Thinktank Urges Smaller Hospitals to End NHS ‘Permacrisis’

Published: 24 November 2025. The English Chronicle Desk. The English Chronicle Online.

A leading thinktank has urged that hospitals must become smaller to help rescue the NHS from its “permacrisis.” Re:State, formerly known as Reform, said hospitals require a fundamental reinvention to prevent widespread overcrowding that has worsened over the past decade. Politicians and NHS leaders may need to make difficult, potentially controversial decisions to downsize hospitals while maintaining patient care and service standards.

The report argues that smaller hospitals could save billions of pounds, improve patient outcomes, and relieve pressure on overworked staff. By expanding care delivered in people’s homes and local community settings, thousands of hospital beds may become unnecessary. Diagnostic tests, outpatient appointments, and treatments can increasingly be provided outside traditional hospital settings, reflecting changes brought by an ageing population.

Rosie Beacon, the author of the report, said, “It is less about counting beds and more about what hospitals do and how care is delivered. Hospitals can shrink while providing the same or even better care, more efficiently and cost-effectively.” She emphasised that smaller hospitals are a result of faster, more effective care, not a reduction in services.

NHS England data show that general and acute hospital beds in England have fallen from 180,889 in 1987-88 to 100,916 last month. Advances in treatment have reduced patient stays, easing bed pressure. Yet hospitals still face the recurring challenge of winter demand, requiring temporary expansion of beds.

Prof Joe Harrison, chief executive of Milton Keynes University Hospital NHS Trust, said stabilising the service requires radically rethinking hospital roles and delivery methods. He urged leaders to ask difficult questions and take bold decisions to improve access, quality of care, and staff wellbeing.

The report is endorsed in a foreword by the chief executives of NHS Confederation and NHS Providers, who represent 215 English health trusts. Matthew Taylor and Daniel Elkeles stated, “The NHS, once visionary, now struggles with waiting times more than healing. A system designed in 1945 is not fit for 2025. Hospitals, as the most costly part, must be central to reform.”

A Department of Health and Social Care spokesperson said the NHS is already shifting care away from hospitals through its “three big shifts” initiative. Neighbourhood health centres aim to provide convenient access to healthcare locally, while community diagnostic centres offer tests and scans closer to home. Future hospitals are being designed with single-patient rooms and modern technology to increase efficiency, sustainability, and patient care.