Page last updated at 01:01 GMT, Sunday, 7 August 2005 02:01 UK

The end of hospitals as we know them?

By Nick Triggle
BBC News health reporter

Cumberland Infirmary
Cumberland Infirmary was the first PFI hospital, but will it be the model for the future?

Looking back, it seems 1962 was the year when hospitals really became the public face of the National Health Service.

More than a decade after its birth, it was becoming clear the outdated and war-damaged infrastructure could not cope with the burgeoning health service.

The answer was a wave of hospital building after Enoch Powell, the then minister of health, announced every area of 125,000 people was to have a district general hospital.

And ever since then, hospitals have been the public face of the health service.

But with the government now pushing to provide more care outside hospitals, are we set for a messy divorce?

Already the signs are that the hospital of the future will be much smaller than today's model.

Debts

In June the government announced proposals to reduce the number of patients being taken to hospital following 999 calls, by getting medics to treat them at home.

And with mounting hospital debts, a drive for innovation among GPs and the growth of treatment sectors for minor surgery, it is not surprising that some are claiming hospitals will see many of their functions siphoned off in the coming years.

KEY HOSPITAL DATES
Pre 1948 - Hospitals built in ad hoc way. Charitable and voluntary hospitals had been built over the past few hundred years and local authorities had also built municipal hospitals, many during the Victorian era, to provide maternity and infectious disease services
1948 - Birth of the NHS sees public hospitals brought under the remit of the health service, providing free access for all
1962 - Government announces mass 10-year hospital building programme, but only two thirds of the 200 are eventually built
1980s - Few hospitals built as limited money for big capital public sector projects
2000 - First PFI hospital, Cumberland Infirmary, opens, built and designed using private money
2005 - More than 50 PFI hospitals now open, bringing the total number of acute hospitals to nearly 300

Martin Hensher, policy manager at the NHS Confederation, said: "There is quite a lot of uncertainty, but clearly hospitals are going to change.

"I think in the future only the really sick will go to hospital."

Instead, Mr Hensher sees a future whereby hospitals consultants work more in the community through outreach clinics.

He also believes other staff are going to be more mobile, working in nursing and private homes.

"I think we will begin to see staff working across boundaries.

While shrinking hospitals may come as a shock to many, Mr Hencher believes it is in keeping with a trend dating back decades - the number of hospital beds has been shrinking since a peak of 250,000 in 1960.

"However, there will still be some role for acute hospital. You are going to have some form of emergency department, but surgery may not be done at night."

While Mr Hensher said it could take years to reach this point, evidence suggests his predictions are coming true in some areas.

From the outside Hexham Hospital looks no different from many other hospitals in the NHS.

Demand

But the hospital, which serves a rural area of Northumbria, is one of a number looking at ways of doing things differently.

Faced with limited demand for its emergency trauma surgery facilities, bosses started referring patients to nearby hospitals from May so they could concentrate on a few key areas.

The move has attracted criticism from the local community, but the hospital defended it, claiming it had led to nearly 50% more elective operations being carried out.

Officials also said it had helped doctors consolidate Hexham's position as one of the leading centres for laparoscopic surgery, a form of key-hole surgery.

A&E unit
A&E is one of the areas of hospital care which could change

Ann Wright, the general manger for surgery at the Northumbria Healthcare NHS Trust, said she thought many hospitals would follow their lead.

"At the end of the day dealing with emergencies is becoming more complex. It is very difficult for a small hospital to keep the skill levels up.

"Patient care actually improves because it means they are being treated in places where there is the best expertise."

But others remain less sure about the consequences. Dr Paul Miller, chairman of the British Medical Association's consultants committee, warned the various polices could mean that hospitals do not just get smaller, they could even go under.

A white paper is expected at the end of this year detailing how more services, such as diagnostics and care of long-term conditions, can be done by GPs and other community medics.

Dr Miller said: "There is undoubtedly scope for more things to be done in primary care.

"The effect on hospitals depends on just how radical the government wants to be."

Cash

Mr Miller said there was a danger that if treatments centres and GPs mop up a lot of traditional secondary care work hospitals could feel the pinch.

"Many hospitals are already strapped for cash and if you take away the bread-and-butter work there will not be enough money coming in.

"Hospitals could go bust."

The Department of Health refused to be drawn into the debate, saying it was not going to make predictions for the future.

Sometimes the effect of policies can be overestimated
Joe Farrington-Douglas, of the Institute for Pubic Policy Research

But Joe Farrington-Douglas, a health researcher at the Institute for Public Policy Research, believes the death of the hospital has been greatly exaggerated.

"Hospitals hold a symbolic appeal to the public. They think this is our hospital, our city. They are very visible and, therefore, I can see the public resisting too many changes."

And there is evidence to support this. One of the most famous recent examples of a hospital downgrading proved so controversial to local residents that they elected an MP standing on the ticket of saving the hospital.

Dr Richard Taylor, a retired consultant physician at Kidderminster Hospital, stood for parliament in 2001 as an independent, arguing he would reverse the changes to elective surgery and emergency care.

He won the seat and was re-elected in May.

And Mr Farrington-Douglas also said there could be some practical difficulties.

"Sometimes the effect of policies can be overestimated," he said. If you think about all the PFI hospitals that have been built, these are often large buildings, locked into 30-year contracts so I cannot see much flexibility there."

SEE ALSO
NHS bodies warned over finances
24 Jun 05 |  Health

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