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英国首相布莱尔00系列演讲之Speech at St Thomas' Hospital, London, on Modernisation of A&E - 29 February

2006-05-26 17:59

  I am delighted to be here today to open formally this million pound upgrading of St Thomas' Accident and Emergency facilities - completed on time and to budget.

  As a result of the modernisation, this hospital now has new areas for receiving and assessing patients and for treating minor conditions. It also has improved facilities for treatment, resuscitation, mental health assessment and - I am pleased to see - staff. It also has an impressive state of the art digital radiology system. And later this year a new medical assessment unit for GP admissions will be built.

  It will provide the people of this part of south London with the modern high class A&E services they need and deserve. The facilities you have here rank alongside the best Emergency Rooms in the US.

  As important is the fact that what is happening here is happening elsewhere in the country. The ??115 million modernisation programme which we announced last year is now producing results. Over a quarter of the 244 Accident and Emergency modernisation schemes in 182 hospitals are now complete. Half will be finished by the end of April and all bar a handful will be done and dusted by the end of the year.

  This is a huge achievement. Every casualty department that needed it - that's three-quarters of the total - modernised. NHS casualty departments in their history have never had the benefit of a programme on this scale.

  Like the scheme here the projects elsewhere include new special areas for children, better links between A&E and primary care, improved safety and security for staff and patients, faster access to diagnostic facilities and more assessment and observation wards.

  This is real money spent on real projects to benefit real patients. You can touch it. You can see it.

  Don't believe all that you read in the papers or hear on the radio about health care. I know there is a long way to go - but there is a real change and improvement in many parts of the NHS.

  The NHS is building more new hospitals than it has ever done. 20 are under construction and 17 more are in the pipeline. The first ones open later this year. Another big achievement that will start to transform the face of the NHS.

  It's the same with cancer equipment. With money from the NHS and the National Lottery we are funding over the next three years nearly 500 items of the most modern equipment to diagnose and treat cancer - mammography and ultrasound machines, linear accelerators and scanners.

  And we are getting in more staff too. Yesterday Alan Milburn announced the results of the latest nurse census. There were 4,500 more qualified midwives and nurses in 1999 than there were in 1998 - equivalent to an extra 3,000 full-time nursing and midwifery staff.

  It is the second year running that the numbers have risen and it is the biggest recorded rise for seven years. And since we came into government the number of full-time nurses has increased by over 4,000. Nurses are returning to the NHS - some of them are here today.

  There are more nurse training places - over 4,000 of them. More doctors - over 2,000 of them. And there will be more medical students - 1,000 of them.

  I could go on. True figures. Not invented statistics.

  The extra money that we have put into the health service is beginning to make a difference.

  But extra investment and more staff are not by themselves enough. We need modernisation too. Money and modernisation are two sides of the same coin. In this government's reform of the public services you cannot separate them. Modernisation requires money. But money without modernisation is money not well spent.

  Take A&E as an example. We are getting the modern facilities. Now we need the modern ways of working to go with the modernised departments.

  I was pleased to hear that as part of designing your new A&E department you examined your working practices to see what changes were needed to make the most of the new investment and to improve things for patients.

  So now you are making more use of emergency nurse practitioners in the minor treatment areas. You have someone to oversee the way beds are allocated and managed so that patients get into the right bed more quickly. And you have improved your working arrangements with social services so that when patients who are ready to go home but need some support they can be discharged without delay.

  That is exactly what I mean by money for modernisation.

  We now need to go further. We have to address the frustration that people feel when they come and wait for hours to be seen in casualty in what, if we are honest, have all too often been crowded chaotic conditions.

  The Department of Health's A&E Modernisation team will be reporting within the next couple of months. It will be recommending a big overhaul in how A&E works. A revolution in casualty care. Their recommendations will be wide-ranging.

  For example, slashing waiting times by doing as you have done and separating the treatment of minor injuries and illnesses from major injuries and conditions. And using NHS Direct assessment procedures to help do this.

  Giving appropriately trained nurses greater powers to order x-rays, blood tests and other diagnostic procedures, to interpret the results, give medication and discharge patients.

  Fast-tracking of patients directly to the appropriate speciality - for example, to orthopaedics for patients with fractured hips direct to orthopaedics.

  Training and empowering physiotherapist, radiographer and paramedics to take on new and extended roles.

  Focusing experienced and skilled consultants on the most complex cases.

  I know that you have anticipated many of these changes. But one of the challenges we face is to make the good things happen not just in isolated hospitals but everywhere.

  We do not want a lottery of care depending on how efficient your local hospital is. All patients wherever they live are entitled to prompt, convenient quality when they need.

  So modernisation is not something you opt in or opt out of. Of course, it will take time. But modernisation is not an optional extra. It is a 'must do'.

  Those Trusts that embrace change and modernisation will increasingly find that we leave them to get on and provide local people with a good service. We will not only get off your back, we will reward your effort. But those few that cannot or will not change can expect support and intervention - and, where necessary, someone else running the show.

  So modernisation and investment go together.

  And this investment and modernisation is for a purpose. It is investment and modernisation to build a new NHS. A different sort of health service. The new buildings, the modernised facilities, the modern equipment, the extra staff and the new ways of working are part of a concerted plan to renew the NHS for a new century.

  The health service we are creating effectively has four stages of care.

  Easy access into the Health Service through NHS Direct, through walk-in centres and through more convenient opening times in doctors' surgeries, through modern well run A&E departments. That is point number one.

  Point number two: the doctors and nurses locally grouped into Primary Care Groups that can drive forward innovation in health care in their areas - providing a wide range services on one site. Far better and more efficient than the two-tier system that we inherited.

  The third stage is then for social services and community hospitals to work together to provide community and what are sometimes called step-down or intermediate services. Particularly for elderly people, who may initially need hospital care but then require intensive rehabilitation and support in a more appropriate setting. Care which as Alan Milburn put it the other week is care that is a bridge between home and hospital.

  Fourthly, an acute hospital sector, where we have the doctors and nurses and specialists and the critical care beds that we need to care for people properly. And with proper inspection and accountability in the way those hospitals are run and managed.

  The four stages or levels of care working to provide the right and convenient care for each and every patient. Modern IT systems used to connect the various levels together. So appointments can be booked from the GP surgery. Test results sent and patients' records available quickly and instantly through the latest technology.

  So, our program for the Health Service requires extra investment, which we are getting. And it requires real reform and modernisation, which we are carrying out.

  And since the NHS means so much to Britain, and the people who work in it, I do think it important that the media give a sense of balance about this issue. To read and hear some of the coverage in the past few weeks you would think no-one is being cared for; that it's hopeless, beyond repair. This is alarmist nonsense. Ninety-nine per cent of people do not get their operations cancelled on the day they are due. The vast majority get good NHS treatment. There are real problems, some of a deep and long-term nature which will require time and money and change to put right.

  But there are millions of people every year in Britain getting superb healthcare from the NHS. They are the norm not the exception. We will put right what is wrong. But don't tell people it is all wrong. It isn't. The NHS is a brilliant conception and with that time and money and change, its reality will once again match the vision behind it.

  It will take time, however. I repeat this point constantly, because it is the truth. But let no-one say that the NHS can not be re-built. It can be re-built. It will be re-built.

  Yes, you will always get situations which should never happen. Yes, you will sometimes get people who are treated badly when they shouldn't be.

  But the NHS is a fine institution, that given the resources and the changes necessary will once again be the pride of Britain and the envy of the rest of the world. Taking time is obvious, but it is worth taking the time to get it right. And I am confident that we will get it right.

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