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There is a storm of pressures facing the NHS in Wales, extra bed capacity is vital - RCEM

There is a storm of pressures facing the NHS in Wales, extra bed capacity is vital - RCEM

Royal College of Emergency Medicine

2 min read Member content

The Royal College of Emergency Medicine writes that in 2019 Wales witnessed the lowest winter performance since records began, and unlike previous years there has been no recovery from the winter strain.


Last year, NHS Wales commissioned a review into the adequacy of available beds in hospitals. Changing demographics together with declining bed numbers and inadequate social care has created the perfect storm of pressures facing an already strained emergency care system in Wales.

Although some of these pressures are driven by a growing population, NHS Wales is also caring for an elderly population. The number of people aged 65 and over is projected to increase by 37% by 2041. Wales is ageing faster than any other nation in the UK.

Poor performance is now a year-round reality for Wales. This year witnessed the lowest winter performance in Wales since records began, and unlike previous years there has been no recovery from the winter strain.

Bed occupancy rates provide a good indication of patient flow in hospitals. The Royal College of Emergency Medicine advocates for 85% rate, as this provides spare beds to address additional demand.

We are not alone in advocating this, the British Medical Journal and the National Audit Office have asserted that hospitals with occupancy rates over 85% can expect ‘regular bed shortages’ and ‘periodic bed crises’.

NHS Wales has not met 85% bed occupancy since 2010-2011. When hospitals operate above this level, patients are placed at ‘considerable risk’. We can expect overcrowded hospital wards, patients languishing on trollies, and corridor care.

These conditions are particularly harmful for older patients who have complex care needs.

Research shows that acute and geriatric disproportionally contribute to bed occupancy. Geriatric medicine is operating dangerously close to full bed occupancy. This should sound alarm bells, as demand will continue to grow from Wales’ increasingly elderly population.

High bed occupancy is also associated with increased numbers of hospital-acquired infections. Even those who are lucky enough to secure a bed may suffer as they could be placed in inappropriate wards or juggled from bed-to-bed which can be distressing for older patients.

To deliver safe patient care for a rapidly ageing population, NHS Wales must keep a firm grip on bed occupancy rates.

Extra bed capacity is essential, but this needs to be accompanied by extra Emergency Medicine consultants to staff additional beds safely. A continuation of policies to integrate health and social care, such as extending frailty units, will help to address overcrowding and support the transfer of older patients into care. Together these solutions will support elderly care that NHS Wales is increasingly providing.

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