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4 Investing in NHS facilities

  • 7,000 extra beds in hospitals and intermediate care
  • over 100 new hospitals by 2010
  • 500 new one-stop primary care centres
  • over 3,000 GP premises modernised
  • 250 new scanners
  • modern IT in every hospital and GP surgery
  • clean wards, better food

Introduction

4.1 The NHS has been under funded for decades. Now there will be sustained investment. The funding announced in this year's Budget means the NHS in England will benefit from annual average real terms growth of 6.3% - twice the historic growth rate. The NHS budget will grow by around one half in cash terms and one third in real terms in just five years.

4.2 As the first priority this scale of investment will be used to get the basics right in the health service - the right number and the right type of beds, buildings, services and equipment - alongside the right number of staff.

4.3 We will use this unprecedented investment to modernise NHS services around the needs of patients.

New beds

4.4 The National Beds Inquiry confirmed that the NHS does not have the right beds in the right places to do its job quickly and effectively.

Shaping the future NHS: responses to the National Beds Inquiry

The National Beds Inquiry Consultation invited members of the public and professionals to tell the Government what pattern of services the NHS should provide in the future, focusing on services for older people as the main users of hospital services. More than 5,000 copies of the National Beds Inquiry were requested and 8 Listening Events were held. Around 450 written responses were received from a wide range of sources including individuals, primary care groups, health authorities, trusts, royal colleges, doctors, nurses, other health service professionals, academics, local councils, community health councils, unions, charities, private companies and other representative organisations.

Respondents envisaged a service that would be more 'joined-up' with patients moving along tailored care pathways and no discernible divide between the different elements of the health and social care system. In particular:

  • there was near universal support for development of 'care closer to home'
  • in the short- and medium-term, however, the majority felt that there was a need to at least maintain adequate numbers of acute beds
  • there was a need to radically integrate the way the NHS works with social services
  • the majority of the respondents wanted to create a 24-hour a day 7 day a week 365 day a year integrated health and social service system focused on the patient
  • this new service should be based around the key themes of patient empowerment and education of the public
  • prevention of disease and early intervention in the community would be of fundamental importance.

Respondents saw the use of intermediate care as central to this more joined-up approach. It should concentrate on maintaining and restoring independence, and on rehabilitation. It would act as a bridge between community and hospital care. Both staff and patients would experience new ways of working which would blur the boundary between primary and secondary care. Specific elements of this new service would include:

  • non-appointment 'drop in' facilities
  • fast access to diagnostics and pathology leading to effective interventions
  • multi-disciplinary teams focused on particular groups and conditions
  • a mix of nurse, therapist, consultant and GP led services
  • fast access to acute settings where needed
  • access to non-acute inpatient settings where appropriate
  • timely discharge into appropriate settings.

Within this new service a new generation of staff including specialist GPs, multi-skilled workers, geriatricians, nurses, social workers and professions allied to medicine would apply their particular skills in both acute and community settings. The private and voluntary sector would have important roles to play. This new environment would be supported by electronic patient records and a fuller use of new technologies.

Although much of the National Beds Inquiry was focused on the particular needs of older people, the majority of respondents also felt that other patient groups would benefit from a similar joined up approach.

As a result of this Plan there will be:

  • 7,000 extra NHS beds by 2004
  • of these around 2,100 extra beds will be in general and acute wards. This will be the first increase of its kind in 30 years
  • 5,000 extra intermediate care beds, some in community or cottage hospitals, others in specially designated wards in acute hospitals. Some will be in purpose built new facilities or in redesigned private nursing homes
  • 1,700 extra non-residential intermediate care places
  • a 30% increase in adult critical care beds over the next 3 years as a result of resources allocated this year and to follow over the next three years.

These increases in beds and places, especially for older people, should help improve bed availability levels in hospitals.

4.5 Clear guidelines will be issued on likely future requirements for beds and types of services which should be available in all areas. Future capital developments will need to demonstrate they have taken full account of these guidelines before they receive funding.

New hospitals

4.6 There will be major investment in new NHS buildings. The biggest ever hospital building programme in the history of the NHS is already underway. We have given the go ahead to 38 major developments. Over half of these will be open to the public by 2003/04 and the remainder will be under construction. In addition, we have given the go ahead to a further 31 medium size schemes of which 27 will be open.

4.7 As a result of this NHS Plan there will now be a further major expansion in new hospital building:

  • 9 new hospital schemes given the go ahead in 2001 - worth £1.3billion
  • 9 new hospital schemes given the go ahead in 2002 - worth £1billion
  • this will mean over 100 new hospital schemes in total between 2000 and 2010.

4.8 Capital investment will also reshape services. In partnership with the private sector we will develop a new generation of Diagnostic and Treatment Centres to increase the number of elective operations which can be treated in a single day or with a short stay. These Centres will separate routine hospital surgery from hospital emergency work so they can concentrate on getting waiting times down. As a result of this NHS Plan there will be:

  • 20 Diagnostic and Treatment Centres developed by 2004. By then, 8 will be fully operational treating approximately 200,000 patients a year.

New NHS buildings

4.9 As well as new hospitals there will be a range of other new buildings developed between 2000 and 2010. As a result of the NHS Plan there will be:

  • £7 billion of new capital investment through an extended role for PFI by 2010
  • 40% of the total value of the NHS estate will be less than fifteen years old by 2010
  • the NHS will have cleared at least a quarter of its £3.1 billion maintenance backlog, accumulated through two decades of under-investment, by 2004
  •  up to £600 million realised through a one-off auction of empty and surplus NHS property to reinvest in new NHS premises.

4.10 The new buildings will be provided through a mixture of public capital and an extended role for the Private Finance Initiative. Where there is a major PFI deal to build a new hospital taking place, we will, when appropriate, include local NHS primary and intermediate redevelopment too. In this way we will help ensure that capital investment is contributing to the redesign of local services across a whole health economy.

New local surgeries

4.11 The NHS will enter into a new public private partnership within a new equity stake company - the NHS Local Improvement Finance Trust (NHS Lift) - to improve primary care premises in England. The priority will be investment in those parts of the country - such as the inner cities - where primary care services are in most need of expansion. As a result of this NHS Plan:

  • up to £1 billion will be invested in primary care facilities
  • up to 3,000 family doctors' premises will be substantially refurbished or replaced by 2004.

4.12 This record investment will allow for a range of brand new types of NHS facilities, bringing primary and community services - and where possible social services - together under one roof to make access more convenient for patients. New one-stop primary care centres will include GPs, dentists, opticians, health visitors, pharmacists and social workers. As a result of this NHS Plan there will be:

  • 500 one-stop primary care centres by 2004.

New equipment

4.13 After decades of under-investment there is a crying need for new NHS equipment. We will make real progress by investing over £300 million in equipment to improve cancer, renal and heart disease services by 2004:

  • 50 new Magnetic Resonance Imaging (MRI) cancer scanners to increase procedures by 190,000
  • 200 new CT cancer scanners - 150 replacement plus 50 additional - to increase procedures by 240,000
  • 80 new liquid cytology units to improve cervical cancer screening for 4 million patients every year
  • 45 new linear accelerators - 20 replaced plus 25 additional - to treat an extra 12,000 cancer patients
  • 3,000 new automated defibrillators in public places to help save the lives of the one in five people whose heart attacks happen in a public place.
  • 450 new and replacement haemodialysis stations to treat another 1,850 kidney patients and provide better treatment for a further 1,200 existing patients.

Clean hospitals

4.14 The new investment we are making will allow the NHS to get the basics right. Patients perceive a major deterioration in the cleanliness of hospitals since the introduction of Compulsory Competitive Tendering and the internal market. Patients expect wards to be clean, furnishings to be tidy. The new resources will allow for a renewed emphasis on clean hospitals.

4.15 As a result of this NHS Plan there will be:

  • over £30 million allocated immediately direct to hospital trusts to improve hospital cleaning. In future years, cash for cleaning will be distributed as part of the normal allocation process
  • a nation-wide clean-up campaign throughout the NHS starting immediately. All patient areas, visitor toilets, outpatients and accident and emergency units will be thoroughly cleaned and kept clean. Chairs, linen, pillows, furniture, floor coverings and blinds which are dirty will be cleaned. Those beyond repair will be replaced
  • every hospital will have an unannounced inspection of its cleanliness, by a specialist inspection team including patients within the next 6 months. The results will be made available to the local media
  • national standards for cleanliness will form part of the NHS Performance Assessment Framework. Every hospital's performance will be measured against these standards by the end of 2000
  • ward sisters and charge nurses will have the authority to ensure the wards they lead are properly cleaned. Hospital domestics will be fully part of the ward team - and respected for the important work they do
  • NHS trusts will have to adjust contracts with external cleaning companies to ensure nurses can take the lead in ensuring wards are properly cleaned where necessary
  • every NHS trust will nominate a Board member to take personal responsibility for monitoring hospital cleanliness, and will report to the Board following regular check ups. The Patients' Forum in each trust will monitor standards and use unannounced inspections to do this
  • the independent NHS watchdog, the Commission for Health Improvement, will inspect and report on this aspect of NHS care.

Better hospital food

4.16 The NHS provides over 300 million meals each year at a cost of £500 million. The food is variable in quality, it is not provided in a way which is sufficiently responsive to patients, and too much of it is wasted as a result. These standards are not good enough.

4.17 As a result of this NHS Plan by 2001 there will be:

  • a 24-hour NHS catering service with a new NHS menu, designed by leading chefs. It will cover continental breakfast, cold drinks and snacks at mid-morning and in the afternoon, light lunchtime meals and an improved two-course evening dinner. This will be a minimum standard for all hospitals
  • a national franchise for NHS catering will be examined to ensure hospital food is provided by organisations with a national reputation for high quality and customer satisfaction
  • half of all hospitals will have new 'ward housekeepers' in place by 2004 to ensure that the quality, presentation and quantity of meals meets patient needs; that patients, particularly elderly people, are able to eat the meals on offer; and that the service patients receive is genuinely available round-the-clock
  • dieticians will advise and check on nutritional values in hospital food. Patients' views will be measured as part of the Performance Assessment Framework and there will be unannounced inspections of the quality of hospital food.

4.18 An extra £10 million a year will be made available to deliver these improvements in hospital food.

At Nottingham City Hospital, a ward waitress reports to the ward manager, taking orders from the patient, and ensuring they get something suitable to eat. The introduction of this service has dramatically reduced food wastage by 40%. The waitress has opportunities for NVQ qualification in nutrition and silver service. As well as serving the food, and reporting to the nursing staff on each patient's food intake, she can provide tempting snack alternatives from the ward kitchen, at times to suit the patient.

Bedside televisions and telephones

4.19 In an age of cable and digital TV, with over half the population owning mobile phones, people increasingly expect to have access to these services wherever they are. It is no longer acceptable for patients to have to wait for a nurse to wheel a trolley to their bed or have to stand in a draughty corridor if they want to make a call. With the new resources, the NHS can do much more to provide better facilities at the bedside.

4.20 A number of hospitals have already negotiated contracts with a private company to install bedside TVs and phones. There are modest charges for the service - though normally there are no charges on children's wards. Patients are able to make outgoing calls at a level below the standard national call rate. They can also watch videos and one of the channels is dedicated to use by the hospital to show programmes that will help patients prepare for their operation or to explain aspects of their treatment. As a result of this NHS Plan:

  • The contract to extend this service nationwide will be advertised by the autumn
  • Bedside televisions and telephones will be available in every major hospital by 2004.

New information technology

4.21 The NHS will have the most up-to-date information technology systems to deliver services faster and more conveniently for patients.We are already investing £200 million in modernising IT systems. As a result of this NHS Plan there will be:

  • an extra £250 million invested in information technology in 2003/04
  • electronic booking of appointments for patient treatment by 2005
  • access to electronic personal medical records for patients by 2004. By then 75% of hospitals and 50% of primary and community trusts will have implemented electronic patient record systems. When the necessary infrastructure has been put in place, and we have fully evaluated technical feasibility on effectiveness, smart cards for patients allowing easier access to health records will be introduced
  • electronic prescribing of medicines by 2004 giving patients faster and safer prescibing as well as easier access to repeat prescriptions
  • all GP practices will be connected to NHSnet by 2002, giving patients improved diagnosis, information and referral
  • through investment in electronic patient records all local health services will have facilities for telemedicine by 2005 allowing patients to connect with staff electronically for advice.

4.22 NHS staff will also benefit from the investment in new information technology. Staff will get easy access to up-to-date and accurate information on patients' medical histories. NHS staff will be able to order tests, refer patients and make bookings of appointments for patients using new IT. The National Electronic Library for Health will provide electronic access to state-of-the-art information on latest treatments and best practice. This investment will allow for greater efficiency and also for easier access to the information necessary to monitor local performance and practices against national standards and performance indicators.

Conclusion

4.24 The new resources will allow the NHS to get the basics right. Not everything can be put right overnight - the decades of neglect make that impossible. But over the next few years the NHS will start to look and feel like a different place. There will be better, more modern facilities both for patients and for staff.

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