Intended for healthcare professionals


Hospital closures: the great taboo

BMJ 2007; 335 doi: (Published 13 September 2007) Cite this as: BMJ 2007;335:535
  1. Nick Timmins
  1. Financial Times

    Closing a hospital always generates a public outcry, even if the evidence suggests that closure will improve services. Nicholas Timmins asks why it's so difficult

    The Tory MP Kenneth Clarke used to tell a story, when health minister back in the 1980s, of meeting his Italian counterpart, who complained vigorously about the difficulty of closing hospitals, when rationalisation of health services was badly needed in his own country.

    “We don't have a problem,” Ken chortled. “We just close them.” And, at the simplest level, that is clearly true. In the United Kingdom numerous hospitals have closed or merged with their neighbours over the past 40 years. The exact number is hard to pin down because of the frequency of mergers. But the number of beds has certainly decreased: back in 1948, when the NHS was founded, the UK had around 550 000 beds; today the figure is half that, at around 228 000 in 2003-4.

    True, the great bulk of that reduction is due to the closure of the old mental health asylums and the geriatric “back wards,” whose patients are now in means tested care homes. And people with learning disabilities have been shifted out of hospital and into social care. Even so, there are …

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