By Nick Triggle
Health reporter, BBC News
The hospital bed count has been falling for decades
Thousands of hospital beds in England should be axed to save money and improve care, a think tank says.
Centre right group Reform said in some areas up to a quarter of beds could go.
It said advances in technology and rising rates of conditions like diabetes meant the focus should shift towards more community services.
The government said local health chiefs could decide, while the British Medical Association said cuts made for purely financial reasons would be "immoral".
The hospital bed count has been falling for decades, but Reform's call represents a more rapid programme than has been seen in recent years.
There were just under 300,000 beds in 1987, but by last year that had fallen to 160,000 as advances in treatment have meant patients do not need to spend as long in hospital.
WHY BED NUMBERS KEEP FALLING
Keeping people in hospital is costly. So it is unsurprising that successive governments have tried to wean the NHS away from them..
But they have only been able to do this because of medical progress which has meant patients no longer need to spend so long in hospital.
For example, cataract surgery used to require a patient spending a week immobile in hospital. Now it is done in 20 minutes as day case surgery.
Indeed, the rise in operations where the patient returns home the same day has been staggering. There are now about 200 different operations that can be done on a day case basis compared to only a handful 30 years ago.
What is more, thanks to developments such as key hole surgery the length of stay in hospital in cases where patients are kept in has fallen dramatically too.
However, the majority of the closures happened during the 1990s and the think tank believes politicians now need to be brave about pushing ahead with reform - even if that led to some hospitals being closed or downgraded.
It criticised ministers and opposition parties for interfering with hospital restructuring - the Tories have even said they would have a temporary ban on closures if they won power.
And Reform called for consideration to be given to cutting the NHS budget to get the public finances on a stronger footing.
Patrick Nolan, chief economist at Reform, said: "Health systems around the world are gearing up to shift care out of hospitals and into the community.
"Politicians would be best to engage local people in the choices facing their NHS services rather than foment short-sighted opposition to them."
The think tank suggested that more than 30,000 beds could close in the coming years if all areas matched the bed to population ratio achieved in the south central region.
This would mean London, the north east and north west removing about a quarter of their beds.
The Department of Health said it was not opposed to reducing the bed count, but it was essential patients were put first when considering restructuring.
A spokeswoman added: "The local NHS is best placed to decide how best to meet the needs of patients in their areas."
The Tories agreed, adding that it was important that doctors were given a key role in the process.
But Dr Mark Porter, chairman of the BMA's consultants committee, was sceptical about the suggestions.
He said that, while cutting bed numbers was perhaps necessary, carrying out such a programme so quickly was "nonsense".
And he added: "Cutting beds for purely financial reasons would be immoral and catastrophic for patient care."