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New BMA analysis shows NHS needs thousands of extra beds to meet pressures this winter

New BMA analysis suggests hospital emergency care departments in England are on course for their worst winter on record and that up to 10,000 additional hospital beds will be needed for patients to be cared for safely1

The analysis also shows that over 300,000 patients could be left waiting on hospital trolleys in emergency care departments for more than four hours before being admitted.

The new figures build on a recent BMA analysis, released earlier this month, of NHS England data from the past seven years. This painted a picture of rising pressure on emergency care departments, with the most recent winter showing record levels of admissions. 200,000 more patients were left stranded on hospital trolleys in emergency care departments than in the same period in 2011 while new lows were registered for other key indicators, such as the four hour wait to be seen on arrival.


By analysing bed occupancy rates and trends from previous winters, the BMA has produced a likely picture for January to March 2019 and predictions on how many beds the NHS in England needs. This analysis suggests:

Bed demand: 10,000 extra beds needed

  • Last winter, bed occupancy in general and acute beds peaked at 96.1% in February 2018, despite guidance from the National Audit Office suggesting occupancy should not exceed 85% to avoid impacting on the quality of care.  NHS Improvement has said that above 92%, the deterioration in emergency care standards begins to accelerate.
  • High bed occupancy leads to issues across all hospital departments and is often a decisive factor in the decision to cancel planned operations (for example last winter, which saw tens of thousands of operations cancelled with little warning). It can also delay patients moving from the emergency department to a ward. On the 20th February 2018, over 5,000 general and acute escalation beds were open in English hospitals. These figures are contained in NHS England’s Winter Data report for winter 2017/18.
  • To even maintain occupancy at this high rate, the NHS had to open between four and five thousand temporary escalation beds from January to March.
  • To bring bed occupancy down to the recommended minimum safe limit of 92%, the NHS in England this winter will need to continue using 5,000 escalation beds opened at the peak of the winter crisis last year and will need an additional 5,000 general and acute beds.
  • Hospitals in busy areas have the greatest need – with London requiring as many as 900 extra beds this winter. Regional figures are included in the briefing papers attached.

Predictions for the winter: Pressure on emergency care

  • Without extra resources, the BMA believes approximately 238,000 patients will spend more than four hours waiting to be admitted to hospital, 12,000 higher than the record from the previous winter; if conditions deteriorate more dramatically, a staggering 305,000 could endure long waits on trolleys. 
  • The percentage of patients seen, admitted or discharged within four hours of visiting an emergency department will reach record lows, with compliance falling to somewhere between 84.3 per cent and 82.5 per cent, down from the previous low of 85 per cent. The Government target is 95%.

Dr Rob Harwood, BMA consultant committee chair, said:

“The NHS is facing an all year crisis that is leaving patients in an intolerable situation. This winter could be the worst on record for frontline emergency care departments, with a BMA analysis suggesting hundreds of thousands of patients will be left either waiting to see a doctor for an assessment or stranded in cramped corridors on a hospital trolley waiting for a hospital bed to become available.

“A key part of this problem is the lack of available beds within the NHS system. Last winter saw incredibly high levels of bed occupancy, well above recommended limits, and despite thousands of escalation beds being put into action temporarily. At this level patients will struggle to get the attention and care they need. The uncertainty being caused by Brexit, especially the future of thousands of EU doctors working in the NHS, is only exacerbating concerns about the level of care the NHS can deliver.

“While there is a commitment for the NHS Ten Year plan funding to come on stream next April, there is a pressing need to tackle shortages in hospital capacity and improve care for patients in the community. The BMA believes that, at the very least, the NHS in England needs 10,000 hospital beds to meet the rising levels of pressure that we are predicting will come to bear on the NHS this winter.

“The Government must address these endemic resource issues that are denying patients the level of care they deserve.”


Notes to Editors

The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

1. The BMA’s paper which lays out the basis for the predictions for this winter and the BMA’s basis for the call for 10,000 more hospital beds can be found here.