Budget 1999: The NHS - pounds 430m will help rebuild crumbling hospitals

THE CRUMBLING buildings and Victorian ward blocks of the NHS persuaded the Chancellor to open his wallet for the second time in less than a year. He announced an extra pounds 430m to smarten up accident and emergency departments and improve GP surgeries.

The sum, to be paid over three years, is in addition to the 50 per cent increase in capital investment in NHS buildings and equipment announced as part of the comprehensive spending review in July. On that occasion Gordon Brown said half the beds in NHS hospitals were in accommodation built before the First World War and three-quarters of ward blocks were hand-me-downs as he announced a 66 per cent increase in the Treasury's contribution, from pounds 1.2bn to almost pounds 2bn over the three years.

Yesterday he topped that increase with an additional pounds 120m for the UK next year, representing the first instalment of the pounds 430m. However, this time the cash is to be spent on the NHS's two front doors - casualty departments and GPs' surgeries. The money will be used to "upgrade every single accident and emergency department which needs it in every part of the country", Mr Brown said. That follows hard on the heels of the pounds 30m allocated by the Department of Health for the same purpose only last month.

It will also be used - although how the pounds 120m was to be divided was unclear last night - to upgrade GP surgeries, some of which have not come far since they were described 20 years ago by a former health secretary as "like gangers' huts under the railway arches".

The NHS Confederation, representing health authorities and trusts, said the boost to capital spending represented a 10 per cent increase in the contribution from the Treasury (the rest coming from the private sector via the Private Finance Initiative).

Stephen Thornton, chief executive, said: "This is pretty good and we are very pleased. My only hesitation is - why A&E departments? The NHS has suffered a huge backlog of maintenance for more than a decade. We do have a major problem of capital maintenance. We are still operating out of Victorian institutions, which is pretty surprising in a modern economy."

He said concentrating on the NHS's front door was a reasonable priority for the Chancellor to choose but it might not accord with local wishes. "First impressions are important and the physical quality of some of our A&E departments is pretty deplorable. Let's have more capital but let's give more discretion to local people to decide how it is spent."

The British Medical Association welcomed the extra spending on hospital buildings. Mac Armstrong, secretary, said: "We saw A&E departments stretched to the limit this winter. Modernising our facilities will improve services ... should defuse the tensions which result when patients wait for hours in unsatisfactory conditions and relieve stress on doctors and nurses."

The Chancellor gave notice that the Health Department plans to build on the success of NHS Direct, the 24-hour helpline, which is being rolled out to the whole country by the end of next year.

Later this week Frank Dobson, Secretary of State for Health, is to give details of plans to "carry NHS Direct right into communities - with a network of health centres and drop-in centres where people can get immediate advice about treatment", Mr Brown said.