A revolution in health care

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A NATIONAL Health Service revolution was heralded yesterday by Virginia Bottomley, Secretary of State for Health, when she predicted that dramatic advances in medicine could lead to a 40 per cent cut in the number of hospital beds by 2002.

This would amount to a loss of 50,000 beds. Mrs Bottomley told health service managers in Brighton that the changes now taking place were not being driven by the NHS reforms, managers or politicians; instead they were led by the pace of change in medicine and the needs of patients.

It emerged last night that the predictions Mrs Bottomley used came from a report written by Dr Morton Warner, of the Welsh Association of Health Authorities, that is due to be published today by the National Associa5tion of Health Authorities and Trusts. Dr Warner urges caution and warns that the changes in hospitals must not happen before community services have been provided.

'The developments envisaged for the future could be potentially disruptive to existing services. Paced change should be the objective,' the report says.

Among the advances are treating ulcers with drugs and not surgery, early diagnosis to reduce the number of major operations and key-hole surgery which avoids making big surgical wounds that need long, slow recovery.

Women with breast cancer are increasingly given chemotherapy before surgery to reduce the tumour size, which means a small 'lumpectomy' and only two days in hospital. Previously a full mastectomy might have been followed by a hospital stay of 10 days to a fortnight.

But the advent of keyhole surgery is one of the most powerful of the driving forces. Surgeons make tiny cuts into which they feed their miniature cutting or sewing implements and a laparoscope - a viewing instrument - to 'see' inside their patient on a screen.

Mrs Bottomley quoted estimates from UK chief nursing officers predicting, by the early part of the next century, that 80 per cent of operations would be keyhole surgery; 60 per cent would be day surgery and 40 per cent of specialist consultations would not be in hospital. As a result 40 per cent fewer acute beds would be needed.

'The GP and the community nurse will move centre stage. More routine work, rehabilitation and continuing care can take place outside hospital with the needs of patients being met in their homes. Modern health centres, built around teams of family doctors, practice nurses and other health professionals are becoming the cottage hospitals of the futures,' she told the annual conference of the National Association of Health Authorities and Trusts.

Afterwards she told the Independent: 'This is a vision for the future, not a set of planning figures. I am setting out the direction in which we should travel. The rate of progress has to be determined by each health authority. GPs and the community services will decide the pace of change.' The 'dramatic' changes had to be explained and she told the health authorities that there would be a new 'code of openness'.

Mrs Bottomley's vision was criticised by David Blunkett, Labour's health spokesman, as unrealistic: 'She has no understanding of the chaos being caused by the internal market in the NHS. One in three beds have gone in the last 10 years, waiting lists have shot up by a third. Cutting so many beds while waiting lists remain so high will not help patients.

'Mrs Bottomley and her trusts have shown themselves to be completely unable to manage change in the NHS. You can't have planned change in the NHS and the internal market. She doesn't understand the contradiction.'

Hospital of the future, page 3

Leading article, page 19