Intended for healthcare professionals


What if the NHS moved most care out of hospital?

BMJ 2017; 356 doi: (Published 08 February 2017) Cite this as: BMJ 2017;356:j602
  1. Sue Brown, former head of public policy, Sense, London, UK
  1. suecbrown{at}

Last year the King’s Fund ran an essay competition for contributions to its series“the NHS if,” exploring hypothetical futures for the health service. Here, we publish the winning entry by Sue Brown

I’m sitting in the coffee shop of my local primary health centre. In the corner a nurse is chatting to a man over coffee. They have some forms on the table. I guess that she’s helping him claim benefits, and no doubt slipping in some healthy eating advice as they talk.

On the noticeboard is a photo of the closure of another ward in the local hospital. There was quite a crowd cheering as the local MP drew a curtain over the door in celebration of another sign of the success of moving care closer to home. I’m old enough to remember it wasn’t always like this; years ago, the crowd would have been waving placards in protest. I tried to tell my grandchildren this but they didn’t understand. “You mean people wanted to be in hospital?” they said, incredulous.

The change all started with the election of the second coalition government. Those were difficult times. Home care agencies were closing, and the government had to step in to prevent the complete collapse of social care in three areas in just six months. It was taking four weeks to get a general practitioner appointment, and several patients died in ambulances queued up outside overcrowded emergency departments. …

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