How many beds should the NHS have?

The political environment is alive with competing claims for the reduction of bed numbers. Who can promise the smallest number of beds and remain credible?

This is a very strange debate to be having, especially as it so often involves people who are neither patients nor clinicians.

It is true that the nature of medicine is changing and the vast numbers of beds that were present in 1948 have no role now. However, other factors are coming into play. Our population is vastly greater than it was, ‘hot-bedding’ is associated with infection control problems and resilience or surge capacity is much reduced.

The nature and scale of future demand for hospital beds is inherently unknowable – nobody saw AIDS/HIV coming, nor SARS, pandemic flu is capricious in it’s timing, a major radiological weapon incident would cripple normal NHS operation…

Health services cannot be run on the same sort of ‘just in time’ basis that manufacturing industry employs. Rigid, tightly coupled systems are fragile and non-resilient – quite the opposite of what a health service should be.

Spare capacity, empty beds, reserves of supplies and redundancy in the system may be anathema to the managerial cadre but they will be the life or death of patients in the future.

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