Tony Blair pledged yesterday to make the National Health Service "once again the envy of the world" when he published the Government's national plan to modernise the system for the 21st century.

Tony Blair pledged yesterday to make the National Health Service "once again the envy of the world" when he published the Government's national plan to modernise the system for the 21st century.

The Prime Minister declared that the NHS would become a patient-centred service for the first time since its inception in 1948 as he announced proposals to tie huge investment to widespread reform.

More than 20,000 extra nurses, 7,500 more consultants and 2,000 GPs will be employed, while 7,000 more NHS beds will also be funded over the next four years. More than 3,000 GP surgeries will be modernised and more than 100 new hospital schemes will be built over the next 10 years.

Under the plan, the maximum waiting time for an operation will be cut to three months by 2008, and everyone will be able to get an appointment with a GP within 48 hours by 2004.

The waiting list pledge is the most ambitious in the plan. Currently 30 per cent of patients - about 300,000 - wait longer than three months for an operation. Ministers have set a target of cutting waiting lists by three times the figure of 100,000 promised at the last election. That took investment of hundreds of millions of pounds, and came to be seen as a millstone round the Government's neck.

The maximum waiting time for an operation will initially be cut from the present 18 months to six months by 2005, with the most urgent cases seen most rapidly. Patients whose operation is cancelled on the day it is due will be guaranteed surgery within 28 days, or have their treatment funded in the private sector. "Patient advocates" will be posted in every hospital.

The Government has embraced the private sector in a historic "concordat" for a Labour administration, which will see greater collaboration over the use of operating theatres, equipment and beds to cut waiting lists. Twenty new specialist centres devoted to routine surgery are to be built with the private sector, which will ultimately do 500,000 operations a year.

As part of an overhaul of long-term care, elderly people in residential homes will be given free nursing care, while £900m will be spent on rehabilitation services for those who leave hospital. But organisations for the elderly were angry and disappointed that the Government rejected recommendations by the Royal Commission on long-term care that personal care - washing and dressing - should also be free.

Of the 7,000 new NHS beds, more than 5,000 will be intermediate care places provided in cottage hospitals and nursing homes to stop so-called "bed-blocking" by the elderly.

Mr Blair stressed that the Government was committed to the NHS's founding principle of high-quality care, free at the point of delivery. But ministers working with NHS staff had looked "long and hard" at all aspects of the service, and the Prime Minister said he was determined to end "relics" of a system designed for the 1940s.

Doctors' contracts, demarcations between staff, the split between social services and hospitals on elderly care, and the stand-off between the NHS and the private sector would all be transformed, he said.

Newly qualified consultants will be barred from working outside the NHS for their first seven years, while nurses will be given new responsibilities.

The medical professions welcomed most of the plans, but the British Medical Association warned that moves to change consultants' contracts could drive young doctors out of the NHS.

Alan Milburn, Secretary of State for Health, said the plan represented a "once-in-a-lifetime opportunity" to revolutionise the NHS. He stressed that the system could not be transformed overnight, but said most people would see real change by next year.

Mr Milburn said the plan involved a fundamental change from the outdated culture of the NHS and warned that poorly performing hospitals would not be tolerated. Under a new system of "earned autonomy", those hospitals with the best practice would be left to arrange their affairs but those that underperformed could be taken over centrally.

He was unapologetic about plans to ban new consultants from working in private practice, claiming that such lucrative work should be a reward not a right. "There should only be one vested interest in the NHS and that is the vested interest of the patient," he said.

The Tory leader, William Hague, accused Mr Blair of a "record of failure" on the NHS and said people would be amazed that some changes would not come in until 2008.

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