Hospitals must get smaller to stop NHS ‘permacrisis’, thinktank urges

Hospitals need to become smaller, with fewer beds, to help save the NHS from its “permacrisis”, a thinktank has said. The role hospitals play needs to undergo “a fundamental reinvention” to help them escape the overcrowding that has become widespread over the last decade, according to the thinktank Re:State. Politicians and NHS leaders will have to be prepared to push through a potentially controversial programme of downsizing hospitals for the service to remain viable, it adds. The thinktank – formerly called Reform – argues in a new report that doing so will save the NHS billions of pounds, lead to better care for patients and relieve pressure on overworked staff. Hospitals could shrink in size, shedding thousands of beds, as the result of a massive expansion of care delivered in and near people’s homes. People will have much less need to go to or stay in hospital if they can access diagnostic tests, outpatient appointments and treatment at home or in community settings, to reflect the changed nature of illness that an ageing population has brought, it says. Rosie Beacon, the author of the report, said: “It’s less about counting beds but about what hospitals do and how they do it. Hospitals can become smaller because you can give people the same standard – and often a better range – of care without them being physically present. That [would produce] lower long-term running costs and a system that’s financially sustainable. “Hospitals shouldn’t be made smaller just for the sake of it but because how and where we deliver secondary care no longer needs to be confined to a hospital bed. Related: NHS failing to cut waiting times as promised in recovery plan, report warns “The natural consequence of a health service that succeeds in reducing hospital footfall, through better prevention and faster treatment, is that hospitals themselves will look smaller and different. Being honest about that isn’t radical; it’s simply facing up to what a modern, preventative NHS requires.” She added: “A smaller hospital footprint is simply the outcome of care becoming faster and more effective. It’s not about cutting services. It’s about delivering them in ways that are faster, more convenient and more financially sustainable.” The supply of general and acute beds in hospitals in England has fallen from 180,889 in 1987-88 to 100,916 last month, NHS England figures show. Advances in treatment have given patients shorter stays, relieving pressure on beds. But hospitals have to create thousands of extra beds to help them cope with the usual “winter crisis”. Prof Joe Harrison, the chief executive of Milton Keynes university hospital NHS trust, said: “The only route to stabilising the service, improving access and quality of care, and relieving pressure on exhausted staff is radically rethinking what hospitals do and how they do it.” He said the scale of the crisis facing the NHS was so great that bosses “must be prepared to ask the difficult questions and take the difficult decisions” about how services are delivered. In a foreword to Re:State’s report, the chief executives of NHS Confederation and NHS Providers, which represent England’s 215 health trusts, endorse the case for radical reform of hospitals. While the NHS was “visionary” when it was created in 1948, “that founding vision feels increasingly fragile”, say Matthew Taylor and Daniel Elkeles. “Once revered globally, the NHS has become a service more characterised by waiting than by healing. A model designed 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.” A Department of Health and Social Care spokesperson said it was already shifting care out of hospitals as part of its “three big shifts” to revive the NHS. “Pioneering neighbourhood health centres will provide easier, more convenient access to a full range of healthcare services right on people’s doorsteps, stopping them from having to make lengthy trips to hospital,” the spokesperson said. “Community diagnostic centres – many of which are open 12 hours a day, seven days a week – let people get tests, checks and scans closer to home, again reducing strain on crowded hospitals. “The hospitals of the future are being built with more single-patient rooms and with careful consideration of demographics, as well as maximising the latest technology for greater efficiency and sustainability.”