Will Tony Blair deliver his promises on services?

In week 6 of our campaign, we look at how health reforms are affecting a typical hospital

The promises

Last week the National Audit Office caused outrage when it revealed that Tony Blair's targets for hospital waiting lists had distorted clinical priorities in the NHS. Minor oper- ations were taking priority over serious cases, possibly costing lives. So what has happened to the Government's ambitious promises for the health service? Raymond Whitaker went to Kettering General Hospital in Northamptonshire to find out.

The reality

Dr Ahmed Mukhtar does not believe the targets in the much-trumpeted NHS Plan can actually be met. Last Monday he was able to tell Tony Blair just that.

The Sudanese-born medical director of Kettering General Hospital, which serves 280,000 people in northern Northamptonshire, was among senior health service professionals invited to No 10 to "celebrate excellence in the NHS". He was far from overawed, having met the Prime Minister there before.

"I had only a couple of minutes with him this time, so I stuck to just the one point – capacity," said Dr Mukhtar, a busy consultant paediatrician, as well as an administrator. "I told him that if we had enough physical space in out-patients, in the operating theatres and in the wards, we wouldn't need to talk about meeting the targets."

The hospital, sprawling across 20 acres on the outskirts of Kettering, has plenty of room, but the medical director says it is a question of time. "It will take until 2003 to build new facilities, and while that is going on, our ability to treat people will be affected." Not that he believes the targets should be abandoned. "It is a question of what happens when we accept that the deadlines cannot be met."

Dr Mukhtar's views matter because Kettering, with 2,465 staff, 560 beds and 306,000 patients each year, is absolutely typical: a "middle-sized, district general hospital in middle England", as its chief executive, Geraint Martin, put it. If the NHS Plan is to work, it must work here.

One thing the plan does mean is serious money. In the accident and emergency department a third consultant has been added, two more are about to be appointed in medical assessment, and 20 new beds will be opened. All the same, the department is struggling to meet performance targets. "The facility is only six years old, but already we are outgrowing it," said Marisa Shrimpling, a clinical nurse specialist. It is a classic illustration of the problems of planning in the NHS, where, as the director of nursing, Hilary Scholefield, pointed out: "There is no limit on demand, but resources are finite."

While A&E demand has been growing by 2 per cent nationally, in Kettering the figure is 5 per cent. "The Patients' Charter says 75 per cent of patients should be seen within an hour," said Ms Shrimpling. "We used to meet that easily, and maybe we got complacent. Now the figure is down to 60 per cent."

All over the hospital, though, people make the point that the NHS Plan is about much more than "Tony's targets". They are seen as a by-product of the main aim: rebuilding the service from the ground up. It is an opportunity to reassess everything, from the appointments system to the way doctors and nurses do their jobs. One way A&E is seeking to get back on track is by expanding the medical assessment unit, where Jim Archibald, 61, a former steelworker in Corby, was recovering after the hot weather worsened his emphysema. A year or two ago his condition would probably have required full-scale hospital admission.

Kettering is proud of having given nurses far more responsibility than in most hospitals, and claims to be well advanced towards "airline booking", the promise that by 2005 patients will be able to name their own times for treatment. It is looking at a radical reorganisation to stop emergency cases constantly causing the postponement of routine surgery, an initiative being closely watched elsewhere. "One change in the past couple of years is that if you perform, you get more money," said Robin Lee, a consultant ear, nose and throat surgeon. "Previously the system rewarded the under-performers."

What emerged at every turn, however, was the difficulty of pumping money into a health service whose arteries have been hardened by more than a decade of decline. "We need to work at 80 per cent of capacity to achieve the targets in the NHS Plan, but we are at 100 per cent, and demands will grow as the population ages," said one staffer. "It will cost a great deal to remain in the same spot, let alone go forward."

The hospital has new CAT and MRI scanners, costing £500,000 and £1m respectively, but neither can run at full capacity until more radiographers and radiologists are found. "There is still a tendency to give lots of money for capital projects, while the cash for running costs lags behind," said Dr Mukhtar. "There has been a sea change in the NHS since Labour came in, but we must keep at it, addressing what is important rather than what is easy to achieve."

The response

"We try to take a balanced approach on implementing the targets," said Kettering's chief executive, Geraint Martin. "In March, when we were extremely busy, we had to decide on our priorities. I told the doctors that clinically they should put emergency admissions first, even if it meant missing the waiting list target. Hitting targets is a by-product of modernisation, not the other way round."

Still on the critical list

By Michael Durham

These are the main pledges made by Tony Blair on the NHS. Clearly, the patient is not in good health.

Promise 1: To cut hospital waiting times to three months for outpatients and six months for inpatients by 2005.

The reality: In May, the number of inpatients waiting over 12 months was down 12.3 per cent over last year.

Promise 2: To expand cancer-screening programmes.

The reality: Breast-screening programmes are slowly being expanded, but problems in recruiting trained staff remain.

Promise 3: To cut waiting times for cardiac surgery to 15 months by April 2002.

The reality: On target. The number of rapid-access chest-pain clinics more than doubled to 130 by April this year.

Promise 4: To guarantee surgery within 28 days if operations are cancelled for non-medical reasons by 2002.

The reality: The Department of Health is "confident" trusts are on course to deliver.

Promise 5: To provide 7,500 more consultants, 2,000 new GPs, and 20,000 more nurses by 2004.

The reality: A long way to go. Two new medical schools to open in 2005.

Promise 6: Create 7,000 extra hospital beds and 100 new hospital schemes by 2010.

The reality: Very little evidence of new beds yet.

Promise 7: To provide 335 mental-health teams for immediate response to crises.

The reality: No advance ­ only 35 teams so far.

Promise 8: To set up an NHS Modernisation Agency and a National Performance Fund to implement changes.

The reality: Modernisation Agency was launched in April, but the Performance Fund is still under development.