NHS England chief brings in new rules on ward bed closures

Denis Campbell Health policy editor
NHS England CEO Simon Stevens, who says a loss of thousands of hospital beds cannot occur until there are alternatives for patients. Photograph: PA

Simon Stevens, the head of NHS England, has acted to make it much more difficult for hospitals to slash their supply of beds, after the dramatic loss of the facilities in recent years was widely blamed for exacerbating the winter crisis.

Stevens is introducing, from April, tough rules for hospitals concerning bed closures. The NHS England chief executive wants to ensure that patient care does not suffer due to loss of beds.

His move comes after heavy criticism of the NHS for allowing the number of hospital beds in England to fall by 20% over the last 10 years at a time of growing demand for inpatient care. About 15,000 beds disappeared between 2010-11 and 2016-17, official NHS figures show.

Stevens stressed that his edict would not mean a complete moratorium on hospitals shrinking their tally of beds, but there was a need for tough criteria given the increasingly large number of beds being used by patients who could not be discharged yet were medically fit to leave.

Speaking, on Friday, at the Nuffield Trust’s health policy summit, Stevens will say: “More older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places. So there can no longer be an automatic assumption that it’s OK to slash many thousands of extra hospital beds, unless and until there really are better alternatives in place for patients.”

NHS trusts in England planning to cease provision of a particular service already have to pass four tests before doing so, including showing that local GPs back their move and that the public has had a say.

Stevens’ intervention, in effect, creates a new fifth test that will have to be passed by NHS bosses planning bed closures. They will get the go-ahead only if they can prove that NHS care in the local area outside the hospital can ensure patients will receive good care; permission could also be given if it can be shown that a new medical treatment for patients with a particular condition means beds can be safely deleted. Hospitals which are inefficient in their use of hospital beds will get the green light if they improve their performance to show that losing beds will not affect patients.

It is unclear what the impact of the new rules will have on the sustainability and transformation plans (STPs) developed recently by NHS chiefs in 44 areas of England. Many of the plans envisage a further loss of hospital beds by 2020-21 in efforts to help the NHS save £22bn. Also, the conditions will only apply to “significant bed closures”, which may not stop hospitals gradually reducing their numbers gradually, a few at a time.

Jane Dacre, president of the Royal College of Physicians, welcomed Stevens’ plan as a step in the right direction. “However, the RCP would urge STPs to reduce the potential impact on patient care and have extra capacity in place before any bed closures occur,” she said.

Jonathan Ashworth, the shadow health secretary, said: “The number of hospital beds across the country is actually now forecast to drop again under the government’s STP proposals, with no convincing evidence that the necessary community care will be put in place to replace them. It’s not obvious therefore how health ministers will meet these new tests on bed closures Mr Stevens is setting.”


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