MP Howard Stoate argues that the public needs to be persuaded that the government's plan to close hospitals will be good for health care.

The government is losing the public debate on hospital closures, Howard Stoate MP, and member of the Health Select Committee, will warn ministers at a Fabian Society seminar this week.

Stoate, a GP in Dartford and one of the most respected MPs on health issues, will outline his fears about losing public support for NHS reform at a seminar with health minister Andy Burnham

Stoate's warning comes after a series of MPs have joined demonstrations to save local hospitals from closures. He says: 'The public is confused about what is at stake. This isn't about the short-term financial balancing of the books in the NHS. We need to show why patient care outside hospitals works better."

'People are very attached to the NHS – and hospitals are the most powerful symbol of it. But people going to hospital is a sign of failure for our health system – we need to do more to treat people earlier

'All of the health experts are convinced that a better system would do more outside hospitals. But the language of more prevention and more public health doesn't yet mean much to the public.

Stoate's report for the Fabians, Challenging the Citadel, lays out evidence of why change is needed:

• One in four emergency admissions consist of people with chronic conditions who yo-yo in and out of hospital and who could be helped by medical staff in the community.
• A hospital bed per night costs around £500, compared with £168 for a four-star hotel.
• Patients admitted on a Thursday tend to stay an average of two extra days as hospitals run only a reduced staff over weekends. Patients admitted on Sundays stay an average of 5.7 days.
• Treating a patient in a clinic rather than in a hospital is far cheaper. In Germany where these community medical clinics are used, the cost of hospital treatment is Euro 350, compared to Euro 50 in a community clinic.

Other European countries are successfully pursing policies to bring more health treatment closer to people's homes and out of hospital wards. In France 17,000 hospital beds were closed in five years, instead specialist care units dealing with cancer and Alzheimers were opened in the community.

The average practice nurse has an average of 3,885-5,202 patients, compared to a GP's 1,720-2,183. More nurses are needed in the community, he argues.

A Fabian report on the health service calls for 10% of acute nurses to be moved away from hospitals and into the community. The report's author MP Howard Stoate says hospitals' grip on the health service needs to be loosened in a report for the Fabian Society to be launched this week.

He says: "Our goal must be to use expensive hospital care only when necessary."

But he suggests major changes in the way GPs run their surgeries are also needed: "Can we really blame patients for turning up at their local A&E with relatively minor complaints when their GP's surgery is closed in the evenings?"

His recommendations include:

• Making extra investment available to ambulance paramedics to improve their patient assessment skills, so they can ensure that patients do not have to go on unnecessary trips to A&E.
• Putting teams of GPs in charge of A&E departments to ensure that only patients in need of an acute bed are admitted and others are referred to their GP.

Dr Stoate says: "To the average GP it makes sense to treat patients closer to home for clinical as well as financial reasons."

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