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Thousands of ‘escalation’ beds needed year-round

The Doctor
Issue 11

BMA research shows hospitals in England are regularly using thousands of ‘escalation’ beds – normally designed for emergencies or spikes in demand – as they struggle to cope with soaring activity and stagnating resources

Standing in front of the heavyweights of NHS management last month, NHS England chief executive Simon Stevens performed a policy U-turn of staggering proportions. 

Hospital beds have become ‘overly pressurised’, Mr Stevens told the room full of surprised observers at the annual NHS Confed conference. After years of bed cuts, talk of transformation and aggressive rhetoric around shrinking secondary care and finding vast financial savings, local areas should abandon ‘expectation of reductions’ while planning bed numbers for the next five years. 

As if this weren’t enough, in many areas the NHS would need ‘more bed capacity to deal with demand’, Mr Stevens added – admitting his new approach represented ‘quite a significant gear-shift’.

The audience may have been taken aback, but a recent investigation by the BMA shows why they should not have been. The bed crisis in the country’s hospitals is becoming a year-round crisis and can simply no longer be ignored. If Mr Stevens has finally taken note at least it’s better late than never.


Elective procedures cancelled

The BMA’s research reveals that beds for patients who have left operating theatres are being commandeered as escalation beds – often leading to cancelled operations for elective surgery and delays for emergency surgery, with no facilities left for post-op recovery. Patients have also been put on beds in other hospital facilities despite a lack of room in those areas. 

The figures show that 3,428 escalation beds, those often mothballed, kept in reserve or squeezed into other clinical areas, were in operation across England on 3 March. By 1 May, well clear of winter, the 80 out of 134 acute trusts which responded to the BMA reported that 1,637 were still in use.

BMA consultants committee chair Rob Harwood says: ‘The use of escalation beds is a sign that trusts are at a critical stage and are unable to cope with demand with their current bed stock. This has a direct impact on patient care in numerous ways.

‘Some hospitals are forced to designate their theatre recovery beds as “escalation”, resulting in elective surgical operations being cancelled as there is no space for those patients who need immediate care after their surgery.

‘I have heard of other cases where beds in day-procedure units are used as escalation spaces for admitting patients for longer ward-style care, meaning healthcare staff cannot continue with routine day-care surgical cases. 

‘Most worryingly, the intense pressure on beds can result in patients being placed on beds in corridors or in bits of other facilities, sometimes cramping treatment areas and causing unacceptable stress to the patient and their families. It is obvious in these circumstances that there are also not enough staff to cope with the number of people coming through the hospital’s doors.’

Pressure all year round

The use of escalation beds varies significantly across the country, according to the research, with the East Midlands – and particularly hospital trusts in Nottingham and Leicester – having the highest number of escalation beds in use.

A Leicester consultant, who wished to remain anonymous, tells us the winter bed crisis has ‘slowly and inexorably lengthened over recent years’, leading to ‘bed availability issues… almost daily even in June’, affecting patients waiting for operations.

‘Every effort is made to release beds, but I feel the underlying issue is too few beds to cope with the emergency flow, which in turn then blocks elective surgical work,’ he says. ‘Theatre delays occur even more frequently because of bed availability issues generally.’

The total number of beds in the NHS in England fell by 10 per cent between 2010 and 2019, from 144,455 to 129,992, despite constant warnings from the BMA that reductions would increase pressure caused by demographic change among the population.

At this year’s BMA annual representative meeting, BMA council chair Chaand Nagpaul questioned the Government’s financial support of the NHS, which has led to bed cuts being deemed necessary by hospital trusts and clinical commissioning groups.

‘The new money in England’s Long-Term Plan – while a welcome departure from austerity – just isn’t enough,’ he said. ‘Even with this money, we’ll continue to lag behind our European neighbours. Why does our Government still decide that our patients don’t deserve the same funding as patients in France or Germany?’

Given the parlous state of NHS trust finances – acute providers posted a deficit of £571m last financial year – Mr Stevens’ U-turn is likely to remain little more than rhetoric unless it is echoed by a change of heart in the Treasury and Number 10, with proper funding for increased beds and accompanying workforce planning put in place. Doctors and patients alike will be hoping it is another case of better late than never.

Read more: Overspill beds in use for routine care

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