Sir: Your discussion of the bed closures issue ("Untried cure kills hospitals", 6 March) misreads what the King's Fund has said, as well as misreporting the policy of the NHS. Worldwide, there is no doubt that hospitals are becoming ever more efficient in treating patients as medical technology improves. Many UK hospitals now treat every other waiting list patient as a day case - without the need for a bed.
Neither the King's Fund nor the Tomlinson Report argued that improved primary care would reduce the need for hospital beds. Tomlinson did point out that inner London primary care desperately needed improving. That's what we are doing. We need resources to do it and we can take those from the acute sector if we make the changes in Tomlinson that have been urged on London for most of this century.
Health bodies outside the capital will not accept for much longer the £65m a year subsidy that goes into overhead costs in large London hospitals. But of course district hospitals, both in the capital and outside, will continue to provide routine treatments - in fact they are now treating patients close to home who previously travelled to the London teaching hospitals for care.
The specialist care for conditions such as renal failure, cancer and heart disease is best carried out in departments which have a critical mass of patients so that the medical teams gain wider experience and provide safer care. That is the argument - coming from medical professionals themselves - for larger, fewer hospitals in cities like London.
Yes, there is an increase in emergency cases, and we must address the problem of trolley waits - but the answer is not simply more beds, but getting the right beds in the right place for the right patients. And also working with our colleagues in social services and the independent sector to ensure that sufficient high quality nursing home accommodation is available so that elderly people who should not be in hospital don't have to be.
A moratorium on all bed closures is a nonsense. Medical treatments are constantly changing and the NHS must respond. Hospitals now decide on the beds they require according to contracts they hold with health authorities, which set out where they need particular specialities to be provided.
It is the role of the purchaser and providers together to improve the short-term and the long-term use of beds. It is not the number of beds that matters but the number of patients who are treated and the quality of that treatment in primary, secondary and tertiary care.
Change cannot be avoided. London's hospitals have been absorbing too high a share of NHS resources, at the expense of hospitals elsewhere and primary care standards in the capital. The balance must be redressed, sentiment aside, it is patients who will gain (the Independent, February 1993).
Regional General Manager,
North Thames RHA
Regional General Manager
South Thames RHA