13 September 2018

Jessica Morris

Research Analyst
Nuffield Trust

A health system that is working close to or at full capacity is a strong indicator of a system that is under significant pressure. Health system capacity planning is vital as demand for services varies hour-to-hour, day-to-day, week-to-week and year-to-year. Demand for NHS services has been increasing as our population is ageing and a growing number of people are living with multiple long-term conditions. Will the new NHS 10-year plan ensure that there is sufficient capacity available to meet the anticipated growth in demand?

One of the most direct measures of hospital capacity is the percentage of beds that are occupied. Spare bed capacity can be hindered by large numbers of delayed transfer of care patients, which are also an indicator of disrupted patient flow through the system. In particular, high bed occupancy rates in general and acute specialties can lead to increased delays in emergency departments, which in turn can result in ambulance handover delays. The consequences of poor capacity planning are severe, as elective operations can be cancelled to free up beds, equipment and staff for emergency care. Trolley-waits increase, where a decision has been made to admit a patient attending an A&E department and they must wait for admission onto a hospital ward. Also, more out of area placements in acute mental health inpatient services can occur, where patients are treated in an area which is far away from their family, friends and carers.

This month we updated some of our key NHS system capacity indicators. Please find a summary below and click on the links for more QualityWatch content and analysis.

Hospital bed occupancy NEW

  • Between Q1 2010/11 and Q1 2018/19, the total number of NHS hospital beds (including general & acute, mental health, maternity and learning disability beds) decreased by 11%, from 144,455 to 128,448.
  • The total bed occupancy rate increased from 85% in Q1 2010/11 to 88% in Q1 2018/19.
  • General and acute hospital bed occupancy reached a peak of 93% in January to March (Q4) 2017/18.
  • The number of overnight NHS hospital beds has decreased over time in all bed types. Between Q1 2010/11 and Q1 2018/19, the number of general and acute beds decreased by 8%, mental health beds decreased by 22%, maternity beds decreased by 2% and learning disabilities beds decreased by 58%.
  • In contrast, the number of day only beds increased from 11,783 in Q1 2010/11 to 12,480 in Q1 2018/19 (a 6% increase).

Delayed transfers of care

  • The average number of patients that were delayed per day fluctuated at around 3,800 between 2010 and 2013. After this, the number increased rapidly to reach a peak of 6,660 patients that were delayed on average per day in February 2017. Since then the number has decreased, falling to an average of 4,516 patients delayed per day in July 2018.
  • In July, two thirds of delayed transfer of care patients were receiving acute care and one-third were receiving non-acute care.
  • The NHS is responsible for the majority of delayed transfers of care. In July 2018, the NHS was responsible for 62% of patients delayed, social care was responsible for 30% of patients delayed, and both the NHS and social care were responsible for 8% of patients delayed.
  • Since July 2016, the most common reason behind delayed transfers of care is people awaiting a care package in their own home.

Ambulance handover delays NEW

  • Since 2010-11, there has generally been an upward trend in the number of ambulances experiencing a handover delay of over 30 minutes during the winter period.
  • There was a peak of 16,690 ambulances delayed by over 30 minutes in week 1 of 2018. By week 9 of 2018 (most recent data), this had fallen to 11,499 ambulances delayed, although this is still 58% higher than in week 9 of 2015 and over 2 ½ times higher than in week 9 of 2014.

Cancelled operations

  • The number of elective operations that were cancelled at the last minute for non-clinical reasons has increased over the last seven years. There were 12,780 cancelled operations in Q1 2011/12 compared to 18,806 in Q1 2018/19 – a 47% increase.
  • The number of patients who were not operated on within 28 days of cancellation has gradually increased since 2014. In Q4 2017/18, 2,948 patients were not operated on within 28 days of cancellation - an 85% increase on the previous quarter. By Q1 2018/19 the number had decreased slightly to 2,022 patients.

Out of area placements NEW

  • At the end of June 2018, there were 680 active out of area placements in mental health services of which 95% (645) were deemed ‘inappropriate’. Inappropriate out of area placements are where patients are sent out of area because no bed is available for them locally.
  • It is estimated that inappropriate out of area placements make up around 4% of occupied mental health beds.
  • Between February and June 2018, the number of inappropriate out of area placements that travelled a distance of 300km or greater increased from 35 to 50.


The nhs has been failed by successive government’s throughout my 40+ years. 1. The Griffiths report of 1983 has been a catastrophic failure. We now have an executive structure with no serious accountability and is out of control. It increasingly relies on ‘The Big Four’ at taxpayers expense with no measures of outcome rather than use the knowledge of those who work in clinical care. Doctors who become full time managers or want to survive in the financially incentivised culture, have to tow the corporate line. They are not a healthy interface between the executive and the clinical body. Healthy debate is stifled by corporate bullying which the likes of the CQC turn a blind eye to if their staged visits with months of planning cover over the cracks. Even in the rare instance failure is identified the individuals are recycled to reappear at another hospital or government department. 2. PFI and the deception surrounding it, radically reduced bed numbers (excluding the debt mountain) without planning based on flawed mathematical modelling (the all important tool of management consultants), especially around length of stay. This when common sense showed an increasing population, in age and number, with increasing numbers and complexities of treatments available. 3. The inevitable political reorganisations and misuse of the concept of privatisation as a political vote winner is depriving the nhs of a valuable resource. If this demonised concept was rebranded as the independent sector working in harmony with the the Nhs to provide at least some of the under capacity, whilst the capacity problems that are intrinsic in the system are resolved. 4. Throwing more money at the nhs (as every political party does), because of its sacred status, is fundamentally flawed as it is like pouring water into a leaking vessel. The government could put in another £50billion and a year, it would all get used and in many instances wasted due to lack of an accountable structure. 5. Until there is political honesty with the electorate (that we all have to pay more, and/or treatments are rationed), the executive culture is truly accountable and staff do not live in fear of reprisal for speaking out, the downward spiral will continue. 6. Regrettably in my opinion doctors and nurses are let down by their heavily politicised and unaccountable regulatory bodies (GMC/NMC) as well. There is no better example of the GMC being an out of control culture than the shameful Bawa - Garba case. This only reinforces the culture of bullying in the nhs and why recruitment and retention are at an all time low. There is a total failure to understand the fundamental principle that the better you treat and support people the more you get out of them. The entire system is a culture which allows bullying and corporate bullies to thrive and survive. The nhs is no longer a happy safe place to work.
Lee Taylor (not verified)
(changed )

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