Bed shortages are now the worst for 30 years, according to the British Medical Association, yet a new survey being published tomorrow shows that cities such as Glasgow, Edinburgh, Birmingham and Manchester are going to suffer new permanent bed cuts similar to those proposed for London by the recent Tomlinson Report.
As the new National Health Service market begins to bite, city centre hospitals are losing contracts to suburban and county hospitals because they are cheaper. Loss of contracts means loss of beds.
The survey, appearing in a new medical magazine Healthcare Management, shows that Glasgow will lose 1,200 beds, Edinburgh 1,000, Cardiff 1,000, Manchester 500 and Birmingham 500.
'The effects on medical education will be devastating,' says Professor Arie Zuckerman, dean of the Royal Free Hospital School of Medicine, north London.
'It is impossible to solve the problem of bed shortages by training medical students entirely in the community because GPs are not trained in teaching and are too busy, and if you send them to district general hospitals all over the country, it is expensive in time and money.'
Although doctors and patients are aware of the plight facing London, following the Tomlinson Report's proposal to cut 2,500 beds in the capital, many do not realise a similar fate is about to hit their own cities over the next few years.
Managers are more conscious of the coming cuts. 'We are convinced that after the Government has implemented the changes in London, it will do a similar exercise on Birmingham or Manchester,' said an NHS manager.
Professor Chris Ham, a health economist, of Birmingham University's Health Services Management Centre, added: 'You will find the Tomlinson issue arising in many major cities. There are two strands. One is the impact of the NHS reforms and the other is the way medical technology is developing, so that we will need fewer hospital beds on fewer sites in the future.
'The two strands reinforce each other. The reforms make it less viable to have services on many expensive sites with high capital charges,' he added.
In south Manchester, managers are proposing to merge the Withington and Wythenshawe hospitals on to one site with the loss of 500 beds, while in south Birmingham, they are proposing to merge five hospitals into the South Birmingham Medical Centre, with a similar loss of beds.
In the first year of the market, the Royal Orthopaedic Hospital, Birmingham, lost pounds 1m of contracts, seriously destabilising the hospital, as doctors sent their patients to cheaper alternatives.
In Glasgow, the problem is worst, with the authority proposing to close 1,200 beds out of a total of 4,400. 'This is not an issue we can duck,' says Laurence Peterken, general manager of the Greater Glasgow Health Board. 'Jobs will be lost and we estimate that they will be of the order of 3,500 over four to five years.'