Intended for healthcare professionals


A more encouraging future for hospitals?

BMJ 2014; 349 doi: (Published 13 November 2014) Cite this as: BMJ 2014;349:g6780
  1. Nigel Edwards, chief executive
  1. 1Nuffield Trust, London W1G 7LP, UK
  1. nigel.edwards{at}

Forget the view that hospitals are bad and expensive while community and primary care is good and cheap

The quality of the debate about the role of hospitals has improved recently. Evidence of this can be found in the work of the Royal College of Physicians’ Future Hospital Commission1 and last month’s Five Year Forward View2 from NHS England. Orthodox views about the planning of hospitals, their role in the healthcare system, and how they should develop are being re-evaluated. This scrutiny offers hope to a beleaguered part of the healthcare system.

The Department of Health has not put much serious thought into hospital policy for some time, which may explain why current UK policy could be crudely characterised as: “hospitals—bad and expensive; community and primary care—good and cheap.” This warped view has distorted decision making—for example, by focusing more on where rather than how care is provided. The reports from the Future Hospital Commission and NHS England both challenge this. The commission proposes partnerships between hospitals and primary and community services. NHS England envisages a range of options such as hospitals …

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