HSJ asks Andrew Lansley about his pledge to give every patient access to a single room in five years.

Does it require a lot of new building?

In some cases, but sometimes not. Because we're in a situation where over the last couple of years we've had about 4,000 beds taken out each year and in many places taking out beds has often meant taking out wards. Of course it's perfectly possible sometimes to take out beds because you have legitimate reasons to reduce the number of beds... but actually the way you do it might be to take a number of beds out of a number of wards and increase the number of single rooms.

I've been to hospitals recently where they've done precisely that and actually they've sometimes been quite old buildings and have been able to create a much more modern result including more single rooms.

Isn't five years quite ambitious?

Well, I think if people gear up... Actually some hospitals are there, others have quite a long way to go. But the resources will be relative to the task. The reason we want to do it quite quickly is because it seems to us to be instrumental to two things. Firstly, to achieving certain service standards that people have a right to expect including infection control and secondly we want to get to the point where hospitals are able to offer services to patients on a comparable basis. If we have older hospitals with relatively poor standards of accommodation in an any-willing-provider situation they are going to be exposed, aren't they? And we don't want them to be exposed. We want them to be able to make the offer to patients that patients might otherwise say well I can go to the Nuffield of the Spire Healthcare or whatever and I'll automatically be in a single room. We don't want flight out of NHS hospitals, we want them to be in a position to compete.

Some people were saying it sounds like a central diktat.

There are standards. Patients not being in mixed sex accommodation is a service standard. It's not a target, it doesn't distort any clinical judgements, it's just a service standard. Having enough isolation facilities doesn't distort anybody's clinical priorities, it's not a process target, it's supporting the NHS to do this thing.

I'll tell you how this really arose. I've been to a number of hospitals talking about their infection control strategies and David and I at the beginning of the year were talking about payment for performance and it seemed to us that probably the single greatest obstacle for many hospitals to delivering the infection control strategy they wanted was the lack of isolation facilities. And it wouldn't be fair for us to expose the NHS to payment for performance on infection control where the hospital didn't have enough infection control facilities. Now where's the money going to come from? The tariff at the moment does not support spending money for new isolation facilities because the tariff doesn't give you any extra money if you reduce infections as a result. So we've actually got to get people to a certain level.

There's a capital underspend at the moment, couldn't they do it at the moment?

Yeah, the government should be doing these things. Of course. But they are not doing it, are they?

Is it about the government or is it about trusts?

No, it's about government. It's about the government making capital grants available to do this particular job. And I don't understand why they don't. There are reasons why there is a capital underspend, which are principally to do with the delay on NPfIT and the need for the Department of Health to set aside capital allocations against FTs' prudential borrowing limits. So when you leave those aside there's still a lot of money that isn't being spent.

But that's about the government pushing that?

Yeah of course. But it's not really a top-down target, no.

There's a constraint to doing it, which is a physical constraint. And my objective is I want to get to an NHS where they enjoy much greater freedom but we've always recognised that to some extent we've got to get everybody up. It's a bit like getting everybody to FT status. We're going to have to put extra effort into the non-FTs to get them to the point where they can be full participants in this more competitive market.

Will hospitals have a choice about this?

Well strictly speaking they will, yes. We will make it [funding] available. I mean I think you'd be mad. If you look at the press release you'll see strictly speaking we are making the resources available in order to give...

But you are giving a pledge to the public.

Yes, but of course the public will be booking their operations through a system where we will be sure that if they want a single room, a single room will be available. All hospitals should be in a position where they have a given proportion of single rooms. But actually that doesn't necessarily mean that every hospital will be able to offer a single room to that patient on that ward. It's not a guarantee. I haven't used the guarantee word. What I've said is every patient should have that opportunity. It may not necessarily be in the hospital of their choice.

What is your definition of a single room?

There is a formal separation, there is a technical definition.

When you talked about single rooms yesterday, is that what the public will think of as a single room with four walls?

Well, at least three, properly separate, yes.

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