The data in this deep dive are taken from the NHS Urgent and Emergency Care Daily Situation Reports (UEC SitRep Collection), which comprise daily returns collected from acute trusts. These data include both adult and paediatric general and acute bed availability - split by core and escalation beds, in addition to adult critical care, paediatric intensive care and neonatal critical care.1 2
While there are no official standardised guidelines, high levels of occupancy provide an indicator of a service or health system under pressure,3 Â where it is difficult to find beds for patients in need, impacting patient flow, waiting times, and potentially linked with higher infection rates.4 Â However the National Institute for Clinical Excellence () recommended a 'pragmatic maximum' of 90%,5 and the NHS recommended not to exceed 92% occupancy in the 2023/24 operational planning guidance,6 Â and stated to maintain these levels in the 2024/25 operational planning guidance.7
Our deep dive data
The data presented cover the average number of daily available and occupied beds over an entire month collected from 135 acute trusts across England. Data are examined according to general and acute services - open and occupied beds; adults and paediatrics (adults are included to provide a comparison); and core and escalation beds. For clarity, this document only looks at the overall available beds and occupancy.
General & acute
The figure below shows adult occupancy and paediatric occupancy timeseries for general & acute from December 2020a to July 2024.
The occupancy rate adult general & acute beds is higher than the rate for paediatrics with occupancy rate above 90% since June 2021. For paediatric beds, average occupancy was 70.6% compared to the 93.2% for adult beds, with a maximum of 80.5% in November 2023 and minimum of 55.6% in January 2021.
Adult critical care, paediatric intensive care, neonatal intensive care
When looking at paediatric and neonatal intensive care, occupancy rates were closer to that of adult critical care than for general & acute.
Neonatal intensive care occupancy rates have remained fairly constant at on average 67.7% (going above 70% in four of the recorded months) with the highest rate at 71.4% in August 2021 and the lowest at 63.2% in December 2020.
There was more variation in paediatric intensive care occupancy rates, with peaks of 82.3% and 82.7% in October and November 2021; 87.4% and 88.5% in November and December 2022; and 86% in November 2023 (with a brief dip to 64.8% in August 2023. Since 2024, rates appear to have levelled off and are very similar to that of adult critical care - 75.9% paediatrics, 75.8% adults in July 2024.
Paediatric beds occupancy by region
For paediatric general & acute and neonatal intensive care regional breakdowns appear to follow similar trends each month. For paediatric intensive care there was more variation and less linearity in the data, where some regions reached particularly high levels of occupancy, specifically.
General & acute paediatric bed occupancy by region
Trends appear predominantly linear for each region, increasing until November 2021, before dropping and then spiking in November 2022, followed by a consistent drop again until August 2023, followed by a subsequent spike peaking in November 2023. The increased occupancy in winter months could be a reflection of pressures that services face each winter.
London frequently recorded the highest occupancy rates - this was the case for 33 of the 43 months. However, the highest occupancy rate was in the South East in November 2023 (85.6%), and the lowest recorded overall, for the East of England in January 2021 (47.1%).
Paediatric intensive care bed occupancy by region
The overall occupancy rate for paediatric intensive care was on average 76.4% (max 88.5%, min 65.2%), not dissimilar from the adult critical care (77% average, max 85.7%, min 69.9%). However, the data appear to be less linear than general & acute and neonatal intensive care, with substantial regional variation.
The East of England region returns lower rates of occupancy than other NHSE regions with an average of 45.4%, over 30% less than other regions’ average.  However, these are based on a low number of beds available, which is likely impacting the national average. The Midlands, for instance, recorded occupancy rates of over 90% for just under a quarter of months recorded, with a maximum of 97.2% in December 2022. While the South East experienced 90% occupancy for three consecutive months, the South West reached 94.4% occupancy in October 2021, November and December 2022 and the North West reached 91.4% occupancy in February 2023 and 94.3% in December 2023.
Neonatal intensive care bed occupancy by region
Occupancy rates for neonatal intensive care beds appear to be more linear than those for paediatric intensive care and have generally lower occupancy rates.
On average, occupancy rates were between 61-69% for most regions, with the exception of London which experienced an average 76% occupancy; the highest being in December 2023 (79.5%) and January 2021 with 79.1%. There were no data points going over 80% occupancy for any of the regions. In the most recent months taken into account there was a decrease in the South East from April 2024 (64%) to July 2024 (52.8%).
- 1NHSE - Bed Availability and Occupancy
- 2NHSE - Critical Care and General and Acute Beds - Urgent and Emergency Care Daily Situation Reports.
- 3Nuffield Trust - Hospital bed occupancy, 27.06.2024.
- 4The King's Fund - The number of hospital beds, 23.03.2023
- 5National Institute for Health and Care Excellence (NICE), guideline 94, March 2018, p.20.
- 6National Health Service (NHS) - 2023/24 priorities and operational planning guidance, January 2023, p.7.
- 7National Health Service (NHS) - 2024/25 priorities and operational planning guidance, April 2024, p.14.
- aPrior to December 2020 only data for acute trusts with type 1 A&E were collected.