BMJ  2005;331:1331-1333 (3 December), doi:10.1136/bmj.331.7528.1331

Education and debate

Does the district general hospital have a future?

¹ Health Service Management Centre, University of Birmingham, Birmingham B15 2RT c.j.ham@bham.ac.uk

Increased patient choice and a bigger role for the independent sector threaten the future of district general hospitals. As the public remains firmly attached to these hospitals, a managed transition represents a huge political challenge

The first 150 words of the full text of this article appear below.

Introduction

It was in 1962 that Enoch Powell, then minister of health, published the Hospital Plan for England and Wales.¹ The plan served as a framework for the development of hospital services in the decades that followed, leading to the building of many new hospitals and the refurbishment of others. At the heart of this framework was the district general hospital, designed to provide a comprehensive range of inpatient and outpatient services to populations of 100 000 to 150 000. District general hospitals have formed the backbone of NHS hospital care ever since.

Today, many of these hospitals face an uncertain future. The uncertainty has arisen as a result of advances in healthcare technology enabling more specialist services to be provided outside the hospital, changes in the workforce (particularly a reduction in the hours worked by doctors in training), evidence that some services are better concentrated in fewer centres able . . . [Full text of this article]

Market reforms

Treatment centres

Patient choice

Payment by results

Practice based commissioning

Alternative futures

Will it work?

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