Tony Blair yesterday staked the political credibility of a second Labour term in government on a five-year plan to slash NHS waiting times and create a patient-friendly health service to suit the consumerist values of the 21st century. He promised to recruit 7,500 more consultants by 2005, along with 2,000 extra GPs, more than 20,000 extra nurses and at least 6,750 more therapists and other health professionals.
The national plan for health in England will create 7,000 extra NHS beds by 2004, including the first increase in numbers of general and acute wards for nearly 30 years. Modernisation of primary care will include the creation of 500 one-stop centres, combining GPs, dentists, opticians and other health care and social care professionals under one roof.
The investment will be supported by a 35% real terms increase in NHS resources over four years - double the historic trend of growth in health spending. Ministers said lack of money was no longer the problem and the key tests of delivery would now be how fast they can recruit trained staff and how well they can retain them.
The plan is specific enough in its objectives to create many hostages to Labour's fortune if the NHS does not deliver.
Mr Blair told MPs: "By 2005 the maximum waiting time for an outpatient will be three months and for an in-patient six months, rather than the present 18 months."
Average waiting times would be cut from seven to five weeks for outpatients and from three months to seven weeks for operations. The eventual objective "is to get the maximum waiting time for any stage of treatment down to three months by the end of 2008". Other targets include a commitment that by 2002 all patients will be able to see a primary care professional within 24 hours and a GP within two days.
Alan Milburn, the health secretary, said the 144-page national plan was "the most fundamental and far-reaching reform programme", addressing every one of the problems facing the NHS. "From the state of the wards to the doctor's contract, not one issue has been ducked."
The proposals include steps to break down the boundaries between the health professions, expanding the responsibilities of nurses, midwives and therapists.
Changes for NHS doctors will include a new consultants' contract linked to annual appraisal of their work. Newly qualified consultants will be obliged to work exclusively for the NHS for seven years, but after that they will be allowed to undertake private practice in their own time.
There will be a nationwide clean-up campaign of wards and six-monthly undercover inspections of hospital cleanliness. Hospitals will be set tough performance targets linked to extra cash and those who fail will be taken over and run by a management hit squad.
Early reaction from the NHS professions, managers and patients suggested there would be strong support for the general direction of reform, but months of in-fighting over the detail.
The plan included a preface signed by 25 leaders of organisations on which its delivery will depend, welcoming its "direction of travel". They included representatives of the British Medical Association, Royal College of Nursing and the NHS Confederation, representing the managers.
But Peter Hawker, chairman of the BMA consultants committee, said proposals for changing the consultants contract showed "profound lack of understanding of the work they do". After two years of discussion, the government's only new idea was "an ill-conceived, vindictive attack on new consultants' freedom to work outside the NHS".
There was also bitter disappointment among organisations representing older people about the government's decision to reject the royal commission's recommendation that the NHS should pay for personal care in residential homes. Although the government will increase spending on care for older people by £1.4bn, services such as bathing and changing dressings will continue to attract means-tested charges.
Liam Fox, the shadow health secretary, said the plan was full of half-truths. "This was a wonderful opportunity for Tony Blair to move from political to clinical priorities. Unforgivably, he has put his own political survival before the survival of patients."
Christine Hancock, general secretary of the Royal College of Nursing congratulated the government on "a survival plan that puts patients first and tackles the hardest issues facing the health service".
"We're optimistic because every good idea in the plan is already happening somewhere in the health service. These ideas work and with the right support and opportunities, nurses and doctors will turn them into a reality for all patients."
The president of the Royal College of Physicians, Professor Sir George Alberti, said the plan was a "once-in-a-lifetime opportunity... At last we have government recognition of the shortage of doctors and beds in England and a commitment to tackle these problems".
Reforms at a glance
• 7,000 extra beds
• 100 hospital projects
• 7,500 more consultants
• 2,000 new GPs
• 20,000 more nurses
• Over 6,500 health professionals
• The creation of an NHS modernisation agency
• The creation of a national performance fund worth £500m
• Closer ties between health and social services with a £900m investment in intermediate care
• New consultants' contracts
• New GPs' contracts
• New roles for nurses, midwives and therapists
• Better pay
• Better training
• Patients' choice will be strengthened and they will have more rights
• Redress if operations are cancelled
• Patients' representatives on trust boards
• Electronic patient records and smart cards for patients
• Reduced waiting times for beds, operations and in accident and emergency
• Waiting lists eventually abolished and replaced by a booking system
• Reducing inequality of health provision
• Increasing cancer screening
• Investment in research
• Ending the postal lottery that controls access to cancer treatment
• Expanding out of hours pharmacy service
• Increasing the number of over the counter drugs
• Nicotine replacement therapy on prescription
• Cleaner hospitals
• More private rooms
• Higher standards of care for older people
