On 22 May the NHS Confederation, which represents more than 90 per cent of NHS organisations, published a controversial report with a hard-hitting message.

'Why we need fewer hospital beds' provoked much debate amongst the health community. Nearly a month later, Dr Gill Morgan, Chief Executive of the Confederation, reflects upon the issues raised in the debate.

'More patients are being treated faster and more effectively than ever before by the NHS. That was the key message of our report which stated that from 1984 to 2004 the number of hospital beds has reduced by 31 per cent from 211,617 to 145,218.

What is interesting is that the service was able to reduce bed numbers by significant amounts whilst treating more and more patients every year. Official figures show us that the number of patients needing to stay overnight has increased by 57 per cent between 1984 and 2004.

It is not surprising that people believe that more beds mean better patient care - this has been the assumption for many years. We must start judging the NHS by the number of people we make better and keep well, not by the amount of beds which are, after all, only hospital furniture.

Some argued when the Confederation published 'Why we need fewer hospital beds' that due to bed numbers falling and admissions rising, patient care has suffered. However, I am still struggling to find the supporting evidence for this argument when national patient surveys state that satisfaction is at an all time high. In 2005, over 92 per cent of NHS patients rated their care as excellent, very good, or good.

I do understand however that, as we reduce beds, the people in the beds will be sicker and this will need dealing with by increasing staffing ratios and adjusting the tariff payment. If we don't do that then the staff in hospitals will become increasingly pressurised and distressed.

Some believe that beds are being cut in order to save money. It is not news that a small minority of NHS trusts are dealing with financial problems and are therefore facing tough decisions. However, it needs to be made clear that if beds are being reduced due to financial pressures, it will be in areas where patients can be treated elsewhere, for example in a community setting. Staff will need training to allow them to deliver care in a range of settings not just in hospitals.

Cutting beds therefore is not about cutting patients services - just the opposite in fact. This is about the NHS becoming more efficient and productive, using modern technology to best effect, so it can better treat the 1 million patients it sees every 36 hours.

Furthermore, reducing beds in the NHS is not a new trend. Figures show that the number of beds has been consistently falling since 1959 and has reduced by 40 per cent as new technologies and ways of treatment have come into being.

In 1850 Sir Henry Burdett, who established the Burdett fund for nursing said 'the purpose of a hospital is to cure with the smallest number of beds the greatest number of cases in the quickest possible time'.

We need to move away from this fixation with bricks and mortar. The world is changing, patients' needs are changing and the NHS is adapting to meet those needs. It should not be criticised for trying to improve the service it offers to patients.

Let's be clear - we are not calling for beds to be shut for the sake of it but are trying to point out that the debate is a complex one. We need to deal with the 'catch 22' of delivering the type of community services needed whilst the money is tied up in beds.

We are in full agreement with the Conservatives that there is little point reducing the number of beds until there are sufficient community services in place to manage patient demand.

It is for this reason that we are calling for an 'invest to save' fund so that new services can be developed in parallel with the existing delivery of services. This is not a cry for extra money but a pacing of investment. This would bring us closer to the goal that most people support - better services in the home and community including community hospitals supported by a well staffed, high tech hospital sector which can deal with the sickest and most complicated cases and which uses 21st century technology to the best effect.

We need an informed debate without hysteria about whether beds, bricks and mortar are always the best place to be putting valuable NHS cash. The NHS Confederation believes that we must judge the investment of taxpayers' money by assessing improvements in treatments for patients rather than by counting the furniture.'

Nursing Standard - 12th July, 2006