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“Those who cannot remember
the past are condemned
to repeat it.”
So wrote George Santayana in 1905.
Perhaps West and North London’s integrated care board should circulate copies of his book; The Life of Reason.
NWLICB thinks it could need only 5,700 hospital beds within a decade. Today, it has 6,279. If present trends continue, its own modelling says it'll need about 7,500.
A chasm between what might happen and what their plan says must happen.
The UK already has one of Europe’s lowest bed ratios; 2.4 per thousand people, against an OECD average of 4.2.
The UK figure covers public hospitals; international comparisons aren’t exact, but, it still raises the bar for evidence before removing a single bed.
The ICB’s planning figures imply 91.9% occupancy, although this is not a verified current monthly rate. Its future scenarios assume 90%.
When is full, full? Dunno?
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The Royal College of Emergency Medicine recommends around 85% for hospitals accepting emergencies.
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NICE says minimise risks above 90%.
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NHS England’s 2023/24 target was 92% or below.
Who's correct? Dunno… the great and the good aren't so great and not so good when it comes to bed numbers.
Meeting one of those targets does not establish that beds can safely close.
Meanwhile, the CQC reports relentless pressure on mental health beds. Different beds and timescales, but a familiar question; can we remove capacity on the promise that care elsewhere will replace it?
Probably not… we’ve been here before.
The community care reforms of 1993 pursued independence, dignity and support outside institutions. Worthwhile objectives.
They still are.
Research found properly funded community provision could work well. It also warned...
'... expecting closures to generate savings could leave replacement services short.'
In plain English; moving care someplace else still needs money, people and kit.
By 2016, the Public Accounts Committee was describing rising admissions among older people, reduced social care spending, fragile providers and increasing delayed discharges.
Today, West and North London says about 800 acute beds hold people medically fit for discharge.
There, in a nutshell, is the unfinished business of community care.
Patients still need care. Moving responsibility out of hospital does not remove the work or its cost.
The ICB deserves credit for proposing another £360m annually for proactive, community and mental health care by 2028/29. Its bed figures describe a strategic scenario, not an operational closure plan. Walter-Mitty, not Water-Tight.
That scenario would require;
- flat A&E attendances,
- barely growing emergency admissions,
- bed-stays shortening 2% annually and
- productivity improving 2% annually for a decade,
... Good luck with that.
What about virtual wards… they already operate them.
The strategy explicitly proposes expanding them and hospital a home, to avoid admissions.
There is sort-of encouraging evidence.
Cochrane’s 2024 review of 20 trials found admission-avoidance hospital at home probably...
'... makes little or no difference to mortality or readmissions among older patients.'
... does no harm but does it help?
NHS England’s South East evaluation associated every 2.5 virtual ward admissions with one fewer emergency hospital admission.
Encouraging, although association does not establish causation.
An October 2026 review of technology-enabled virtual wards found broadly comparable outcomes for selected patients, but only three of its 22 studies were randomised trials...
... costs remained uncertain.
These services require top-notch clinical teams, monitoring and fast-access to hospital when patients deteriorate.
They also depend on patients’ circumstances.
Some manage independently. Others need help washing, dressing, eating or getting to the toilet.
Who will do it?
If that means social care or unpaid relatives, their capacity, willingness and costs must be included. NHS England explicitly says virtual wards are not a bridging service for people awaiting care packages.
A virtual ward can’t magic-up real social care.
The jury's still out on whether today’s reported savings can be sustained, scaled and safely converted into fewer hospital beds.
Existing virtual ward activity cannot simply be counted again. Additional capacity released may be needed by patients already waiting, and…
… someone must fund the transition while hospital and community services operate together.
Former NHSE CEO, Simon Stevens recognised this in 2017. 'Beds should not disappear'... He said;
'..unless and until there really
are better alternatives
in place for patients'.
Nine years later, that remains the test.
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Build the teams.
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Secure the social care.
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Demonstrate safe discharge and
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fewer avoidable admissions.
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Show that improvements survive winter and rising demand...
... only then assess how many staffed beds are needed.
An ageing population makes reliable community provision more necessary, and optimistic assumptions more dangerous.
We should insist on evidence that the care has arrived before the hospital beds disappear.
It's a coincidence, Santayana’s The Life of Reason and an edition of Hans Christian Andersen’s fairy tales both appeared in 1905...
I wonder which one West and North London’s board has been reading.
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