government need to consider all sides of the issue when formulating a plan. The recommendation is to begin by targeting older patients who stay in the hospital for a prolonged period of time, before moving on to other groups. 

Public health campaigns have certainly attempted to mediate the situation. The BMA is calling for a short-term plan for this Winter focusing on these strategies and encouraging greater transparency into the bed shortages. In the long term, they wish for NHS England to set out a plan to deal with the situation. The hope is that the devastating effect bed shortages can have is reduced in the future. 


We hope that this was a helpful overview of this NHS issue and you feel more confident tackling it if it comes up as a question. Don't hesitate to send us any questions or comments by email at hello@theMSAG.com. Good luck in your interview! 

Pippa Morris
Pippa Morris

Pippa is a third-year medical student at the University of Cambridge. She is a member of the Oncology Society and the vice president of Caius Medical Society. She is also a tutor for science, maths, and medical school entrance exams. She writes blogs and is a BMAT Tutor for theMSAG.


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