The accelerating pace of medical advances could make the traditional district general hospital obsolete by the early part of the next century, according to leading doctors, health service managers and academics.
The notion of a hospital without beds is already under scrutiny as part of the proposed reorganisation of London's health services. It is one of a range of options being examined by the Guy's and St Thomas's NHS hospital trust.
Day-case surgery accounts for a growing proportion of NHS and private sector operations, 25 to 30 per cent in some hospitals. Most trusts are planning to expand day surgery facilities. The rise of the bedless hospital is predicted in a report on health trends in the UK, based on the views of more than 400 doctors, managers, policy-makers and academics. 'Patients are likely to find that they need to be admitted less frequently. Hospitals may become hospitals in name only, providing a range of out-patient and day care services.'
Most of those contributing to the report predict more explicit rationing of health services over the next few years, and the phasing out of certain state-funded treatments. But the availability of certain NHS treatments will increasingly depend on where you live, as district health authorities pick and choose what services to buy from hospitals.
Rationing by price, according to the experts, is unlikely before the next general election. A bigger contribution by patients to prescribed drug costs is widely mooted.
However, the cottage hospital - once a cornerstone of health care in rural and suburban areas - appears set to make a comeback to accommodate long-term patients, having virtually disappeared from most parts of the country over the past two decades. More doctors are likely to be promoted into management jobs, and given financial incentives to ensure that medical colleagues stay within budgets.
Survey respondents believed that private health companies would diversify and offer additional services, perhaps even contracting with health authorities to provide accident and emergency treatment.
An increase in people covered by private health insurance, from about 12 per cent to 19 per cent by the turn of the century, was also predicted.
Bill Lattimer, a partner in Andersen Consulting, which carried out the study, said yesterday: 'In response to increasing demands, the Government has three options - restrict access to health care, introduce more money into the system . . . or make the NHS more efficient. Probably it will pursue a combination of all three.'
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