Britain: An official handbook > 1993

BRITAIN 1993: AN OFFICIAL HANDBOOK
maternity departments; infectious disease
units; psychiatric and geriatric facilities;
rehabilitation facilities; and other forms of
specialised treatment. There are also specialist
hospitals or units for children, people
suffering from mental illness, those with
learning disabilities, and elderly people, and
for the treatment of specific diseases.
Examples of these include the world-famous
Hospital for Sick Children, Great Ormond
Street, and the Brompton Heart and Chest
Hospital in London. Hospitals designated as
teaching hospitals combine treatment facilities
with training medical and other students, and
research work.
Many of the hospitals in the NHS were
built in the nineteenth century; some, such as
St Bartholomew’s and St Thomas’ in
London, trace their origins to much earlier
charitable foundations.
Much has been done to improve and
extend existing hospital buildings and many
new hospitals have been or are being opened.
Since 1979 in Great Britain over 600
health building schemes, each costing
£1 million or more, have been
completed. A further 400 schemes are
at various stages of development. This
is the largest sustained building
programme in the history of the NHS.
Recent policy in England and Wales has
been to provide a balanced hospital service
centred around a district general hospital,
complemented as necessary by smaller, locally
based hospitals and facilities.
A new development in hospital planning
in England and Wales is the nucleus hospital.
This is designed to accommodate a full range
of district general hospital facilities and is
capable of being built in self-contained phases
or as an extension to an existing hospital. By
mid-1992, 83 nucleus hospitals had been
completed. A further 56 are at various stages
of construction or planning. Those already
open have proved economical to build and
are providing high-quality and cost-effective
services to patients.
The world’s first low-energy nucleus
hospital, which is expected to use less than
half the energy of a conventional nucleus
hospital, opened on the Isle of Wight in
1991, and another is being built in
N orthumberland.
The hospital service is now treating more
patients a year than ever before. Between
1979 and 1990-91 lengths of stay for
in-patients declined and the number of
people treated as day patients more than
doubled. Newer forms of treatment and
diagnosis are being made more widely
available. These include kidney dialysis, hip
replacements, laser treatment and body
scanning.
In 1986 the Government launched a drive
to reduce hospital waiting lists and times. In
1992-93 £39 million is being invested in a
variety of projects, including mobile operating
theatres, to improve waiting times for
patients. Preliminary figures show that the
number of patients waiting between one and
two years for treatment fell by nearly 40,000
or 33 per cent while the total waiting list
dropped bv over 33,000 or 3-5 per cent in
1991-92.
Community services such as the
psychiatric nursing service, day hospitals, and
local authority day centres have expanded so
that more patients remain in the community
and others are sent home from hospital
sooner.
NHS Trusts
Under the NHS and Community Care Act
1990 hospitals and other health service units
(for example, ambulance services and
community health services) may apply to
become independent of local health authority
control and establish themselves as self-
governing NHS trusts. These are run by
boards of directors, and are free to employ
their own staff and set their own rates of pay,
carry out research and provide facilities for
medical education and other forms of
training. Self-governing NHS trusts derive
their income mainly from NHS contracts to
provide services to health authorities and GP
fundholders. The trusts may treat private
patients. All trusts must provide annual
reports, and annual accounts modelled on
commercial accountancy practices. By August
1992, 156 NHS trusts had been established.
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