Does the ageing population correctly predict the need for medical beds? Part two: wider implications

Abstract

The first article in this two-part series demonstrated that the post-World War II ‘baby boom’ and increasing life expectancy implies that there will be a considerable increase in deaths in the UK over the next 40 years. As the highest proportion of lifetime hospital bed occupancy occurs in the last 1 year of life, this has significant implications for bed planning. Not only can death act as a predictor of hospital use in the final year of life, it is also a key indicator of wider morbidity and mortality trends. Part two of this series investigates the wider implications of these findings, showing that the current NHS funding formula completely omits the nearness-to-death effect when predicting bed usage. As a result, the formula becomes dependent on the year in which it is primed, leading to gross over- and under-funding in subsequent years. These same issues also have serious implications for the minimum number of beds for financial stability in a Clinical Commissioning Group. A pragmatic overview is given regarding how to modify current bed models so that they can give answers that reflect real-world demand.