Smaller community hospitals should play a bigger role especially in the care of older patients, the new head of the NHS in England has said.
In an interview in the Daily Telegraph, Simon Stevens signalled a marked change in policy by calling for a shift away from big centralised hospitals.
The health service chief executive said there needed to be new models of care built around smaller local hospitals.
The NHS said he was not suggesting the return of 50s-style cottage hospitals.
In recent years the health service has emphasised the benefits of centralised services.
This has paid dividends in areas such as stroke care and major trauma where significant benefits have been gained by concentrating specialist care.
But this has raised questions about the future of the many smaller district general hospitals across the NHS.
In the interview in Friday's paper, Mr Stevens said they should play an important part in providing care, especially for the growing number of older patents who could be treated closer to home.
He said: "A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS.
"Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised."
Hospital closuresSimon Stevens' support for smaller hospitals comes as, in some parts of England, such hospitals close.
On Tuesday the closure of Ashby District Hospital in Leicestershire was announced.
A commissioning group said the 16-bed hospital needed £900,000 of repairs and was underused, and said it wanted to provide "more services closer to people's homes".
Earlier this month a health trust said Poltair Hospital in Cornwall would close, saying the "cost of backlog maintenance work to meet current standards is too expensive".
But West Cornwall Health Watch said the decision was based on "dangerously unproven assumptions" and West Cornwall MP Andrew George called it a "backward step".
Lowestoft Hospital in Suffolk closed its 25-bed inpatient facility at the end of March and the main hospital building is due to close later this year.
The hospital's north wing is to be redeveloped to offer services including phlebotomy and outpatient clinics.
But Lowestoft Coalition Against the Cuts said many elderly people would suffer owing to the closure of such "excellent local hospitals".
Mr Stevens said elderly patients were increasingly ending up in hospital unnecessarily because they had not been given care which could have kept them at home.
Mr Stevens also told the Telegraph:
- The NHS needed to abandon a fixation with "mass centralisation" and instead invest in community services to care for the elderly
- Waiting targets introduced by Labour became "an impediment to care" in too many cases
- The European Working Time Directive damaged health care in the NHS, making it harder to keep small hospitals open
- Businesses should financially reward employees for losing weight and adopting healthy lifestyles
An NHS England source said Mr Stevens was saying that smaller hospitals had a part to play in shifting services into the community, not that there would be no closures of local hospitals in the future.
Helen Tucker, vice president of the Community Hospitals Association, told BBC Radio 4's Today programme Mr Stevens' comments were "great news", sending a "good, strong message that small is beautiful".
A "balance is needed" with centralised specialist hospitals, she said, but smaller institutions were "the hospitals that local communities really value," she said.
Mr Stevens, a former adviser on health to Tony Blair, will outline his vision for the NHS in a major speech at the NHS Confederation conference in Liverpool on Wednesday.
He took up the post of chief executive of the NHS in England after 11 years working for private health care firms in Europe, the US and South America.
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