North West hospitals relying on 'emergency' beds to meet demand

Empty hospital beds Image copyright Thinkstock

Many hospitals are now looking after patients in temporary beds traditionally reserved for emergency and winter use, the BBC has found.

So-called "escalation beds" are being used after many years of cuts in the number of regular "overnight beds".

Royal College of Emergency Medicine vice-president Chris Moulton said "it's almost become a national disgrace".

An NHS spokesman said that while community-based care was often a better solution, capacity would be examined.

Escalation beds top up permanent overnight levels and are only intended to provide extra capacity for limited periods.

But data returned following a Freedom of Information request submitted by the BBC revealed that hospitals in Greater Manchester, Cheshire, Merseyside, Lancashire, and South Cumbria had a combined total of between 196 and 205 escalation beds open for use on 28 June.

Use of 'emergency' beds in North West hospitals

Escalation beds open for use on 28 June 2019 compared with total beds in use

TrustEscalation bedsTotal beds occupied
Pennine Acute Hospitals23 - 32949
Wrightington, Wigan & Leigh19434
Aintree Uni. Hospital22819
Countess of Chester17472
Royal Liverpool & Broadgreen24727
St Helens & Knowsley Hospitals21631
Warrington & Halton3411
Wirral Uni. Teaching Hospital3736
Blackpool Teaching Hospitals24621
East Lancashire Hospitals24949
Lancashire Teaching Hospitals6836
Uni. Hospitals of Morecambe Bay9546
Source: Freedom of Information requests

Data from three other sample dates - 1 April, 1 May, and 1 June - was also requested from the same NHS trusts.

In total there were 349 to 358 escalation beds open in the region on 1 April, rising to 358 to 367 a month later.

The number dipped to 292 to 301 on 1 June and fell further by 28 June to 196 to 205.

The figures reflect the national picture suggested in June by British Medical Association (BMA) research, namely that nearly all hospital trusts were having to continue to use escalation beds well into spring, and that they were being used at similar levels in May as in the height of winter.

Why the decline in regular beds?

According to the The Kings Fund health charity, a shift in national policy towards providing care outside hospital has seen the number of beds in England drop by 50% in the last 30 years.

BBC analysis of government figures showed that the North West has lost nearly 1,400 overnight beds since 2000.

More recently there has been growing concern that the cuts may have gone too far as the NHS struggles to cope with the demands of an aging population.

In June, head of NHS England Simon Stevens said there should be no more cuts to acute beds because of year-round pressures on hospitals.

Image caption Dr Chris Moulton is vice-president of the Royal College of Emergency Medicine

Dr Moulton told the BBC his organisation had been campaigning for thousands of extra beds, as had the BMA.

He said: "It's bad for patients, bad for staff, and really it's almost become a national disgrace."

The BMA said "core bed stock" needed to grow by at least 3,000 to reach a level that can cope with year-round demand, reserving escalation beds for responses to peaks in demand.

When is a bed not a bed?

When they are not used for overflow purposes, escalation beds are used for routine day care, assessments, or post-operative recovery.

But when the beds are reallocated due to increased demand, planned operations are often cancelled at the last minute, leading to longer waits for patients awaiting elective surgery like hip and knee replacements.

At Whiston Hospital in Knowsley, bosses have been been converting rooms originally intended for other purposes like offices on ward floors into bed space.

Image caption Rob Cooper, Director of Operations at Whiston Hospital, says there's 'nowhere left to escalate to'

While stressing that his trust had managed to keep waiting times down, operations director Rob Cooper said: "We're at a stage now in the trust where we wouldn't be able to take any more escalation beds. There's nowhere to escalate to.

"Essentially, our pressure has not reduced after winter. That pressure has continued."

The hospital is running a number of schemes to ease the situation, including "home for lunch", which makes sure support packages are in place for older people to leave the wards at an appropriate time.

This both allows existing patients to go home earlier, and frees up the bed for others.

Mr Cooper said the ultimate solution had to lie in greater resources for primary care (like GPs) and social services.

"Those patients that shouldn't be in hospital - they need that care elsewhere. They need the capacity out in the community to manage that."

An NHS spokesman said: "The NHS Long Term Plan sets out a series of measures to keep more people well with the care they need in the community, but local areas are also looking at how many beds they will need to help them deliver the improvements in care we want to see.

"Where they identify a case for more beds we will support them in seeking the capital investment to deliver this."


By Gill Dummigan, Health Correspondent, BBC North West

For a long time, the push in the NHS has been to reduce the number of overnight beds. It's widely acknowledged that long stays in hospital should be avoided if possible. Elderly people in particular are vulnerable to muscle waste and to infection - and the loss of independence may never be regained.

In addition, there's an increasing emphasis on improving community support for older and vulnerable people, and a drive to have more people treated earlier by their GP or a practice nurse.

Add to that advances in medical care which mean that recovery time from surgery is often much quicker than before, and it seems logical that fewer beds will be needed.

But that doesn't take into account the steady increase in the number of older people with complex medical conditions.

In general, life expectancy has risen year on year but healthy life expectancy - the age before people need extensive medical and social care - hasn't kept pace.

The resulting demands on health and social services have left every part of the system struggling to cope.

Most health leaders still believe that the long-term goal should be to improve services out of hospital so fewer people end up in it.

In the meantime, however, NHS England says it doesn't want to lose any more overnight beds.

These figures show that hospitals were already pretty full in the summer. The big fear is of an extensive flu outbreak which the current system might struggle to contain.

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