Benenden Hospital is paid for by public sector workers
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Managers at an independent hospital in Kent have said they have to lay off up to a fifth of their staff because of a lack of work.
Beds at Benenden Hospital, near Ashford, are lying empty despite the fact the NHS still has significant waiting lists.
The hospital, run by an independent trust, is paid for by the contributions of more than a million public sector workers across the country, in a scheme which dates back to 1905.
A review by KPMG of the way the hospital works has said £4m must be saved to ensure it offers value for money.
Managers say this means up to 100 of its 500 workers face redundancy as services are streamlined.
The hospital is likely to carry out more out-patient appointments and specialist diagnoses in the future, in the place of general surgery.
Hospital director Ken Hesketh said: "We are recognising that medicine and surgery as specialities are changing.
"The model of service that we provide in some cases has become out of date and it needs to catch up with events."
The hospital has carried out some work for the NHS in the past but the Kent and Medway NHS Trust now says it can adequately provide places for patients within its own facilities.
But others say more could be done to allow NHS patients to make use of the fully-staffed, 150-bed facility.
Roy Isworth, a consultant at Benenden, said: "It seems extraordinary that having had a waiting list for 18-and-a-half years of six months, I now have one of just over a week."