Published: 16/06/2005, Volume II5, No. 5960 Page 6

It would be 'ridiculous' to imagine that hospitals will close all over the country as a consequence of choice and payment by results, the health secretary has said.

Patricia Hewitt said the government was devising a 'set of rules' for how the service would deal with 'a part of the service that is failing, a part that wants to grow fast, or a new entrant'.

She said it was 'early days' to talk in detail about the work, but guidance including a code of practice would 'start to surface in the autumn' on how health communities should manage failure in the system. She told HSJ: 'I think It is quite wrong if anybody were to imply that hospitals are going to be closing all over the country, because That is ridiculous. But clearly what will happen as we create a patientled NHS is that there will be hospital departments that. . . are not working effectively and efficiently and not delivering the quality as well as the clinical care that patients want.

They will have to change - and if they do not change then some of them may have to close.' But Ms Hewitt took a softer line than predecessor John Reid in describing how 'a very carefully and sensitively managed market' might work. She acknowledged that small changes in the popularity of hospitals among current patients - which could fatally undermine their incomes under choice - would have to be balanced against the needs of the local populations. And she suggested that 'We have got to have a brake in the system' to ensure essential services could be protected.

Asked who would decide to pull the plug if a hospital found its income at risk because it had lost, for example, 5 per cent of patients, and how such a decision would impact on choice for the local population, Ms Hewitt said: 'We already have made it very clear that it is for the local health community to decide what is going to be right for that community so I am not going to sit in London and pretend to know what is the right service configuration. It is got to be done as locally as possible, reflecting not only the patients who are voting with their feet, but also the broader need of the public.' Ms Hewitt said a presentation by a London primary care trust had brought home to her the 'frightening' differences in value for money that hospitals offered. She said it showed some hospitals with almost twice the average length of stay rate for one procedure. The same hospitals had worse clinical outcomes than their peers.