EDUCATION & DEBATE Is London overbedded?

Objective-To examine whether there are too many hospital beds in London. Design-Analysis of data from the Hospital InPatient Enquiry, Mental Health Enquiry, health service indicators, and Emergency Bed Service. Setting-England, London, and inner London. Results-Hospital admission rates for acute plus geriatric services for London residents were very similar to the national values in all age groups. In the special case considered in the Tomlinson reportacute services in inner London-the admission rate was 22% above the value for England. However, the admission rate of inner deprived Londoners was 9% below that ofcomparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded, in 1990-1 there were 4% more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985. Conclusions-Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London's relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and evidence from the Emergency Bed Service of increasing pressure on beds. Higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally. Department ofGeneral Practice, St Mary's Hospital Medical School, Lisson Grove Health Centre, London NW8 8EG Brian Jarman, professor of general practice BMg 1993;306:979-82 Introduction The King's Fund report on health care in London, the Tomlinson report, and the government's response to the Tomlinson report have suggested the closure of several hospitals in London.' Pressure for the closure of hospitals comes from three sources: the claim that Londoners use more hospital services than they should; demands for improved efficiency, resulting in a higher caseload per bed and therefore a reduced bed requirement; and the impact of market forces, resulting in fewer patients being referred to London from outside. This paper examines the validity of each of these to determine their possible impact.