A total of 32 trusts are due to merge on 1 April in the first wave but many more are discussing sharing services. The scale of the change is greater than anything that has happened in the last decade. A year ago, a leaked report in The Independent on Labour's plans for a programme of hospital mergers and closures drew fierce denials from the party and triggered a political storm.
Twelve months on, although proposed changes have triggered some local opposition, their extent has not been recognised. A quiet revolution is underway which has attracted little public or political comment.
A spokesman at the Department of Health said: "Ministers have made it clear that changes must be driven by local needs."
Stephen Thornton, director of the NHS Confederation representing health authorities and trusts, said: "There is hardly a health authority in the land that is not considering some form of reconfiguration of services. They are grasping the nettle at last."
The survey exposes the pressures on the National Health Service as it prepares for survival into the 21st century. Demand for savings to meet tight budgets is only one of the factors driving change. The pace of medical advance means that care can no longer be delivered safely from small local hospitals but requires the full range of specialties that only a large institution can offer. In addition, changes in working conditions - such as the cut in junior doctors' hours - mean some hospitals are struggling to provide 24-hour cover.
Typical of the changes are Manchester's plan to concentrate acute services at the 800-bed Wythenshawe hospital, which is to be rebuilt, leaving the Withington, currently with 600-beds, as a community hospital. There are similar plans in Birmingham, Leeds, Newcastle, Durham, Derby and Leicester.
Reports by the British Medical Association and the Royal College of Surgeons back the trend towards bigger hospitals serving populations of around 500,000 on the grounds that consultants with larger caseloads have higher standards of care. Christine Hancock, general secretary of the Royal College of Nursing, said: "The public understands that in specialist units expertise grows with the number of cases nurses and doctors see. If we spread that too thinly, quality suffers."
However, critics say that the strategy is flawed. The Centre for Health Economics at the University of York concluded that there was "no good evidence" that increasing the size of hospitals improved outcomes, and Hay Management Consultants warned that 70 per cent of mergers failed to deliver the required benefits.
Frank Dobson, the Secretary of State for Health, announced in a speech last June that the NHS had to be reshaped to survive, with fewer trusts, an end to the duplication of services by neighbouring hospitals and more, basic care provided in GPs' surgeries closer to people's homes. Last month, following an independent review of hospital closures in London, he announced that most of the changes planned before the election would go ahead - with the exception of St Bartholomew's hospital which won a reprieve.
That has given the green light to other health authorities planning similar closures, mergers and transfers of services. Encouraged by the ending of the culture of competition, doctors and hospital managers have recognised that sharing services with a neighbouring hospital is a better guarantee of survival than protecting their own bricks and mortar.
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