Intended for healthcare professionals


What is the future of hospitals?

BMJ 2013; 347 doi: (Published 12 September 2013) Cite this as: BMJ 2013;347:f5442
  1. Mark Newbold, chief executive
  1. 1Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
  1. marknewbold51{at}

Future Hospital Commission advocates a return to general physicians and greater focus on acute care


With the holiday season only just over, hospitals will already be finalising their winter plans, conscious of the unprecedented struggle to manage acute demand in the previous year. Indeed, the prolonged pressure led doctors to voice concerns about clinical standards,1 adding to the attention brought by the Francis Report2 and Keogh Review.3 Does the Future Hospital Commission4 offer a way forward that is both achievable and sustainable?

While acute beds have reduced by a third over 25 years,5 there is little evidence of a commensurate reduction in demand. This leaves England with a relatively low bed base6 and occupancy levels that are too high for optimum efficiency or quality of care.7 The precarious position of hospitals was pointed out by the Royal College of Physicians in 2012.8 It highlighted the impact of wider health and social care system performance on hospitals and helped to balance a debate in which the unarguable need to shift the emphasis of care from hospital to community (and the resources …

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