Enoch Powell’s A hospital plan for England and Wales set out plans to develop a programme of hospital building until the 1970/71 financial year. The plan had two purposes: first, to establish the size and types of hospitals needed together with GP and domiciliary services, and, secondly, to initiate rebuilding. Local authorities had also been asked to prepare similar plans for their services.
The government highlighted the fact that hospitals had evolved in a piecemeal fashion over a period of time by different institutions and for different purposes, serving different sized populations. The plan accepted the concept of the district general hospital, which should be in or near the centre of the population it served so the hospitals were easy to reach and accessible by public transport. The paper also focused on the development of community care and the role of primary care professionals.
The government estimated the capital cost of the programme to be £500m in the first 10 years. Perhaps unsurprisingly, those costs rose. It was estimated in 1964 that capital expenditure for the first five years of the plan would be £300m, with £450m being spent in the next five years. In the first three years of the plan, 95 major schemes were completed and 66 new or substantiality remodelled hospitals and 84 other major schemes had been started. There had been little hospital building for years and, unsurprisingly, the costs were grossly underestimated.