RT Journal Article SR Electronic T1 The problems of smaller, rural and remote hospitals: Separating facts from fiction JF Future Healthcare Journal JO Future Healthc J FD Royal College of Physicians SP 38 OP 45 DO 10.7861/fhj.2019-0066 VO 7 IS 1 A1 Louella Vaughan A1 Nigel Edwards YR 2020 UL http://www.rcpjournals.org/content/7/1/38.abstract AB Smaller hospitals internationally are under threat. The narratives around the closure of smaller hospitals, regardless of size and location, are all constructed around three common problems – cost, quality and workforce. The literature is reviewed, demonstrating that there is little hard evidence to support the contention that hospital merger/closure solves these problems. The disbenefits of mergers and closures, including loss of resources, increased pressure on neighbouring organisations, shifting risk from the healthcare system to patients and their families, and the threat hospital closure represents to communities, are explored. Alternative structures, policies and funding mechanisms, based on the evidence, are urgently needed to support smaller hospitals in the UK and elsewhere.