Priorities in a London teaching hospital: a health services research approach to gynaecology provision.

In late 1987, as part of the response to an overspend of pounds 3.2 million, the health authority of an inner London teaching district, Paddington and North Kensington, proposed to close urgently 16 of the 56 gynaecology beds at the Samaritan hospital. They did so on the assumption that the hospital often served women who were neither local nor required the special expertise of a teaching hospital. To test this assumption, we reviewed the functions and funding of the hospital, how its activity level and size compared with other districts, and the nature of the workload, i.e. the extent to which the patients were local or non-local, or needed routine or specialist care. It was agreed that non-local routine patients are the district's lowest priority, and we demonstrated that such patients account for no more than six to 11 beds. This information helped to resolve negotiations over the bed numbers. This study demonstrates that it was possible to defuse a potential confrontation by using routinely available and additional survey data to inform the debate.