Bottomley seeks radical change at hospitals: Major increase in day surgery with minimal overnight stays is at forefront of Utopian vision for health service of the future

'YOU CAN'T expect to walk into a hospital ward, get into your pyjamas and gaze at neat ranks of hospital beds; the hospital of the future is going to be a very different place,' Virginia Bottomley said yesterday, expanding on her vision for the NHS.

Earlier, the Secretary of State for Health had treated health service managers to an almost utopian glimpse of specialised state-of-the-art hospitals working in symbiosis with caring teams of family doctors conducting minor operations in the modern health centre-cum cottage hospital.

While sceptics will say her support for an NHS directed by dramatic advances in drugs and medical technology is just another way to try to cut costs, it is indisputable that medicine has changed hugely in less than 20 years.

'There are hospitals in America where there is only day surgery,' Mrs Bottomley said. 'You have to think about what people want. It is clearly better to be at home than in a hospital. Keeping people in hospital is costly for the NHS and inconvenient for them . . . We really are conjuring up a very different kind of health service.

'With angioplasty for instance there is only an overnight stay; it used to be 10 days.' This is the procedure using a catheter fed from a blood vessel in the groin to coronary arteries to smooth out bumps in the the artery wall and improve the blood flow.

She foresaw a need for more community nurses to take on 'hospital at home' work and possibly more GPs. However, Mrs Bottomley pointed out the list sizes of GPs had already reduced.

Her speech yesterday marked a moment in the life of the NHS, three years after the reforms had been instigated. Largely because of financial difficulties hospital bed numbers have been dropping steadily for 10 years. The increase in day surgery will have accelerated the trend more recently.

Between 1982 and 1992 the number of hospital beds fell from 348,000 to 231,000, of which 144,000 and 113,000 were acute beds. At the same time day cases for all specialities rose from 706,000 to 1,807,000.

The length of stay for medical cases fell from 9.9 days to 6.6 and for surgical cases from 7.6 to 5. Geriatric patients stayed an average 62.3 days in 1981-82 but for 27 days in 1991-92. In maternity wards the stay fell from 5.3 days to 3.3.

Last September, surgeons and senior DoH doctors made an assumption that, by 2000, 50 per cent of surgery would be provided as day cases. Latest figures for some common procedures show the proportion of those treated as day cases against patients admitted overnight. For anal stretch for haemorrhoids, 44 per cent are now treated as day cases; varicose veins, 50.5 per cent; grommets, 39.1 per cent; and abortion, 55.7 per cent.

Leading article, page 19

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