Leading Article: Mrs Bottomley's credibility gap

ONLY A few years ago, having a pacemaker fitted was traumatic and dangerous. It required open-heart surgery and frequent battery changes. Yet today's techniques mean the operation could hardly be simpler.

The device is inserted, almost bloodlessly, via a catheter. A cardiologist in Los Angeles can reset the pacemaker of a person thousands of miles away in New York if doctor and patient are linked along a telephone line by a modem.

Such technological advances help explain Virginia Bottomley's prediction yesterday that the National Health Service could see the loss of 50,000 acute beds. In future, people will need to stay in hospital less often and for shorter periods. Instead of recovering in what the Secretary of State for Health styled 'the Gothic horror of St Swithin's', they will be treated more at home, in health centres or as outpatients.

Patients' needs, too, are changing. Those who would once have died now live for years with illnesses such as diabetes, kidney failure and cancer. Life expectancy has lengthened in the past 50 years, but so, too, has the period in which people's lives are restricted by chronic and crippling diseases.

For most people, ill-health is better than death and home is preferable to hospital. Only in this century have hospitals become a popular option for the sick. Previously, they were avoided as dangerous places rife with infectious disease. Only the very cautious will miss long stays in hospital.

Mrs Bottomley was therefore partly right to herald bed reductions as a sign of improvement rather than decline. Britain has been at the forefront of a trend common to most industrialised countries. A figure of 50,000 may seem large, but more than half that number disappeared virtually unremarked during the Eighties.

Yet it is hard to congratulate Mrs Bottomley on bed closures when waiting lists exceed one million. Psychiatric patients are still discharged scandalously early into inadequate care in the community and elderly people see their savings rapidly dwindle on fees because the NHS has shut public nursing homes. The Secretary of State's enthusiasm for closing beds, however rational, is hard to swallow.

Mrs Bottomley has failed to convince Londoners of the reasonable case for reducing the number of hospitals in the capital. After that public relations disaster, she might have been expected to display more political sensitivity.

Yet she still seems to think that figures spelling success to an accountant will also win over a housebound pensioner waiting for a hip replacement, or a mother who fears that her schizophrenic son will commit suicide because no psychiatric bed can be found for him.

The case for the long-term switch from hospital care is sound. But Mrs Bottomley deludes herself if she thinks the public will believe her until she makes sure that services fulfil the real and often urgent needs of patients. So far, she has not earned that trust.