21 February 2003
Health Secretary Alan Milburn has overturned more than a decade of NHS thinking by giving small hospitals a new lease of life.
Many local cottage hospitals have closed as the health service sought to centralise secondary hospital services. The theory was that treatment could be improved by having large numbers of more specialised doctors on a single hospital site. It also reduced overheads.
Reconfiguration, as it was known, led to a wave of bitter disputes as people protested about the downgrading or closure of beloved local institutions.
Some managed to stay open and reinvented themselves as diagnostic centres, intermediate care units and day hospitals. They are often run by GPs and will provide a blueprint for the new era of small local hospitals.
While Milburn did not rule out further centralisation of services in large hospitals, he insisted on February 14 that 'big did not necessarily mean best'.
He said that developing technology, including telemedicine, and new roles for nurses and other care staff, meant that a wider range of procedures could be provided safely in community hospitals.
New models of sustaining small hospitals by providing emergency care will be piloted in Central Middlesex, Bishop Auckland and West Cornwall.
Milburn added that proposed hospital reconfigurations must be based on three core principles – local people must be consulted and their opinions reflected; the viability of redesign rather than relocation of services should be discussed; and the needs of the whole local health and social services should be considered.
'Changing local health services does not necessarily mean centralising services, with fewer, larger "super hospitals".
'New resources combined with reforms to the way care is delivered mean greater emphasis can now be placed on the role and importance of smaller hospitals,' he said.
NHS Confederation chief executive Gill Morgan said 'redesign, not relocate' should be the health service mantra. But she added that difficult decisions to close or downgrade some hospitals will still be necessary, even if the public disagree.
'Politicians need to play their part by acknowledging that changes in hospital configuration will still be necessary, and by supporting those who carry it out,' she said.
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