How will the hospital service be provided in future?Concern expressed about GMC's performance proceduresMinister agrees to discussions on the staff gradeBMA meets health secretary on savings exerciseGetting on to the specialist registerGPs' staff should have NHS pensionsDoctors' careers services should be properly fundedMinister rejects bill on patient confidentialityFinal guidance on NHS complaints procedure issuedBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.781 (Published 23 March 1996) Cite this as: BMJ 1996;312:781
- Linda Beecham
How will the hospital service be provided in future?
The future organisation of the hospital service has been the subject of several recent reports and last week the Joint Consultants Committee held a half day seminar to stimulate discussion on the subject.
According to the chairman of the Central Consultants and Specialists Committee, Mr James Johnson, there would be several advantages in the proposal for megahospitals serving between 50000 and two million people. There would be an appropriate number of subspecialists, there would be many facilities on one site, and there would be no problem with out of hours cover. On the other hand, there would be enormous logistical problems and many hospitals would have to close, doctors would have to change the way they worked, and there would be problems of patient acceptability. If the model of one major hospital providing the majority of services with several smaller local hospitals—perhaps with some of the smaller specialties being concentrated in them—was adopted Mr Johnson said that it would be important for them all to form one trust. He feared that otherwise there would be two grades of consultant.
The CCSC is looking at the future of the district general hospital and this will be the subject of debate at the consultants' conference on 6 June. Mr Johnson said that the present district general hospitals were of a manageable size—serving between 150000 and 380000—and were acceptable to patients. The pressures on the hospitals were the trends towards subspecialisation, the destructive effects of competition between them, and the threat of the private finance initiative. The CCSC chairman warned that this could lead to a proliferation of NHS units providing a day service for specific conditions. The comprehensive nature of the district general hospital would be lost.
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