There is a tendency in some quarters to defend the very small hospital on the grounds of its localism and intimacy, ' declared Aneurin Bevan 50 years ago, during the parliamentary debates that led to the establishment of the NHS.
'But if a hospital is to be efficient, it must provide a number of specialised services, ' he went on. 'Although I am not a devotee of bigness for bigness' sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one.'
It is a measure of how little the debate has moved on that these words might just as easily be spoken by a health minister today - if ministers today were as inclined to be quite so forthright when faced with the massed ranks of middle England complaining about the loss of cottage hospitals (See News, page 4).
Alas, they are not. Health minister Baroness Jay says only four cottage hospital closures have been referred to the health secretary. This is disingenuous: had consultation in Oxfordshire and elsewhere ended, there might be rather more awaiting his decision. Not that her words will have given Oxfordshire health authority much cause for celebration. Reconfiguration has its merits - and they have as much to do with changing patterns of population and equity of access as with the 'cold efficiency' versus the 'gush of warm sympathy' argument. But to judge by Baroness Jay's comments, ministers now do not incline towards Bevan's example.