Hospital services in nearly two-thirds of England could be cut or scaled back, BBC analysis of local plans shows.
The proposals have been made by NHS bosses as part of a national programme to transform the health service and save money across 44 different areas.
The BBC found 28 affect hospital care, from full closures to centralising services such as accident and emergency and stroke care on fewer sites.
Ministers argue patients will receive better care in the community.
Alongside cuts to hospital care, the proposals include the creation of “super” community hubs of GPs, care workers and district nurses, seven-day access to GPs and getting hospital specialists to run clinics in the community.
But the King’s Fund think tank, which has also carried out its own review, warned a lack of investment meant these ideas were not always credible.
The government is investing more money in the health service, but a fund set up to pay for changing services has been used to tackle NHS deficits, figures released on Monday showed.
The BBC analysis found:
- Plans to reduce the number of hospital sites in Leicester, Leicestershire and Rutland from three to two
- Maternity and children’s services being “centralised” on to one site in Lincolnshire
- A warning in West Yorkshire and Harrogate that having five hyper-acute stroke service may “no longer be viable”
- The downgrading of two out of three A&Es in Mid and South Essex, with only one retaining specialist emergency care
- In South West London, proposals to reduce the number of major hospitals from five to four
- Plans in Nottinghamshire to significantly downsize City Hospital and reduce the number of beds across Nottingham by 200
- In Cambridgeshire and Peterborough, consideration being given to centralising specialised orthopaedic trauma services at two local hospitals
The King’s Fund went on to warn that community services in many areas were already “feeling the strain” and could not cope with an increase in workload.
And the think tank said further reductions in the number of hospital beds could de-stabilise services that were already “stretched to their limits” following the difficult winter.
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Find out the NHS plans in your area
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The proposals – known as sustainability and transformation plans – have been drawn up as part of NHS England’s five-year strategy to release £22bn of efficiency savings by 2020.
Reviews were set up in early 2016 and consultations on major changes will take place later this year with the hope implementation will follow soon after.
But the King’s Fund warned the changes could be subject to legal challenges.
How closing hospital services can be good
Stroke care in London is now world class – and it is all because some services were shut down.
The capital’s stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight “super sites”.
It has meant patients get fast, 24-hour access to the best care, saving hundreds of lives a year.
If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.
However, Prof Chris Ham, the think tank’s chief executive, said they were still the “best hope of delivering essential reforms” in the NHS, as care needed to be moved out of hospital.
This is seen as vital because the ageing population and growth in long-term conditions such as dementia and heart disease mean people are more likely to benefit from support in the community to stay well rather than inpatient hospital care when their health deteriorates.
But Prof Ham said this could not be done without extra funding – and urged the government to find the money to invest in the services to enable transformation to happen.
A £1.8bn pot set aside this year for funding transformation has been used to shore up NHS trust finances as they struggle to balance their books.
“Local plans must be considered on their merits, but where a convincing case for change has been made, ministers and local politicians should back NHS leaders,” Prof Ham said.
A Department of Health spokesman maintained the extra money was being invested in the NHS this Parliament gave the health service enough funds to change the way it worked.
“These NHS plans – developed by local doctors, hospitals and councils working together with the communities they serve – will help patients get better care,” he added.
And a spokeswoman for NHS England said current plans offered the best hope of improving patient care in a sustainable way.
“They will allow the NHS to take advantage of new technologies, adopt successful practice more widely, and make practical improvements in areas that we know matter most to patients,” she added.
“These proposals are all about putting collaboration at the heart of our care system, with health and local government working more closely together than at any time since the NHS was created. Everyone in the NHS wants help to ensure we can all get excellent care whenever we need it.”
1. Northumberland, Tyne and Wear
2. West, North and East Cumbria
3. Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby
4. Lancashire and South Cumbria
5. West Yorkshire
6. Coast, Humber and Vale
7. Greater Manchester
8. Cheshire and Merseyside
9. South Yorkshire and Bassetlaw
11. Shropshire and Telford and Wrekin
15. Leicester, Leicestershire and Rutland
16. The Black Country
17. Birmingham and Solihull
18. Coventry and Warwickshire
19. Herefordshire and Worcestershire
21. Cambridgeshire and Peterborough
22. Norfolk and Waveney
23. Suffolk and North East Essex
24. Milton Keynes, Bedfordshire and Luton
25. Hertfordshire and West Essex
26. Mid and South Essex
27. North West London
28. North Central London
29. North East London
30. South East London
31. South West London
32. Kent and Medway
33. Sussex and East Surrey
34. Frimley Health
35. Surrey Heartlands
36. Cornwall and the Isles of Scilly
39. Bristol, North Somerset and South Gloucestershire
40. Bath, Swindon and Wiltshire
42. Hampshire and the Isle of Wight
44. Buckinghamshire, Oxfordshire and Berkshire West