How many hospital beds will the NHS need over the coming decade? Projections: General and acute hospital beds in England (2018–2030)

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.