More than 20,000 extra nurses, 7,500 more consultants and 2,000 GPs are to be employed in the NHS as the cornerstone of the government's national plan for reform of the health service, the prime minister promised today. An extra 7,000 NHS beds - including 5,000 intermediate care places to look after elderly people and stop so-called "bed-blocking" - will also be funded.
As part of the shake-up, unveiled by Tony Blair in the House of Commons, ministers aim to cut the maximum waiting time for an operation from 18 months to six months by 2005. By 2008, no patient will wait more than three months for treatment on the NHS, according to the plan.
And from 2002, any patient whose operation is cancelled for non-medical reasons will have their surgery within 28 days - even if it means the NHS paying for them to go to a private hospital, the government promised.
The blueprint - The NHS Plan: A Plan for Investment. A Plan for Reform - is being billed as the most radical reform of the health service since it was founded in 1948.
It includes proposals for 100 new hospital schemes over the next decade, an overhaul of consultants' contracts and the creation of new "senior sister" posts for nurses - a modern-day matron.
As part of modernisation of primary care services, 500 one-stop centres will be established, combining GPs, dentists, opticians and other health and social care professionals under one roof.
By 2002, all patients will be able to see a primary care professional within 24 hours and a GP within two days, under the plan.
By 2004, all patients arriving at hospital casualty departments will be seen within four hours, the plan pledges.
Millions of outpatients who are currently seen in hospitals will instead be referred to 1,000 "specialist GPs" in areas such as eye treatment, skin diseases and ear, nose and throat problems.
Contracts for family doctors are to be overhauled so that they are paid if they meet set standards and quality targets.
Under the plan, more than 20,000 extra nurses and 5,500 more training places will be established to boost staff numbers.
Senior sisters will be put in charge of ward cleanliness and being given greater powers to discharge patients.
A new grade of "therapist consultant" will be established by 2004 to end traditional demarcations between nurses and doctors.
It also pledges that new diagnostic and treatment centres will be built to ease the burden on hospitals and specialise in particular areas of surgery which can be performed in a single day or with a short stay.
But older people are set to be disappointed by the government's refusal to accept the recommendations of a Royal Commission that all nursing and personal care should be free. Instead, nursing care in homes will be free from 2001 - currently people pay for this. But personal care, which can include changing dressings and catheters, will still be charged for.
Cottage hospitals and specially designated wards in hospitals will have intermediate care beds in a bid to stop "bed-blocking" by elderly patients who do not need acute care.
A nationwide "clean up" campaign of hospitals is also to be launched under the plan. Hospitals will be inspected by undercover teams, including patients, every six months. National standards for cleanliness are to be set down and every NHS Trust will have to appoint a board member who will be responsible for monitoring standards.
A new Modernisation Agency is to be set up to implement the changes and cut waiting times to meet the ambitious new targets set out in the plan. And a new "traffic light" system will show how different hospitals and trusts are performing.
Trusts which meet all their targets and are in the top 25% of well performing organisations will be give the "green light" - and rewarded with greater powers, extra cash from a new Performance Fund and less inspections.
"Yellow light" trusts will meeting most of their targets will have to draw up plans with regional bosses before they can get their hands on the Performance Fund.
Failing trusts will be shown the red light. They will have to draw up a "recovery plan", will only be able to get extra money by applying to the Modernisation Agency and could be taken over by managers from "green light" trusts.
Sharon Holder, national officer of the GMB union, said: "This represents a real improvement in the delivery of care to patients and is what those who work and rely upon the NHS have been crying out for."
In a bid to tie doctors more closely to the NHS, newly-qualified hospital consultants will have to work exclusively for the health service for the first seven years of their careers before they can undertake private work.
Consultants will have to work at least seven "fixed sessions" in the NHS a week in a bid to cut the amount of time they can spend doing private work.
And a new "concordat" between the NHS and the private sector will mean NHS doctors and nurses will be able to use beds and operating theatres in the independent sector to treat patients.
Nigel Edwards, policy director of the NHS confederation, which represents health authorities, said: "The government has been brave to address head-on the really difficult problems facing the NHS, particularly: changing the relationships between government, the professions and patients; how to move to common standards of performance; and how to persuade clinicians to do the most effective things not what they have always done.
"This makes it truly radical and presents NHS staff, particularly its managers, with a huge change agenda."
Ian Bogle, chairman of the British Medical Association, said: "The BMA supports the national plan's aspirations to build a stronger NHS."
A spokesman for the Patients' Association said: "There are some very good ideas in this plan but now these things have really got to happen and the money has got to be there."
The boost will mean that in five years time there should be nearly 349,000 nurses working in the NHS. A spokeswoman for the Royal College of Nursing said: "We do believe these are new nurses."
An extra 7,500 consultants and 2,000 GPs are also pledged to be in place by 2005. There are currently 35,000 consultants and
25,000 GPs.
But a spokesman for the British Medical Association said: "It is very difficult to unravel all of the figures. Some of those consultants are already in the pipeline and would have been brought on-stream anyway."
