Consider how much has changed within hospitals since the launch of the NHS. Fifty years ago there were few consultants, even fewer drugs, specialisation was in its infancy, anaesthetics was still at a primitive stage (open ether dropped onto a mask), while treatment was still based on good nursing, bed rest and sedation at night. Fifty years on there have been more medical breakthroughs than in the previous 2,500 going back to Hippocrates: to name just three pioneered in the UK, ultrasound, hip replacements and in-vitro fertilisation. Given the speed of this change, is it sensible of the government to lock itself into an inflexible pattern of hospital provision?
Last month in a review of Labour's first five years, the King's Fund, one of the country's leading health thinktanks, concluded that the government "has rushed into a massive capital building programme without any collective or central reflection as to precisely what type of facilities it ought to be investing in". Late last week, after a one-year study of the current hospital building programme, the biggest in the history of British medicine, a review team of architects and health specialists argued that the 60-plus hospitals which are being built under the private finance initiative (PFI) could become obsolete long before taxpayers have footed the bill for their 30-year contracts.
The two reports should be taken seriously. The latest one, by the Building Futures Group, brought together 100 leading health and design professionals to look at medical, technological and demographic trends. It noted how public access to health information would con tinue to grow; IT change the location of different parts of the health service; and "telemedicine" (video conferencing) bring care closer to the patients (both between the home and clinical workers and between primary and specialist care).
Its most fascinating forecast was that 50,000 new beds would be available to the NHS through new technology that allows patients to be monitored in their own beds at home and also make use of self-administered, automatic drug-delivery systems. Other new services which are already emerging include nurse-led minor injury treatment centres; combined health and social care centres where patients would have access to telemedicine consultations with specialists; and hi-tech specialist care units, considerably smaller than existing hospitals.
Professor John Worthington, head of the review, rightly found its findings both exciting and worrying: "We can look forward to a future where we will be treated in environments that are more intimate, cleaner and closer to our families and friends. And yet we are still building institutional hospital buildings that mimic those of the Victorian era and have little to do with the healthcare needs of our children's generation." Labour does not like criticism, but it cannot afford to ignore the warnings raised by the latest report. It is not too late for it to change track. Only seven of the 70 planned new hospitals have been built. The contracts for at least half the PFI hospitals have not yet been signed. Continental health systems are already beginning to introduce the adjustments proposed. Time for the UK to follow suit.
