Bottomley urged to rethink bed closures

Virginia Bottomley, the Secretary of State for Health, is under growing pressure from leading health policy advisers to reconsider the Government's hospital bed closure programme.

Top health analysts who once supported the closure programme have started to raise serious doubts about its rationale.

The calls for a rethink of the policy have been prompted by a steep and unforeseen increase in demand for beds in acute wards. Over the last three years there has been a 20- to 25 per cent increase in the number of patients requiring immediate or emergency admission.

Under the Government's health reforms many of these cases were meant to be treated by general practitioners. The theory behind the changes was that cuts in hospital services would free resources for improved care in the community. However, proponents of the switch three years ago are now beginning to warn of a growing crisis in the NHS if more wards are closed.

There is growing evidence that better primary care is leading to more, not less, demand for hospital care, and research suggests that, far from saving money, the policy of shifting more acute care into the community could actually cost more.

Closures have caused chaos in some London hospitals with operations being cancelled and patients lying for hours on trolleys waiting for admission.

The theory behind the pioneering programme of bed closures in London is now being adopted in many other big cities, especially those with large numbers of beds compared with the national average.

Leeds, Newcastle, Manchester, Liverpool, Sheffield, Birmingham and Bristol all have more beds per 1,000 population than London and the UK as a whole. All these cities have either carried out or just started reviews of acute services, most of which involve hospital or bed closures.

The strategy pioneered in London was proposed by a commission set up by the King's Fund, an independent health think tank, in 1992. It called for the closure of hospitals, focusing acute hospital care on fewer, larger, world-class "centres of excellence" linked to universities, together with a major shift of care from hospitals to primary care in the community.

Its report, London Health Care 2010: Changing the Future of Services in the Capital, assumed that more and better primary care in the community would reduce the demand for secondary care in hospitals and release resources to develop primary care. It called for the closure of hospitals with the loss of 5,000 beds over 18 years and the sale of sites to finance developments in the community.

The King's Fund Commission's vision was shared by Professor Sir Bernard Tomlinson in his report of the inquiry into London's health services, medical education and research, published in October 1992.

The Department of Health endorsed the findings of both the commission and Tomlinson and about 2,400 beds have been closed since 1991.

But West Midlands Regional Health Authority told the Independent its review of services was not based on the assumption that better primary care would lead to less demand for hospital care. A spokesman said this was the "conventional wisdom" but health economists commissioned to examine the theory had concluded the reverse.

The King's Fund recently called for a halt to closures until alternative services were in place. Robert Maxwell, chief executive, said a second commission was being appointed to re-examine London acute services and see "where we got it wrong".

Alarm bells ring, page 2

Leading article, page 14