Key points

  • We review past trends in hospital bed numbers and set out our projections for the number of general and acute beds required in 2030/31 under different assumptions about the time patients spend in hospital.
  • Under our central projections, an additional 23,000 to 39,000 beds would be needed in 2030/31 to deliver 2018/19 rates of care.
  • Policymakers have options available to meet demand but anticipating and planning for the long term is critical to ensure the NHS has the capacity it needs.

Over the past 30 years, hospital bed capacity in England has more than halved, leaving the NHS with one of the lowest rates of hospital beds per person among OECD countries. This reduction was permitted by shifting some services out of hospital (especially mental health) but also by making efficiency gains in hospital settings. Activity levels increased over the same period, enabled by reductions in the average time each patient spends in hospital – specifically, a decrease in the average length of stay and an increase in the proportion of planned admissions delivered as day cases.

Looking forward, the 2030/31 population is expected to be larger, older, and to have higher levels of complex health conditions than the 2018/19 population. This will result in a significant increase in demand for NHS services. To deliver pre-pandemic rates of care for patients in a similar way could therefore require a substantial increase in the number of hospital beds. Under our central projections, in which time spent in hospital continues to fall but at a slowing rate, an additional 23,000 to 39,000 general and acute hospital beds would be required. Even with this scale of increase, the NHS in England would be at or below the average number of hospital beds per person relative to current levels in other OECD countries.

Our projections imply the NHS has four options:

  1. Increase hospital bed supply – provide additional hospital beds that are suitably staffed to meet demand.
  2. Do things faster – continue to reduce the average time each patient spends in hospital.
  3. Do things differently – for instance, by expanding potential substitutes for hospital beds such as expanding virtual wards or nursing home beds.
  4. Do less – either by better meeting patient need, for instance by investing in primary care to reduce unnecessary emergency admissions, or by delivering less of some services, either explicitly by changing thresholds or implicitly by reducing supply.

Some combination of all four may be pursued. But regardless of the approach, anticipating and planning over the long term is critical for ensuring the NHS has the hospital bed capacity it needs to deliver care and build resilience.  

Further reading

Report

Health and social care funding projections 2021

October 2021
Report

The REAL Centre sets out projections of the funding the NHS and social care system in England may...

REAL Centre

Working paper

How many NHS workers will we need over the coming decade?

May 2022
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The latest REAL Centre working paper examines how many full-time equivalent staff the NHS in England...

REAL Centre

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