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Hospitals must shrink or shut, says NHS Clinical Commissioners' president

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Half of hospitals will have to drastically shrink or shut altogether because half their services should be provided in the community, according to interim president of NHS Clinical Commissioners.

Dr Michael Dixon, whose organisation represents many of the 211 clinical commissioning groups (CCGs) that last week took control of £65 billion of health spending, said there was 'an awful lot of fat' in the NHS budget.

Dixon cited the example of frail elderly patients, who occupy about 70% of hospital beds and who could be looked after at home by teams of community-based health professionals.

He told The Guardian: 'A very large amount of what's currently done in hospitals could or should be done elsewhere. I think 50%. The implications are that hospitals would need to downsize and become places where you go if you are very ill or need very specialist care and not places where you go for more generalist care or where you can be looked after in the community.'

He added: 'CCGs are up for it. But [doing] this isn't everyone's cup of tea … because it's at a high level and it's politically difficult. We are used to being loved by our patients and having 90% trust and all the rest of it.'

He said CCGs would need 'considerable protection and support' to implement necessary changes.

NHS Confederation chief executive Mike Farrar, said: 'We have a big opportunity to improve care and the way things work. The clinical expertise of commissioning organisations will be a huge asset and we need to take full advantage of it. The NHS is facing its biggest financial challenge, coping with a flat budget and rising demand and costs. This pressure will continue despite the new system, and organisations have a tough job on their hands to continue providing quality care within a much tighter financial envelope. We need to think urgently about changing the way we deliver care, so that it is modern, safe and sustainable for the people who use it.'

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