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National Health Service: Hospital Beds

Volume 754: debated on Wednesday 11 June 2014


Asked by

To ask Her Majesty’s Government what is their response to the Organisation for Economic Co-operation and Development’s report on the number of hospital beds per person in the United Kingdom in comparison to Europe.

My Lords, numbers of hospital beds per person do not provide meaningful comparisons of good-quality care. Our NHS is making efficient use of its beds by judging patient demand and managing bed numbers accordingly. In the NHS, as in Europe, the number of beds has reduced because progress in medical technology is enabling more patients to be treated and discharged on the same day, and average length of hospital stay has reduced over the past decade.

My Lords, France has twice the number of beds we have here in the UK while Germany, I think, has nearly three times as many. We are now seeing dangerous levels of overcrowding, with greater risk of infection due to beds not being cleaned properly in time. Does the Minister not see that this is very reminiscent of the previous time his party was in office and that the NHS is just not safe in their hands?

No, in a word. First of all, it is very important to compare like with like. A number of other health systems have completely different models from our own. For example, they still have large, long-stay hospitals for people with mental health problems and older people. The NHS has a strong primary care tradition and is committed to providing care in the community. Some of the statistics that have been collated by the OECD include systems in Europe where nursing home beds are included in the figures or indeed the private sector. We are seeing healthcare infections at their lowest ever levels. There have been dramatic falls in both MRSA and C. diff infections since 2010.

Would my noble friend like to ask the noble Lord, Lord Kennedy of Southwark, how funding is undertaken in Germany? German hospitals are funded on the basis of length of stay. In this country, we have demonstrated that we can get patients home much more quickly, particularly after surgery, with the use of day case surgery. Furthermore, Sweden has fewer beds than we do.

My noble friend makes the case very eloquently that it is very difficult to compare different health systems. We should pay credit to the NHS for performing very efficiently and effectively in the face of rising demand over recent years.

My Lords, is there any linkage between hospital-acquired infections and the reduction in the number of beds?

My Lords, no. By comparing the OECD bed-provision data and the 2011 joint prevalence survey, the available European data indicate that bed provision and healthcare-associated infection rates across countries are not correlated. Indeed, as I have said, we have seen a dramatic fall in the number of healthcare-associated infections in hospitals, combined with a rising level of demand for in-patient beds.

My Lords, the noble Lord, Lord Kennedy, mentioned France. In France, most patients who have had a hip replacement spend a month in a convalescent hospital having in-house physiotherapy, whereas of course in the UK most people return home. I wonder whether my noble friend can tell us whether there are data to show how medical technology has improved both hospital care and community care, so that we can confirm the OECD report’s phrasing that the reduction in the number of hospital beds,

“has been driven … by progress in medical technology”.

Quite a bit of the technology has enabled day case rates to rise dramatically. Day cases now account for 80% of all in-patient episodes. For example, comparative data suggest that our rates for day case cataract surgery are among the highest at nearly 98%.

My Lords, is the noble Earl aware that we have one of the highest rates of bed occupancy in the EU, approaching 90%, and yet we have the lowest average length of stay? All this makes it extremely difficult to think about reducing bed numbers still further.

In fact, average annual bed occupancy rates have been stable at around 84% to 87% since 2000. Of course, that rate goes up and down. We know that winter sees greater pressure on bed occupancy, but the NHS has long experience in managing peaks in demand, particularly over the winter. We do not set optimum bed occupancy requirements on the NHS. As the noble Lord knows well, that is a matter for the local NHS to manage.

My Lords, does my noble friend recall that the previous Government did not run their NHS policy on the basis of the number of beds in the NHS, and rightly so? Will he continue robustly to reject the arguments of those who, using beds as a criterion, are so out of date with modern medicine delivery?

My noble friend has encapsulated the point very well. One cannot correlate bed numbers as a stark statistic with the quality of care that a health system delivers. Our system is dependent not just on acute settings but on care in the community, and that is where the focus should rightly lie at the moment.

Then can we look at outcomes rather than beds as far as the OECD figures are concerned? For the United Kingdom, I will take just three factors: infant mortality, cancer survival rates and obesity. We are beyond the 20 best performers in terms of outcomes—20 OECD countries do better than us. Why are we operating so poorly compared with these other countries?

There are a number of issues there. The noble Lord is right to raise obesity, in particular, where only one solution is available to us, which is a public health policy which embraces all parts of the system and, indeed, individuals. The issues that he raises are too complex for me to encapsulate in a short answer but I will be happy to write to him about what we are doing in all three areas. He is of course absolutely right to raise them as very important issues for the health service.