Closing beds is often something you will here when there is talk of efficiency savings in the NHS. However, closing beds is not as straightforward as it sounds. It has to be planned, thought through and importantly be part of a longer term strategy plan for the organisation to deliver sustainable patient flow from admission through to discharge. Patient flow must never be managed in isolation.

However, the management of patient flow can often become secondary when pressure mounts and the focus inevitably shifts to the front door. This means we end up putting our effort into meeting the four hour target rather than putting it into creating capacity that can actually relieve pressure at the front door. At this point we increase admissions, which often includes those patients who otherwise might have had a zero length of stay and sometimes we open more beds.

Although opening beds takes pressure out of the system, it only fixes the symptom not the cause. The cause is simply that the downstream flow has not been fixed. To do that we must look at our internal waits, not our complex discharges, but our internal waits. These are the things we have control over and can do something about. Many time in motion studies have demonstrated the ‘waste’ we have in the system caused by tasks outstanding on a day to day basis. These waits not only prevent discharge, but result in late in the day discharges.

Simply put, remove the waits, discharge earlier and we maintain flow. This will help to reduce length of stay which in turn means beds can be closed and remain closed.

Closing beds in isolation doesn’t save the NHS money, closing bays starts the process, and closing wards definitely saves money, but we must ensure that we are closing the beds for the right reason. Capacity modelling is the key and NHS trusts should be trying to adopt a split bed base culture, one that increases bed base for certain periods of the year and reduces this for the remainder of the year. This can only be done through modelling and matching this to the activity levels that can succinctly be carried out. This together with the removal of internal waits means that we can close beds.

So whenever you hear someone talk about closing beds, remember that fixing downstream flow in hospitals will improve flow across the board from admission through to discharge. If you focus on taking out the waste, plan your required bed capacity so you can close beds. Use information to drive that plan and always keep pressure in the system to drive performance. Trusts that do this will genuinely realise the cost reductions associated with closing beds.

Ben Rosling
Director of Transformation