Beyond the Bed Challenge: Why community-based care must play a bigger role in supporting NHS hospitals

The NHS is facing sustained and ongoing operational pressure, impacted further by the seasonal demands of ‘winter pressures’ and this is now an everyday reality rather than a temporary challenge. Bed occupancy remains consistently high, with general and acute beds running at 92.5% occupancy in the first quarter of 2025 - levels that leave little flexibility for surges in demand. NHS staff continue to deliver care with professionalism, dedication and commitment, but the system itself is operating with increasingly narrow margins.

Much of the national conversation still focuses on hospital beds: how many we have, how many we need, and where new capacity should be built. While expanding hospital infrastructure may be necessary in some areas, it risks addressing the symptom rather than the underlying issue.

NHS Hospitals are at their best when they are able to focus on complex, urgent, and high-risk care. Yet a significant proportion of bed capacity continues to be occupied by patients awaiting discharge or by those undergoing straightforward elective procedures that could safely be delivered elsewhere through existing, long established external relationships. In 2024, over 14,000 beds were filled each day by patients who were medically fit to leave hospital but unable to do so due to wider system constraints, particularly in social care. At the same time, tens of thousands of patients experienced long waits in A&E simply because beds were unavailable. These pressures are not the result of failure, but of a system that has not yet fully adapted to changing demand.

This is where community-based surgical hubs and specialist clinics should play a more prominent role. By design, they focus on low- to medium-risk elective procedures and operate with streamlined pathways that reduce delays and improve throughput. When used effectively, they are proven to free up much needed capacity within NHS hospitals, enabling acute teams to concentrate on the patients who most need their expertise.

From our experience at One Health Group, having supported the NHS for over 20 years, this model works best when it is treated as a partnership rather than a workaround. Maximising the amount of care delivered in community-based locations is not about shifting risk away from hospitals; it is about aligning care settings with patient needs. By delivering appropriate elective care in community hubs, NHS hospitals gain capacity, patients benefit from faster treatment, and the overall system functions more efficiently.

There is strong evidence to support this approach. The Royal College of Surgeons has highlighted the role of surgical hubs in improving efficiency and reducing waiting times, while the GIRFT programme has identified more than 90 elective hubs across the NHS. Many of these operate in collaboration within dependent sector providers and were expected to deliver over one million additional procedures in 2024/25 alone. This is not a marginal contribution, it is becoming a core part of elective recovery and capacity planning.

Independent providers are occasionally criticised for focusing on lower-risk patients, but this misses the point. That focus is precisely what makes the model effective. By reducing post-operative bed usage and supporting faster recovery pathways, community-based providers help stabilise hospital flow and protect capacity for more complex care which is where the NHS excels. This is not competition with the NHS; it is a practical response to shared pressures.

Importantly, this direction of travel aligns with wider NHS reform and the NHS ‘10 Year Health Plan’. The development of neighbourhood health centres and the expansion of community diagnostics reflect a growing recognition that care does not always need to be delivered within large, busy NHS hospitals. Delivering more patient care in the community closer to home is not just more convenient for patients, it is essential for long-term sustainability.

The challenges facing the NHS are complex and deeply rooted, and no single intervention will resolve them. But continuing to rely primarily on NHS hospitals to absorb rising demand is unlikely to succeed. In my view, a more deliberate shift toward community-based care, that is supported by strong, long-standing partnerships between the NHS and independent providers, offer sone of the most credible ways to relieve pressure, improve access, and build resilience into the system.

If we want the NHS to thrive in the years ahead, we need to be confident in using every part of the healthcare system to its full potential.