Long term trends in NHS inpatient bed provision in England, 1960–2020

Objectives

To examine the reduction in NHS inpatient hospital beds in England from 1960 until 2020, including five categories: Acute, Geriatric, Maternity, Mental Illness and Learning Disability beds; and to measure regional differences at the end of the study period.

Design

Retrospective observational study.

Setting

NHS in England.

Participants

Inpatient hospital beds.

Main outcome measures

NHS inpatient bed provision per 100,000 population. Rate of reduction calculated as percentage change each year. NHS bed provision in 7 regions of England compared for the year 2019/20.

Results

NHS inpatient bed provision declined for sixty consecutive years. The overall reduction was 78.0% between 1960 and 2020. Greatest reduction was in Learning Disability beds (98.7%), followed by Mental Illness (90.6%), Geriatric (75.0%), Maternity (67.4%) and the least reduction in Acute beds (63.0%). There were two periods of accelerating rates of bed reduction, the first in the 1980s, and the second in the 2000s. At the end of the study period there was significant regional variation in bed numbers.

Conclusions

Bed reductions were a constant feature, with important differences between bed categories and across time. This needs to be addressed when planning for future pandemics and winter bed pressures. By the end of the study the NHS was no longer providing the same level of inpatient care in different regions of England, particularly for Learning Disability.