A new Fabian pamphlet Challenging the Citadel: Breaking the hospitals' grip on the NHS sees health select committee member Dr. Howard Stoate MP and Bryan Jones argue that the NHS is far too focused on the hospital as an insitution.

The new NHS should be about public health and health prevention. But if the dominance of the hospitals continutes we will find ourselves unable to make substantial improvements in health outcomes, and the NHS will be ill-equipped to cope with the pressures it will face in the 21st century.

The report, 'Tackling the Citadel, breaking the hospitals' grip on the NHS' proposes a coherent package of changes:

• Ensure that there is a school nurse in each and every primary and secondary school.
• Abandon the foundation trust model and integrate primary and secondary care services to form single care trusts with single budgets to remove the divide between the primary and secondary sectors.
• Put teams of specialist GPs in charge of A&E departments to help ensure that only patients in need of acute nursed beds are admitted, and that patients with non-urgent conditions needing follow-up care are treated in the community.
• Draw a line under the PFI initiative as far as hospitals are concerned, and look for other more flexible ways of financing our future acute sector infrastructure needs.
• Redeploy 10 per cent of nurses working in acute trusts in order to increase the range of preventative and disease management activities undertaken in the community.
• Make extra investment available to enable ambulance paramedic crews to develop their patient assessment and management skills and ensure that patients with primary care needs are referred to their GP, or the primary care out of hours service, rather than being taken automatically on an unnecessary trip to their local A&E department.
• Prioritise the creation of a network of multi-disciplinary polyclinics across the country.
• Ensure that every local authority appoints its own health champion and give them the power to scrutinise every major policy decision taken by the local authority.

About the authors

Howard Stoate has been the Labour Member of Parliament for Dartford since 1997. He is a member of the House of Commons Health Select Committee, Chair of the All Party Parliamentary Group on Primary Care and Public Health and an Officer of the Parliamentary Labour Party Health Committee. He is also a practising GP and a fellow of the Royal College of General Practitioners.

Bryan Jones is researcher to Dr Howard Stoate MP and a Labour Councillor on Dartford Borough Council. He is also a research student at the LSE.