Thanks to cuckooshoe for alerting us to this:

Scotland’s high-profile media auditor, Stephen Boyle, has been all over with his latest claim of delayed discharges costs damaging NHS Scotland.¹

From the Institute for Government report – Performance Tracker 2025: Hospitals – published on 14 November 2025:

There was no month in 2024/25 in which general and acute bed occupancy was below 91.4%, well above the Royal College of Emergency Medicine’s recommendation that trusts should have an upper ceiling of 85% for bed occupancy.²

The auditor general for England has not audited this in living memory and certainly never bothers to suggest any such worries for NHS England.

The figure in Scotland was 88.6%, far safer in the event of unexpected surges such a flu epidemic.

Sources:

1. https://talkingupscotlandtwo.com/2026/01/08/in-scotland-97-of-patients-experience-no-delay-in-hospital-discharge-its-been-the-same-since-records-began-but-only-one-auditor-general-in-the-uk-seems-interested-wonder-why/comment-page-1/#comment-99063
2. https://www.instituteforgovernment.org.uk/publication/performance-tracker-2025/nhs/hospitals
3. https://publichealthscotland.scot/publications/acute-hospital-activity-and-nhs-beds-information-annual/acute-hospital-activity-and-nhs-beds-information-annual-year-ending-31-march-2025/

Footnote: Why does Royal College of Emergency Medicine recommend that trusts should have an upper ceiling of 85% for bed occupancy

The Royal College of Emergency Medicine (RCEM) recommends an upper ceiling of 85% for hospital bed occupancy (particularly general and acute beds) to ensure safe and effective patient care, primarily because it provides essential “headroom” or spare capacity to handle unpredictable surges in emergency admissions and maintain smooth patient flow.Key Reasons for the 85% Recommendation

• Managing variability in emergency demand: Emergency admissions are stochastic (unpredictable and fluctuating). A seminal 1999 stochastic simulation model (published in the BMJ) of a typical acute hospital showed that at occupancy below 85%, the risk of bed shortages (where at least one emergency patient cannot be immediately accommodated) is near zero. Above 85%, risks rise discernibly; at 90% or more, hospitals face regular shortages and periodic “bed crises.”
• Preventing emergency department (ED) crowding and exit block: High inpatient bed occupancy means patients ready for admission from ED cannot move to wards promptly. This causes “exit block” or “boarding,” leading to ED overcrowding, corridor care, longer waits, delayed treatment, and increased patient harm (including higher mortality risk). RCEM consistently links occupancy above 85% to worsened ED performance, such as breaches of the 4-hour target and excess deaths.
• Patient safety and system resilience: Maintaining 85% occupancy allows hospitals to absorb seasonal pressures (e.g., winter surges), infections (which close beds), and unexpected events without compromising care. RCEM describes levels consistently above 90–95% (common in recent NHS data) as “dangerously high,” contributing to overcrowding that “kills” through delayed care.

This 85% figure has become “conventional wisdom” in emergency medicine, cited in NICE guidelines, RCEM position statements, and reports. While some critiques note it stems from a specific model and may not apply universally to all hospitals, RCEM continues to uphold it as a safe benchmark for the NHS, arguing that significantly more beds are needed to achieve it year-round.RCEM resources emphasize that reducing occupancy to 85% would improve ED flow, reduce long waits, and enhance overall safety.

Sources –

https://www.bmj.com/content/319/7203/155

https://rcem.ac.uk/wp-content/uploads/2022/05/RCEM-Acute-Insight-Series-Beds.pdf