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dren in 1878. It soon found itself unable to place the children back into the community and only ten years after it was founded it was accommodating 1,000 adults and children. The National Health Service took over responsibility in 1948. At one time there were over 2,000 residents on the site. The hospital served the whole of South East London, Kent and parts of Sussex. There were more than 40 wards, ten containing more than 50 residents. In January 1973it was agreed to work towards closure. A long and complex process followed which is analysed in a forthcoming study (Korman & Glennerster, 1990). The hospital did finally close in August 1988. Alternative facilities had been provided for all the residents except a few who left in the early years of their own accord. In 1978-79 there were 1,138 resi dents in Darenth. The plans for alternative provision date from the early 1970s and were continuously revised until shortly before the hospital closed. Districts to whom residents were returning varied in their approach and philosophy. Examining the successive plans is rather like looking at a geological map showing layers that represent changing atti tudes to the care of mentally handicapped people. In the early years an old hospital was converted to pro vide for 120 people who had been looked after in Darenth Park. Subsequently residential homes for 80 and then 40 people were designed. In the end most of the residents were rehoused in hostels, residential centres and most recently staffed group homes ad ministered by local housing associations (for details see Korman & Glennerster, 1990-Table 1-3). Two hostels were converted properties. These were per haps the most institutional. More informal were the residential centres, the designs for which became more and more like ordinary housing. The oldest has four buildings with 20 places in each. There are two, three and single person bedrooms, with shared kitchens, domestic staff and a central laundry. The other centres consist of separate houses or bunga lows, with single or double bedrooms. Each has a housekeeper, cleaning staff and six to eight residents. Living room space is crowded, especially where there are wheelchairs. Day Centre facilities are attached. The group homes vary in size. Some accommodate two and some as many as eight residents. Most made use of existing housing stock. Because, as we shall see, these homes were able to attract non-NHS funds the staffing levels were more generous. Eight staff for four residents was not unusual. In some homes cater ing for residents with difficult or challenging behav iour, staffing ratios were as high as three staff to one resident or in one case fivestaff to one resident. At the other extreme there were five staff to seven residents. Local day centres and other facilities such as swim ming pools were used where they existed. The impact on the residents and their adjustment to their new accommodation is being studied by Lorna Wing (Wing, 1989). Our concern in this paper is to present an economic appraisal of the cost of alternati ve facilities that have been provided, and to compare that with the cost of the hospital care the residents used to receive.

The costs of hospital closure: reproviding services for the residents of Darenth Park Hospital