A lot has been written and said about the crisis in hospitals this January. Much of it repeats what was written last January. And yet it shouldn’t have been like this. The Health Secretary and the Prime Minister and various NHS managers continue to insist that planning for the annual ‘winter crisis’ was better than ever. You just wonder how bad things would be if it hadn’t been…
Simon Stevens is nothing if not a clever political operator. By demanding in public that the NHS got an extra £4 billion (knowing full well he wouldn’t get it) he covered his back. If things went tits up, he could blame ministers rather than put the blame where it really ought to lie – at his own door. This was supposed to be a man with a plan. Indeed he did have a plan – a five year plan. He put it to ministers and they accepted every word of it and agreed to fund it down to the last penny. It turned out that Simon Stevens became Oliver Twist and kept asking for ‘more’.
In 1997 Stevens became a special advier to the then Health Secretary Frank Dobson. If ever there was a health secretary in need of advice it was him. He held the same position with Alan Milburn and then in 2001 became health policy adviser to Tony Blair. He was closely associated with the development of the NHS Plan 2000. This plan promised to reverse 30 years of hospital bed cuts, and provide and extra 7,500 hospital beds over the ensuing five years. In actual fact the number of beds fell by 3,000, continuing a seemingly irreversible trend.
It was the Blair government that promoted the theory that people much preferred to be treated in their own homes, and therefore fewer hospital beds were needed. In addition, new technology and faster treatments also meant that whereas in the 1980s someone might need a five day hospital stay, nowadays that might be reduced to one or two, or even none if the treatment could be done in a day. Jacqui Smith (who was a Health Minister at the time) and I spoke about this on this week’s FOR THE MANY PODCAST. She admitted the policy had been a mistake. But it’s a policy which has continued since that time under all shades of government. Small hospitals in rural areas in particular have been hit, with many being closed altogether. The very concept of a convalescent hospital has virtually disappeared.
There has been a perfect storm. Although the number of doctors and nurses has increased, and brand news hospitals have been built (often funded on the never-never) the population has also increased exponentially. This seems to have come as a bit of a surprise to NHS executives. On top of that, instead of the population becoming healthier, we’ve become more obese, prone to be diabetic and more generally more ill, more often. Again, this seems to have taken the NHS by surprise. Demands on mental, as well as physical health have increased hugely in recent years, yet the number of mental health beds has declined sharply. Not only that but non-residential mental healthcare funding hasn’t kept pace with demands in any shape or form. As I say, in short a perfect storm.
So why do politicians still refuse to acknowledge the reality that more beds are needed? One explanation is that the advice from NHS England remains that the policy shouldn’t change. But isn’t it the job of politicians to challenge that advice? Let’s look at the evidence…
Well the trend couldn’t be clearer, could it? Under all governments in the last thirty years the total number of hospital beds has been cut – or slashed depending on your viewpoint. These figures come from the King’s Fund. Click on THIS LINK and you can see the exact numbers by running your mouse over the graph. It’s very telling.
The total number of beds in the NHS has declined by more than half, from around 300,000 in 1987 to around 148,000 now. In 1987 the UK population was 56.8 million. The population now is around 66.2 million. The population has increased by 17%, yet the number of hospital beds has declined by more than 50%. Medical advances have certainly been made, but surely not to that extent.
If we look at the number of General & Acute beds, which is the biggest category, the numbers are startling…
The average decline in beds per year during the Blair/Brown government was 2,909. During the Coalition/Conservative years the figure is 1,098.
The figures for mental health beds are even starker.
The biggest cuts in mental health beds came when Care in the Community was launched. However, it’s continued ever since. In the last thirty years bed numbers have been cut by 72%. Astonishing.
The average decline in mental health beds per year during the Blair/Brown government was 1,315. During the Coalition/Conservative years the figure is 786.
Given that the population has increased and the birthrate has increased from 1.64 to 1.81 per woman between 2000 and 2015 (Source: World Bank) you might expect the number of maternity beds to have stabilised or even increased. But no…
The average decline in maternity beds per year during the Blair/Brown government was 291. During the Coalition/Conservative years the figure is 14. Now let’s be clear, maternity care has changed beyond recognition during this period. More women like to give birth at home, and even those that have their babies in hospital are now often in and out within twenty four hours. Back in 1962 when my mother gave birth to me, she was in a nursing home for two weeks, even though it was an easy birth – albeit I was the longest baby any mother had given birth to in that particular establishment!
The only section in that graph that bucks the trend is the number of day beds. This is to be expected given that medical science has advanced and so many more treatments can now be conducted without the need for an overnight stay.
The average increase in day beds per year during the Blair/Brown government was 413. During the Coalition/Conservative years the figure is 218.
A narrative has grown up that it’s the ‘wicked Tories’ who have cut beds and they’re determined to cut the NHS to the bone. These figures demonstrate that hospitla bed cuts are part of a long term strategy that governments of all colours have implemented. And they’ve done this at the behest of the medical establishment.
And when you compare the number of beds per thousand people in Britain and other countries… well, it doesn’t look good.
Admittedly these figures are from 2010, but it’s almost certain that things haven’t changed an awful lot, comparatively, since then. UPDATE: I’m told the UK figure is now 2.6/1000.
And this leads us on to the real issue here – and that’s social care. NHS professionals and administrators have been very keen to cut bed numbers on the premise that once patients have been discharged it’s up to the social care system to take over – especially with geriatric patients. The trouble is that side of the healthcare equation has been largely ignored despite politicians constantly telling us that it’s a policy which needs solving.
I know from personal experience how elderly people take up beds in hospitals even though they shouldn’t be there. They should be in care homes, but the places just don’t exist. Since 2002 an average of 7,000 new care home beds have opened in the UK every year, but by 2026 there will be an additional 14,000 people needing residential care home places per year. (Source: Radio 4 You & Yours). How will these beds be financed? There’s little doubt, that along with housing provision, social care one of the two biggest social challenges facing government.
Chris Hopson, the publicity hungry head of NHS Providers, said this week that 10-15,000 new hospital beds are needed if we are to avoid the kind of crisis we’re seeing at the moment in hospitals up and down the country. That’s between 60 and 90 per acute trust. Bear in mind that some acute trusts have more than one hospital.
Each hospital bed costs the NHS around £150,000 per year. The annual cost of increasing bed numbers by 15,000 would be around £2.25 billion, plus all the infrastructure and staffing costs.
It’s all very well for Simon Stevens to call for an extra £4 billion of funding. Jeremy Corbyn has called for an extra £6 billion. But what would it be spent on? We all remember the huge amounts of extra money that went into the NHS in the early Blair years, but the overwhelming amount of it went on salaries, not into directly improving healthcare.
If we are going to spend a higher per centage of our national income on the NHS then we surely need to decide our priorities. I would suggest that reversing the decline in hospital beds ought to be fairly near the top of that list.
Three years ago I wrote a book called THE NHS: THINGS THAT NEED TO BE SAID. You can buy it from Amazon HERE