Objectives. This article aims to describe recent changes in English hospitals, with particular reference to the impact of the National Health Service (NHS) and Community Care Act of 1990.
Methods. Significant policies that have affected the functioning of the hospital sector of the British NHS are reviewed. Data from the NHS Department of Health are used to describe trends in utilization.
Results. The NHS and Community Care Act of 1990 radically changed the financial and organizational framework within which hospitals operate. By creating separate purchasing organizations, the act opened the way for competition between hospitals. In practice, such competition has been very limited. Central directives aimed at reducing waiting times for nonurgent admissions, as well as at raising the volume of work done relative to the finances available have been more significant influences. These changes, combined with rising numbers of emergency admissions, have put the physical and human resources of English hospitals under intense pressure. Admissions have risen, lengths of stay have fallen across all age groups, and ambulatory care has grown rapidly.
Conclusions. There is little consensus on the future direction regarding the role and structure of acute-care hospitals. There is evidence, though, that improvements in the process and outcomes of care are possible within the current financial and organizational framework of the hospital sector.