Search tips
Search criteria 


Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 11; 335(7614): 272.
PMCID: PMC1941888
Insolvent Hospitals

It's not just whole hospitals

Stephen Black, management consultant

Ham points out the importance of the choices the government makes around failing hospitals.1 Almost every proposed reconfiguration will provoke local opposition from the people who live next door to the hospital. But what should matter for serious decision makers is not the views of the IMBYs (everyone wants a hospital “in my back yard”) but a rational standard of provision. For example, we might try to maintain general hospital levels of service in a certain travel time of the population (with perhaps a much less stringent limit for services that require substantial critical mass).

But this sort of analysis is rarely seen in the context of reconfiguration. For England we recently found that if we set an acceptable access standard of 30 minutes' travel by road (actually quite a stringent target) we find that about 7% of the English population have no provision (this is mostly the rural fringes), but a remarkable 55% of the population have three or more hospitals available. Ten per cent have more than 10 choices at this standard of provision.

Thus there are parts of the country where even the complete closure of a major hospital would not leave a black hole for provision, and the government should stand up to the IMBYs. Many of the most controversial proposed reconfigurations are in well provisioned parts of the country, where the proposed changes could give people substantially better quality provision at an only marginally less convenient location.


Competing interests: None declared.


1. Ham C. What to do with insolvent hospitals. BMJ 2007;335:170 (28 July.) [PMC free article] [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group