Hospitals must become smaller and with fewer beds to save the NHS from a “permacrisis”, a think tank has said.
The role played by hospitals must undergo a “fundamental rethink” to help them avoid the overcrowding that has become widespread over the past decade, according to think tank Re:State.
Politicians and National Health Service leaders will have to be prepared to push through a potentially controversial program of hospital cuts to ensure the service remains viable, he adds.
The think tank, formerly called Reform, claims in a new report that it would save the NHS billions of pounds, lead to improved patient care and ease the burden on overworked staff.
Hospitals could shrink in size, losing thousands of beds, as a result of the massive expansion of care provided in and around people's homes. People will be much less likely to need to go to or stay in hospital if they can access diagnostic tests, outpatient appointments and treatment at home or in the community to reflect the changing nature of disease brought by an aging population, the report says.
Rosie Beacon, author of the report, said: “It's not so much about counting beds as it is about what hospitals do and how they do it. Hospitals can become smaller because you can give people the same standard – and often a wider range – of care without them being physically present. This [would produce] lower long-term operating costs and financial sustainability of the system.
“Hospitals should not be downsized just for the sake of it, but because how and where we provide secondary care should no longer be limited to hospital beds.
“The natural consequence of the health service succeeding in reducing hospital attendance through better prevention and faster treatment is that the hospitals themselves will look smaller and different. Honesty about this is not radical; it is simply an acknowledgment of what a modern, preventative NHS requires.”
She added: “The shrinking hospital footprint is simply the result of care becoming faster and more efficient. It's not about cutting services. It's about delivering them in faster, more convenient and more financially sustainable ways.”
The number of general and emergency beds in England's hospitals has fallen from 180,889 in 1987-88. 100,916 last monthEngland's National Health Service data shows. Advances in treatment have allowed patients to have shorter lengths of stay, reducing pressure on beds. But hospitals are having to create thousands of extra beds to help them cope with the usual “winter crisis”.
Professor Joe Harrison, chief executive of Milton Keynes University Hospital NHS Foundation Trust, said: “The only way to stabilize services, improve access and quality of care, and reduce the burden on exhausted staff is to radically rethink what hospitals do and how they do it.”
He said the scale of the crisis facing the NHS is so great that leaders “must be prepared to ask difficult questions and make difficult decisions” about how services are delivered.
In the foreword to the Re:State report, leaders of the NHS Confederation and NHS providers, which represent England's 215 health trusts, support the idea of radical hospital reform.
Although the NHS was “visionary” when it was created in 1948, “that underlying vision appears increasingly fragile”, say Matthew Taylor and Daniel Elkeles. “The NHS was once respected around the world but has now become a service that is more about waiting than treating. The model developed in 1945 is not fit for 2025. As the most expensive part of the system, reimagining the hospital must be at the heart of service reforms.”
Department Health A Social Care spokesman said it was already moving care away from hospitals as part of “three big changes” aimed at reviving the NHS.
“The new community health centers will provide easier and more convenient access to a full range of health services right on people's doorsteps, eliminating the need for them to make long trips to hospital,” the spokesman said.
“Community testing centres, many of which are open 12 hours a day, seven days a week, allow people to get tests, checks and scans closer to home, further reducing pressure on overcrowded hospitals.
“Hospitals of the future are being built with more single-bed rooms and with careful consideration of demographics, as well as making maximum use of the latest technology for greater efficiency and sustainability.”
