Hospitals must get smaller to stop NHS ‘permacrisis’, thinktank urges

2 hours ago7 min read

The National Health Service, that great and beleaguered institution born from the ashes of war to promise cradle-to-grave care, finds itself once again at a precipice. A new report from the thinktank Re:State is not merely calling for another round of tweaks or temporary funding injections; it is demanding a fundamental reinvention of the hospital itself, arguing that to save the NHS from its entrenched 'permacrisis', hospitals must paradoxically become smaller, with fewer beds.This is not a simple prescription for shrinkage but a profound reimagining of the very architecture of care, a shift away from the monolithic, acute-focused models of the 20th century toward a more distributed, community-centric ecosystem. For over a decade, the image of hospital corridors choked with patients on trolleys, of ambulances queuing for hours, has become a grim tableau of winter, a seasonal ritual of systemic failure.The Re:State analysis correctly identifies that this overcrowding is not an anomaly but a symptom of a model stretched beyond its logical limits, where hospitals have become the default catch-all for a society's health woes, many of which are better addressed in primary care, social care, or even people's own homes. This vision aligns with a broader, feminist-informed policy perspective that prioritizes preventative, holistic care over reactive, institutional intervention—it’s about building a health system that supports well-being upstream, rather than just rescuing the drowning downstream.The political and human implications are vast. Such a transition would require a monumental investment in community health services, district nursing, and social care—sectors traditionally dominated by female workforces and historically underfunded and undervalued.It challenges a political culture often obsessed with bed numbers as a facile metric of healthcare strength, forcing a more nuanced conversation about what truly constitutes quality care. One can look to the personal impact on a patient like Margaret, an elderly woman with COPD, for whom a smaller, more specialized local unit could provide better, more dignified care than a chaotic, overburdened A&E department.Yet, the path is fraught with risk. Without simultaneous, robust investment in the community safety net, shrinking hospitals could simply mean abandoning the vulnerable, exacerbating health inequalities that already scar the nation. The report, therefore, is not just a technical blueprint; it is a deeply political document, a call to re-evaluate our collective priorities and finally build a National Health Service fit for the complexities of the 21st century, one that truly cares for people, not just processes.

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#NHS

#healthcare reform

#hospital restructuring

#UK health policy

#permacrisis

#thinktank report