Up to 100 cottage hospitals in England which are under threat of closure by primary care trusts trying to control overspending were reprieved yesterday on the orders of the health secretary, Patricia Hewitt. She said they may play an important role in plans to move 5% of the workload of the big general hospitals out into the community, closer to patients' homes.
The change of heart came in a white paper that promised a consumerist revolution in NHS care, including:
· giving patients more choice of GP, including registration with a practice near work instead of near home;
· incentives for GPs to develop practices in under-doctored areas, with national contracts to attract private firms, charities and social enterprises to bid for the work;
· opportunities for respite for carers and individual budgets to allow people to buy their own packages of social care;
· online "NHS life check" questionnaires to help people discover their personal health risks, with advice from health trainers if there is a problem.
The 227-page document sets the stage for a historic switch of spending away from the big acute hospitals that have dominated NHS provision for more than 50 years, with consultants expected to hold routine outpatient clinics in GP health centres and community hospitals. Many inpatients will also be moved to beds in community hospitals.
Ms Hewitt announced the building of a new generation of 50 polyclinics to provide extra capacity, including minor surgery and diagnostic tests. The proposal highlighted an inconsistency in moves to close cottage hospitals by cash-strapped primary care trusts. Lord Warner, the health minister, said 50-100 of the 350 community hospitals across England were being considered for closure.
Ms Hewitt said: "If there are community facilities that are needed for the long term they shouldn't be closed down due to short-term budgetary problems. We are asking PCTs to reconsider their decision against the principles of this white paper."
Ms Hewitt said hospital budgets would not be destabilised by the switch of resources, coming on top of greater competition and payment by results. They would have plenty of work treating more complex cases and bringing maximum waiting times down to 18 weeks. The government would also press ahead with plans to build another wave of acute hospitals under the private finance initiative.
Anna Walker, chief executive of the independent Healthcare Commission, said patients wanted treatment nearer home. "But they need to know there are high standards of quality and safety, whether they are in a clinic in a hospital, a walk-in centre at a railway station, or a GP's surgery in a supermarket." Hamish Meldrum, chairman of the British Medical Association's GPs committee, said: "Many practices are already offering longer opening hours but there will need to be resources in place to expand this more widely. We cannot stretch our existing workforce any further."
Karen Jennings, Unison's head of health, said: "Billions of pounds of public money has gone into building hospitals with outpatient departments which are now in danger of becoming redundant." The new generation of polyclinics would be built using a modified version of PFI "that will lead to more profits for private companies and more debt for the public".
The private firms
The white paper gave private firms the green light to run health centres in under-doctored areas.
Companies in the running to bid for the work include United Health Europe, an offshoot of the largest healthcare corporation in the US, which is headed by Simon Stevens, the prime minister's former health policy adviser. This month it beat off 18 competitors to win the right to run two health centres in Derbyshire.
Other players include Mercury Health, a private provider working in alliance with Chilvers and McCrea, an entrepreneurial chain of GPs. The government will run national procurement contests and local people will be able to trigger a "community call for action" if they think local GP services need supplementing.
