Staffing the Service Available to Purchase

Ever since Enoch Powell, then Health Minister, secured Cabinet approval for the Hospital Plan in the early 1960s, it has been clear that expensive items like hospitals cannot be placed on every street corner, even if that is what some patients would like. In most parts of the UK old scattered institutions have indeed been replaced by large new district general hospitals (DGHs) in fulfilment of the plan, but recently, understandable resistance to the idea of ‘big is beautiful’ has persuaded some authorities that they can afford to split their acute services between two or more sites. This paper will try to show not only that this is a mistake, but that the time has now come for a major new initiative to encourage a rationalisation of the NHS estate so that acute services are provided wherever possible on only one site in each district — in other words, a new Hospital Plan.