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299 VIEWPOINT-although, much like the mythical "85% occupancy" margin, no one appears to have stopped to check why we believe what we believe. 3 Average LOS is simply occupied bed-days divided by number of admissions. 2,8,36,37 LOS itself follows long-term trends that involve peaks and troughs and other behaviour expected of a complex, environment-sensitive system. 37 A method based on the trends in occupied bed-days has therefore been proposed as a better way to forecast bed demand. 2,7,8 Efficiency programs can be incorporated into such forecasts by moving blocks of bed-days out of the acute care setting. But what occupancy level needs to be applied to the annual average bed demand? The occupancy margin The occupancy margin depends on the volatility in admissions and occupied beds and not efficiency (Box 2 and Box 3). 10,13,18,19,38 Queuing theory and the Erlang equation anticipate that the real world is volatile and give insight into the occupancy appropriate to each bed pool. 2,3,39 Smaller bed pools (eg, paediatrics, intensive care) must operate at a lower average occupancy than larger ones. The seasonal component to medical admissions demands different numbers of available beds in summer and winter. 8,13,39 Bed-demand forecasts based on seasonal and climatic conditions are important for enabling hospitals to staff the anticipated number of occupied beds 40-42 (Box 2 and Box 3) rather than merely staffing the available beds or attempting to use an unreliable historical seasonal average (Box 3). Too few beds and chaotic admission into inappropriate specialty beds result in poor patient care and inefficient LOS. The real issue is not about bed numbers but flexible staffing in the face of uncertain demand. 18,19,42 In the absence of climatalogical forecasts , coupled with too few available beds, health services have no other option but to "staff the beds" (staff being the real cost) without basing staffing on the patients in the beds. Others therefore incorrectly conclude that "beds" are expensive. To repeat the call already made 3-can we please have a true evidence-based debate, or will health departments continue to insist on the use of outdated and erroneous models simply because they give the perceived right answer? Both patients and clinical staff deserve to benefit from the tools required to deliver effective and efficient health care. Competing interests I am a senior partner and my wife is a partner of Healthcare Analysis and Forecasting. References 1 Jones R. Crafting efficient bed pools. Br J Healthc Manag 2009; 15: 613-616. 2 Jones R. New approaches to bed utilisation-making queuing theory practical. New techniques for health and social care. Harrogate Management Centre Conference; 2001 Sep 27; London.