From ‘Plan’ to ‘Programme’, 1962–73
In relation to the history of hospital development in Britain, the Plan could be viewed as marking both the high point of regionalism, centralised development and modernism. It could also be viewed as marking the beginning of the end for all of them. Initially, the period reviewed in this chapter was characterised by considerable faith in state intervention, planning and expertise. Combined in the case of hospital provision, the result would be a network of DGHs which would make high-quality medical services available to all. This optimistic vision came to be tarnished in several ways. The Plan’s financial assumptions were partly invalidated by changed economic circumstances, and there were concerns that the associated revenue implications of new hospital development had not been thought through. It was an exercise in modernisation which had to rely for implementation on a construction industry which struggled to cope with the task. The Plan represented an attempt to reform the welfare state through capital investment in labour-and energy-saving technology, and to impose some principles of standardisation on service provision. In this sense the Plan symbolised the triumph of optimism about the capacity of technology to achieve such objectives, but its implementation indicated the limits to such solutions. The top-down nature of the Plan, and the speed of its preparation, almost guaranteed major implementation problems as sites proved unavailable or as local alliances of politicians and professionals threatened major amendments or to derail the plan altogether. As if this were not enough, the period was characterised by growing evidence of dissatisfaction with planning, resulting in opposition to centralised development and resistance to closure of small hospitals.