Hospitals to be axed for NHS 'malls'

Traditional general hospitals-will disappear, to be replaced by specialist centres. There will be:

Three major trauma centres dealing with life-threatening injuries.

Five hospitals to treat stroke victims.

More centres for elective surgery such as hip and knee replacements and cataract operations.

Critics say the reforms are cost-cutting measures which will see the closure of local hospitals. But NHS London insists they will create a world-class health service for the capital. The report, from Prime Minister Gordon Brown's new health minister, Professor Sir Ara Darzi, is a massive shift away from the "one-size-fits-all" hospitals that have defined the NHS.

It says: "The days of the district general hospital seeking to provide all services to a high enough standard are over." Every NHS service from "the cradle to the grave" will be transformed within 10 years if the proposals are adopted.

Professor Darzi, 47, chair of surgery at Imperial College, said: "We will drastically improve the quality of care for people with life-threatening conditions, and at the same time we will significantly improve satisfaction and expectations in 80 per cent of illnesses that are not life-threatening."

He was asked to design a blueprint for the future by NHS London, which manages health provision in the capital, after it found serious weaknesses in the service.

More than one in four Londoners are dissatisfied with the NHS, while doctors' productivity is lower than elsewhere and there are massive inequalities in health across the city.

Professor Darzi's vision aims to overcome these problems, with a mantra of moving care closer to home where possible, but centralising specialist services where necessary. The plans are driven by a rising population that is developing more chronic conditions such as diabetes. The redesign means the health service will be £1.5billion a year cheaper to run than on current projections.

But it will cost millions to implement, and is likely to be funded by sales of hospital buildings, extra money promised to primary care trusts and private finance schemes.

Doctors question the benefit to patient care but health managers say it would improve standards. Studies have shown that victims of strokes and heart attacks fare better when they are treated at specialist centres, but the British Medical Association says shifting work to super surgeries, or polyclinics, would undermine hospitals.

Under a government payment scheme hospitals only get paid for the work they carry out. If they lose work, they lose money.