Education And Debate The hospital of the future

Hospital provision, activity, and productivity in England since the 1980s

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7214.911 (Published 02 October 1999) Cite this as: BMJ 1999;319:911
  1. Martin Hensher, health economist, London Health Economics Consortiuma,
  2. Nigel Edwards, policy director ([email protected])b
  1. a London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b NHS Confederation, London SW1P 4ND
  1. Correspondence to: N Edwards

    This is the second in a series of seven articles

    The secretary of state is due to announce the results of an inquiry into beds in England. This review seems to have been in response to a perception that hospitals were experiencing increased difficulty in coping with emergency pressures and that the reduction in beds had gone too far—a fact apparently supported by a plateauing in the downward trend in the number of beds. The hospital sector, especially in the NHS, has long been a focus from all sides for rhetoric and emotive political appeals. In terms of numbers of both hospitals and beds, the NHS has been shrinking for most of its life. The bed stock of NHS in England peaked in 1957-8 and has declined since. In the more recent past, official statistics on hospital services in this country have been plentiful, yet they are rarely presented together in an easily accessible and unified form. It is the objective of this paper, therefore, to provide a concise summary of key trends and statistics in the sector that will be of use to policymakers, analysts, researchers, and practitioners. We present data on hospital provision in both the public and the private sectors, and on productivity in the NHS hospital sector. The implications of the most significant trends are discussed, and a number of lessons are suggested for audiences both within the United Kingdom and abroad The analysis starts in 1982, the year of a major administrative reorganisation within the NHS, and shortly before the Griffiths Report,1 which ushered in the concept of “general management” in the NHS NHS data reporting conventions in all areas changed in 1987, including a move in reporting from calendar years to financial years, the replacement of “deaths and discharges” with the “finished consultant …

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