Website of the Department of Health

Preventive care

1.4 Routine screening will be extended to cover more conditions. The action patients need to take to minimise the risks to their health - which may have been identified using conventional tests or the new genetic tests that will be increasingly available - will be discussed and agreed with GPs and nurses. The NHS will harness the benefits of advances in genetic technology for the benefits of all.

1.5 The NHS will be at the forefront of assessing new medicines and getting them into use more quickly. It will provide a growing range of products and services to help people adopt healthier lifestyles. As well as drugs to help keep down blood pressure and cholesterol levels, advice on diet and exercise will be accepted as a routine service at the local surgery. The NHS will work with other agencies to tackle the underlying causes of ill health.

1.6 Primary care trusts will identify and maintain registers of those at the greatest risk from serious illness - concentrating particularly on areas where ill health is most prevalent - so that people can be offered preventive treatment. In the process the NHS will help tackle health inequalities.

1.7 NHS Direct nurses will be in regular contact to help patients manage their medicines and check that older people living alone are all right.

1.8 NHSplus will provide an occupational health service to thousands of employers as well as NHS staff themselves.

Self care

1.9 The frontline in healthcare is the home. Most healthcare starts with people looking after themselves and their families at home. The NHS will become a resource which people routinely use every day to help look after themselves. 0845 46 47 will become one of the best used phone numbers as millions of people every year contact NHS Direct to get advice about health problems. Eachweek will see millions of hits on the NHS Direct internet site. As well as providing fast and reliable information on a wide range of conditions, it will also be valued as an easy way to contact patient and self-help groups.

1.10 The digital TV revolution will enable people to tune into channels dedicated to health issues, with the NHS using its expertise and experience to kitemark the best materials. A new service, NHSplus, will provide information for publication as well as broadcast. And professional training will have much more emphasis on supporting self-care, particularly to help people manage chronic conditions.

Primary care

1.11 A single phone call to NHS Direct will provide a one-stop gateway to healthcare, to give patients more choice about accessing the NHS. Depending on the problem, NHS Direct nurses will advise on care at home, going to the local pharmacist, making a routine appointment, arranging for an emergency consultation, calling an ambulance or social services support. If the problem is routine, NHS Direct will offer the option of ordering the prescription and arrange for delivery to the patient's door. Patients will also have the choice of e-mailing or phoning their practice nurse or GP for advice and booking their appointment online and receiving test results at home. Equally patients, such as the elderly or those that have chronic conditions, will be able to have a continuing relationship with their GP providing continuity of care.

1.12 Round the clock medical care for minor ailments and accidents will be available for all within convenient travelling distance. Ambulances will be equipped with video and monitoring equipment so that victims of accidents can get the most appropriate care while they are being taken to hospital. As services are modernised long waits in accident and emergency departments will become a thing of the past.

1.13 Electronic patient records - to which patients hold a key - will enable nurses, therapists and doctors to maintain continuity of care and knowledge of their patients.

1.14 Many GPs will be working in teams from modern multi-purpose premises alongside nurses, pharmacists, dentists, therapists, opticians, midwives and social care staff. Nurses will have new opportunities and some GPs will tend to specialise in treating different conditions. The consulting room will become the place where appointments for outpatients and operations are booked, test results received and more diagnosis carried out using video and tele-links to hospital specialists. An increasing number of consultants will take outpatient sessions in local primary care centres.

Hospital care

1.15 Changes in primary care will help ease the pressure on hospitals so that they can concentrate on providing specialist care. Appointments will be pre-booked to suit the patient. Tests and diagnosis will be normally carried out on the same day. The next stage of treatment - if it is needed - will be arranged there and then, before the patient leaves the hospital. Around three-quarters of operations will be carried out on a day case basis with no overnight stay required. Traditional waiting lists for surgery will become a thing of the past. There will be waits of weeks rather than months. The uncertainty of not knowing when your operation will happen will be replaced by the certainty of a booked date. Special one-stop diagnosis and treatment centres will concentrate on performing operations, not coping with emergencies.

1.16 Where patients have the most complex illnesses and conditions, such as the need for a heart operation, they will be referred to centres with the best equipment and the staff with the most appropriate expertise - even if that means travelling to a specialist centre.

1.17 There will be a new generation of state of the art hospitals. The old Nightingale wards will be phased out, and more intimate ward bays or rooms will become the norm for those requiring an overnight stay. Day case patients will have comfortable lounges in which to recover. Senior sisters - 'modern matrons' - will have the authority to make sure wards are kept clean and that the basics of care are right for the patient. There will be a Patient Advocate and Liaison Service in every hospital to resolve complaints and concerns quickly. Hospital menus will offer a range of attractive choices throughout the day and the quality of the food served will be checked by hospital nutritionists. There will be a personal bedside TV and telephone for every patient.

Intermediate care

1.18 A new range of intermediate care services will build a bridge between hospital and home, by helping people recover and resume independent living more quickly. This will speed up discharge from hospital when patients are ready to leave. The new services will give older people more independence rather than being forced to choose a care home.

1.19 Intermediate care may be provided in a hospital where, for example, intensive rehabilitation after a stroke is needed. If nursing support is needed nursing homes will be well-placed to offer this service. NHS nursing care will be free. Often people will choose to go home secure in the knowledge they will get the social and health support they need.

1.20 Rapid response and hospital-at-home teams will work on an integrated basis with GPs, community nurses, physiotherapists and social care staff to make sure that people get active support to remain independent at home. New technology in the home will make independent living easier for people who are elderly or disabled.

Quality of care

1.21 People will have the reassurance that the NHS is adopting high standards and striving continuously to improve the quality of its care. Every hospital, primary and community care service and nursing home will issue an annual prospectus setting out its standards, performance and the views of its patients. The funding received by local NHS organisations will be based in part on the results of regular patient surveys.

1.22 National standards for treating all the major conditions will have been established. Appropriate drugs and treatments which are shown to be clinically and cost effective will be in use in every part of the country. Doctors, therapists and nurses will increasingly work to standard protocols. There will be independent inspection of NHS organisations.

Progress so far

1.23 Nothing as ambitious as this vision can be achieved overnight. Putting right decades of neglect and under-investment is a huge task. During the last three years the Government has started to put in place the essential building blocks for a modern NHS. Progress has been made but there is much more still to do.

1.24 The decline in the condition of the NHS estate has been halted. The biggest ever hospital building programme is under way. Every accident and emergency department that needs it and 1,000 GP surgeries are being modernised.

1.25 The extra staff, without which it will be impossible to provide improved services, are also being recruited and trained. There are now over 5,000 more nurse training places and over 1,000 more medical school places in the pipeline than in 1997. There are 10,000 extra qualified nurses and 4,780 more doctors working in the NHS than in 1997.

1.26 The number of treatments the NHS carries out is also rising. Compared to 1997 there are over 500,000 more operations a year, 400,000 more patients being seen as first outpatient appointments and 300,000 more emergencies being dealt with every year.

1.27 New services such as NHS Direct and Walk-in Centres have been introduced. Primary care groups and trusts have been set up to provide the basis for GPs and other health professionals to work together to modernise local health services.

1.28 Big steps have been taken to improve the quality of NHS care by introducing national service frameworks and the National Institute for Clinical Excellence and an independent inspectorate - the Commission for Health Improvement.

Conclusion

1.29 Work has already begun to redesign the NHS so that it is built around the needs of the patient. As the next chapter explains, there is a long way to go. The task for this plan is to show how we can bridge the gulf between the reality of the NHS today and the vision of what it should be like tomorrow.