Dear Susan... Mungo & Jaime... are the lights going out on the NHS - as we know it?...

This fourth Dear Susan... paperback came about following the publication of the government's 'Fit for the Future' 10 Year Health Plan - for England, published in July 2025. The author LB was interested to see if the proposal for new smaller hospitals, set out in his previous Dear Susan... trilogy, might also be applicable to the setting up of new centres for Neighbourhood Health Services (NHCs).

The government's proposals are about energising a shift away from hospital-based care to community-based services. It aims to 'end the use of hospitals by default' by introducing neighbourhood health services as an alternative to hospitals. This left LB wondering what a hospital is anyway/anymore and, more to the point, what a neighbourhood health services centre might be.

Clearly the answer has something to do with what an unwell patient needs doing to them to get them back on their feet again and back to school, work or retirement. To date, there have been no helpful hints about what type of facility is now required to make the shift to neighbourhood health services work.

This paperback offers some suggestions and sets out a much needed debate about using SMALLER instead of LARGER hospitals, NEW for OLD hospitals, NEW HEALTH CENTRES vis-a`-vis CONVERSIONS (of any old redundant buildings) and also about the shape of things to come to facilitate the shift to neighbourhood health services.

Exchanges between architects Mungo, Jaime, LB and a few others feature in this Dear Susan... paperback. These show how difficult it is for experienced people who know how to design hospitals to float and implement a proposal to change a failing NHS.

This is a last gasp attempt by LB to hand over his pen/baton/lamp to whoever. This is not so much a whodunnit but more a who didn't do it. Smaller healthcare centres are needed to replace the most "crumbling" parts of the NHS estate and to compliment the shift towards the fulfilment of neighbourhood health services centres for the good health of the nation.