Bed occupancy rates within STPs over winter

Seasonal pressures over winter can impact the quality of health and social care services in England. To focus on performance during this period, NHS Digital publishes Daily Situation Reports on a weekly basis over the winter months. A range of indicators are reported in this data set, which can be compared to previous years, including general and acute bed occupancy levels.

The data is published at trust level and aggregated to indicate national-level performance, which gives an overview of pressures. However, with a place-based, local health system approach central to the NHS Long Term Plan, a local 'health system' perspective is also relevant. Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems have been tasked with producing five-year implementation plans over the next few months and their capacity to manage winter pressures will have a bearing on these plans to improve health and social care for their local populations. 

In this context, we mapped some of the winter data across the 44 STPs in England. You can read more about the methodology behind this (and why we excluded certain trusts) in our recent blog. This data visualisation looks at variation in bed occupancy rates from week to week, comparing this year to last. By clicking on different areas of the map, you can see the weekly variation in bed occupancy rate for STPs over winter 2017/18 and winter 2018/19.

What do the data tell us?

Looking at the average daily trust bed occupancy rates for the full winter reporting period, there are some variations across the country, but it is clear there is significant pressure everywhere. Last winter, NHS Improvement and NHS England stated that occupancy should be below 92% to maintain patient flow through hospitals. 

• More than three quarters of STPs have trust averages above this 92% threshold (pink or red on the map), both this winter and last. 
• While there are fewer STPs where trusts average over 96% bed occupancy (red) than last winter, some have higher levels. 
• In every STP, bed occupancy averages above 85%, the threshold recommended by the Royal College of Emergency Medicine and the Royal College of Surgeons.
• Looking at the first and last weeks of winter, national bed occupancy levels decreased slightly from 94.3% in week 49 (beginning 3 December 2018) to 94.0% in week 9 (beginning 25 February 2019) – compared to an increase from 94.8% to 95.4% between the same weeks last winter. However, this national trend was not reflected in some STPs, where on average trusts had a higher percentage of beds occupied in week 49 compared to week 6.

So, even though the national picture is important, it may mask that some parts of the country have faced even greater pressures than others this winter. It is also worth noting that even within STP areas, there is further variation between trusts. 

We have not attempted to analyse why some areas are experiencing higher pressures than others, or why some are performing better this year compared to last and vice-versa. Yet, if the future of the NHS lies within local health systems, these variations are certainly worthy of further scrutiny.

Please note: the national averages for bed occupancy levels discussed above will vary from the national aggregates reported in NHS England’s Winter Situation Reports due to being a different measure and having undergone data cleaning.