A radical transformation of England's hospital system is essential to rescue the NHS from its permanent state of crisis, according to a groundbreaking new report from thinktank Re:State.
The Case for Smaller Hospitals
The study argues that hospitals need to become significantly smaller with thousands fewer beds through a fundamental reinvention of their role in the healthcare system. This controversial downsizing programme could save billions of pounds while delivering better patient care and relieving pressure on exhausted staff.
Rosie Beacon, the report's author, emphasised that this isn't about cutting services but revolutionising how they're delivered. "It's less about counting beds but about what hospitals do and how they do it," she stated. "Hospitals can become smaller because you can give people the same standard – and often a better range – of care without them being physically present."
Shifting Care to Communities
The massive expansion of care delivered in and near people's homes forms the cornerstone of this proposed transformation. Patients would have dramatically reduced need to visit or stay in hospitals if they could access diagnostic tests, outpatient appointments and treatment in community settings or their own homes.
This shift reflects the changing nature of healthcare demands from an ageing population. The number of general and acute beds in English hospitals has already plummeted from 180,889 in 1987/88 to just 100,916 last month, according to NHS England figures, though hospitals still create thousands of extra beds annually to cope with winter pressures.
Professor Joe Harrison, chief executive of Milton Keynes University Hospital NHS Trust, endorsed the need for radical thinking. "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.
Endorsement from Health Leaders
In a powerful show of support, the chief executives of both NHS Confederation and NHS Providers have backed the case for hospital reform in their foreword to Re:State's report. Matthew Taylor and Daniel Elkeles argued that "a model designed in 1945 is not fit for 2025."
They noted that while the NHS was visionary when created in 1948, "that founding vision feels increasingly fragile. Once revered globally, the NHS has become a service more characterised by waiting than by healing."
The Department of Health and Social Care indicated that changes are already underway, highlighting their "three big shifts" strategy including pioneering neighbourhood health centres and community diagnostic centres that provide services closer to people's homes.
Beacon concluded that smaller hospitals represent progress rather than cuts: "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."
