The Patient Power initiative will make life easier for patients - though at a cost - with a bedside TV and phone and potentially the Internet. Seamus Ward reports

A few years ago the presence of WH Smith, Waterstones and other high-street shops in a hospital building was practically unheard of. Yet in the Gledhow wing at St James' University Hospital in Leeds, staff, patients and visitors pass the newsagents and booksellers without a second glance. A simple vending machine beside the shops attracts more attention. It is not surprising as it represents the latest revolution in nonclinical services to patients.

The machine sells smartcards that operate the Patientline bedside television and telephone units that are installed by 820 beds in St James' and in 30 other hospitals. Though they are far from commonplace yet, the NHS plan promises that every 'major hospital' will have similar equipment by 2004.

The Patient Power initiative is being co-ordinated by NHS Estates, which awarded licences to supply the equipment in December. The awards are based on a number of criteria, including quality of service, ability to upgrade and value for money to patients.

Three companies have been awarded full licences and a further four provisional licences. NHS Estates says full licences are being issued to companies with a track record of delivering systems within the NHS and with a developed product. These companies will be able to enter into agreements with trusts to install systems.

Provisional licences are being issued 'to companies which have a limited track record but who have a system ready to try out. They will need to find a hospital willing to participate with them to develop a technically and operationally robust package.

Upon successful completion of such a pilot, consideration will be given to issuing a full licence.'

Full licences have been awarded to Patientline, Wandsworth Electrical and Hospital Telephone Services, while Unicorn Hospital Communications, Static Systems, Syntec Telecom and Sodexho have been granted provisional licences. A further round of licences will be awarded next year.

Hospitals pay nothing for the installation and maintenance of the bedside units. This is done by the private sector, which recoups its investment on a 'pay as you use' basis. The private sector's initial costs will be high. And 150,000 beds need to be equipped at between£1,000 and£2,500 per bed. Though costs vary, the systems are fairly similar.

The system offered by Wandsworth Electrical is typical. The units, which were recently installed in the Royal Marsden, are mounted on a retractable arm fitted above the bed and include a 10-inch LCD television with a handset that controls the TV and radio and doubles as a phone.

A nurse call-button is included. The company has provided nurse-call systems for hospitals over the last 50 years. Richard Mockett, managing director of Wandsworth, says the system, known as PT2000, is a natural extension of this work.

Static Systems, which has provided nurse-call systems for 35 years, offers both a fully integrated unit and separate TVs and phones. Philip Wade, its sales director, says this gives trusts greater flexibility when they have the equipment installed.

'It may have a lower capital cost so this would be reflected in the charges to the patients.

While we fully support the Patient Power objectives, each hospital will have different requirements. Some hospitals may take the view that it is not relevant to put phones into their elderly care wards because the patients will not use them, ' he adds.

Charging for these services is a contentious issue but NHS Estates will not set charges, saying if they are too high patients will refuse to use them. Payphones and dayroom TVs will still be available to patients, it says.

Most of the complaints have focused on the cost of calling a patient - 50p a minute.

Brian Saunders, facilities operations and contracts manager at Mayday Healthcare trust, Croydon, which has the Patientline system, says a recorded message states the call cost before callers are put through.

'Patientline can't do anything about it - It is the commercial rate, ' he adds.

'The calls patients make to their relatives are 5 per cent less than the current BT rates and there is the advantage of having the phone by your bedside. Patients do not have to wait for the trolley to come round or have to go to a public phone in the corridor.'

Mr Mockett defends the cost of Wandsworth's TV system, which is£2.50 a day.

'The equipment costs£2,500 a bed and the charge is not for the TV programmes but for renting the equipment. BBC and ITV programmes are free through the TV licence but we also provide about 10 Sky or OnDigital channels free.'

Derek Lewis, chair of Patientline, says the NHS could not supply the services free to patients because the cost would be prohibitive.

'If the NHS were to provide these services it would be a significant additional cost and this would hit another part of the budget, presumably some form of clinical care. We recognise that the question of charging patients is a sensitive one and it is something we have wrestled with in the six years we have been in operation.'

Patientline's TV services costs£3.50 a day or£20 for seven days. 'We have tried to keep costs as low as possible, consistent with recovering our costs and making a reasonable return over quite long periods, ' says Mr Lewis.

'The overall measure of whether we are being reasonable is that we have been operating for almost six years and we have yet to make a profit, though obviously we expect to.'

Some services are given free, including radio, TV at breakfast time and each new patient is given a free outgoing call. 'We give free TV to children and It is half price for those aged 60 or over.'

Patientline is working on a more advanced system which will include Internet access and the potential to link up with hospital computers to obtain lab results and access electronic patient records and clinical information.

Patients can access the Internet through Wandsworth's PT2000 system if they have an Internet-ready laptop. If Internet use is popular, the company will consider including Internet access in all its bedside units.

Mr Lewis says extending the units' capability beyond entertainment is an exciting step but he acknowledges it also raises concerns.

'There is serious concern about confidentiality and we are doing a lot of work to ensure that unauthorised people do not get access to patient information. But provided That is done, there is enormous potential, ' he says.

In Leeds, the bedside units have cut calls to the nursing station by 70 per cent in some wards, a phenomenon that has not gone unnoticed at Mayday.

'The nursing staff see it as a boon, ' Mr Saunders says.

'They used to have to relay messages from people ringing in but this has been reduced significantly. They also find that it keeps patients occupied; it makes them less dependent on nurses.'