Hospital mergers prescribed as best tonic for ailing NHS

DOCTORS' LEADERS called yesterday for a programme of hospital mergers and reorganisation to concentrate expertise and minimise risks to patients.

"Super-hospitals", serving a population of at least 500,000, about twice the present size, should be the target to ensure high-quality specialist care for patients, a report by three medical organisations says.

Some casualty units would have to close and smaller hospitals would be downgraded, providing low-tech care in co-operation with nearby larger ones.

The report, by the British Medical Association, the Royal College of Physicians and the Royal College of Surgeons, adds to the growing consensus among ministers, doctors and managers, that the NHS must adapt to survive, with specialist services concentrated in fewer hospitals while routine treatments are delivered by GP clinics and health centres.

The growing complexity of medicine means specialist treatments can no longer be safely provided in small local hospitals, where consultants work alone without the back-up of a full medical team. It will mean more travelling for patients, because there will be fewer, larger units, but better care when they arrive.

The report says there should be no single-handed consultants in any of the main medical or surgical sub-specialties, regardless of the size of hospital, and there must be a big increase in the number of consultants to provide services of the necessary high quality. However, it acknowledges that the average-sized district general hospital, serving populations of 250,000 to 350,000, will remain the backbone of the NHS for some time. Although they can provide most hospital services, "it will not be possible for each locality to have its own acute hospital and accident and emergency unit".

The report adds: "Hospital closure is not intended. Those hospitals no longer able to provide acute services will be valuable in providing out- patient services and rehabilitation."

The Senate of Surgery said the number of hospitals providing advanced surgery should be halved to ensure access to a full range of specialists and top-quality care.