Should trusts be allowed to fail?

摘要

The logic of competition and the inevitable product of collaboration in healthcare markets is that there will be winners and losers. At present, Britain's self governing NHS trust hospitals compete to provide services for patients, and the loss of contracts, for whatever reason, makes their viability uncertain. This was recognised in the government's original white paper on the internal NHS market, which stated that the assets would revert to the ownership of the secretary of state if a trust was wound up. It has now been reported that Anglian Harbour NHS Trust will be dissolved on 31 August after losing contracts to neighbouring trusts. The viability of many other trusts in other places is in doubt, and they await the decisions of the new government to determine their fate. The contraction of the hospital sector is not new. A recent report from the University of London notes that the number of acute beds in London has fallen by 41% in 12 years. Similar trends are evident in me rest of England, where the bed stock fell by 25% between 1984 and 1994. During 1959-90 the number of non-psychiatric hospitals in England fell by 45% to 1185. Since 1990 a further 60 acute hospitals have closed.