24 June 2005
Hospitals must be designed for future
Hospitals being built now could become white elephants if their design is not flexible, the conference heard.
The NHS is undergoing the biggest hospital building programme in its history. But a confederation report claims this investment could be wasted if hospital design fails to take account of changes such as more care in the community, IT advances and clinical care innovations.
Future proofing buildings says new hospitals were expected to last 60 years but the services they were designed to provide could change markedly in just five years.
Architectural adviser Sue Francis said: 'This implies a shift in the way we think about the management of space over time.'
Adviser warns of 'too much health care'
The introduction of private sector providers and the expansion of the NHS could lead to an oversupply of health care by 2008, the prime minister's adviser on health told the conference.
During a debate on what the health service will look like in 2008, Julian Le Grand said: 'We may be moving from a world where demand exceeds supply to a world where there is too much health care.
'There may be too much of the wrong type of health care, where too much is based in the hospital. You find this in other countries that have had the same kinds of reforms.'
But, with the NHS moving to a maximum 18-week wait from GP referral to treatment by 2008, some delegates questioned whether saturation point would be reached so soon.
Le Grand added that the expansion of providers could be counterbalanced by GP practice-based commissioning.
The conference also heard it was likely the number of primary care trusts would be cut over the next few years. In his keynote speech, NHS chief executive Sir Nigel Crisp said reform could introduce greater co-terminosity with local authorities.
There's a productivity pot of gold out there, Hewitt tells managers
The NHS will not require large spending increases after 2008 as it sits on a 'potential pot of gold' in productivity savings, Health Secretary Patricia Hewitt told the NHS Confederation annual conference in Birmingham.
Health service managers had earlier called on the government to continue the unprecedented levels of annual growth of the past few years or risk damaging patient care. However, Hewitt brushed their concerns aside as she delivered a tough message on future funding.
'Spending has doubled since 1997 and will have reached £90bn a year by 2008. By that time we will have tackled the historic under-investment in the NHS and eliminated many of its symptoms. So, while growth will continue, the unprecedented increases of recent years will no longer be necessary,' she said.
Hewitt acknowledged managers' concerns about delivering the government's reforms over the next five years. But she added: 'Quite apart from the funding increases committed for the next three years, a potential pot of gold is already in your hands. There are major productivity gains to be had from the extra investment already in the system. The onus is on you as managers to deliver that goal.'
System reforms to produce productivity gains, such as appropriate reductions in inpatient stays, were not optional, especially in hospitals or primary care trusts facing financial difficulties.
Hewitt was also uncompromising on controversial reforms, such as payment by results and Patient Choice. Choice would enable patients to make decisions about their care while PBR created 'sharp incentives' for under-performing trusts 'to change their ways or give way to others that can do better'.
PBR would be applied to emergency care from next April but only after further consultation with NHS managers. In February, Hewitt's predecessor, John Reid, sanctioned a one-year delay following fears that introducing the regime into emergency care would create financial instability in many trusts and PCTs.
Confederation chief executive Gill Morgan said managers would continue the reform programme to produce leaner organisations. But she vowed to fight for more funding post-2008.
'We need the investment to continue. We'll need to make a strong case and give the public the service they rightly demand.'
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