ABSTRACT
Hospitals are the castles of the twentieth century. The science of medicine may lag some way behind those of fortification and warfare but hospitals show some of the most important features of medieval military fortification: they are strategically positioned, conspicuous and they are easy to defend. Demand on hospital services is growing fast, but these are often inflexible institutions that may not be best suited to dealing with the problems of modem health and social care. The demand for services is rising continuously, linked to increased public expectations of what the National Health Service (NHS) can offer. Changes to hospitals often create massive conflict for very little result. The practical problems indicating the lack of power purchasers have over providers are graphically illustrated in the attempts to reconfigure services in Bristol – and echo the problems hospital managers have in managing change.
