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Feature NHS Reform

The politics of NHS reconfiguration

BMJ 2011; 343 doi: (Published 07 September 2011) Cite this as: BMJ 2011;343:d5311
  1. Sam Lister, health editor
  1. 1Times, London, UK
  1. Sam.Lister{at}

Much needed rationalisation of hospital provision is being hampered by public and political concern over loss of local services, Sam Lister reports

For all its clinical dynamism, the National Health Service suffers from a sclerotic inability to change. Were Aneurin Bevan, architect of the NHS, to take a tour of today’s service, he would marvel at the medical ingenuity on display, from the scans and surgery to the therapies and drugs. He would be astonished at what now constitutes a life that can be saved. And he would be struck by how similar the configuration of the health service is to the one he helped establish more than 60 years ago.

At the heart of Bevan’s NHS was the district general hospital, the multipurpose medical facility for every community to deliver babies, attend to the dying, and respond to episodic dips in people’s health. Society’s healthcare requirements, and the means of delivering them, have shifted dramatically since then: the demands of managing chronic disease far outstrip the incidence of acute illness, access is wanted closer to home, and interventions come far earlier as we take a more proactive approach to public health.

And yet in many parts of the country the district general hospital still stands resolute, a monument to Britain’s healthcare traditions but out of sync, ill equipped, and excessively expensive for the population it serves.

Public opposition

The difficulties that come with change are exemplified by Chase Farm Hospital in Enfield, north London. A former children’s home and hospital for elderly people that was requisitioned as an 800 bed emergency unit during the second world war, Chase Farm became a district general hospital with the nationalising of the health service in 1948. It has had upgrades and additions over the years but is one of at least 20 hospitals round …

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