Published: 14/10/2004, Volume II4, No. 5927 Page 8

Hospitals should operate separate elective and emergency work in the same way as treatment centres.

Modernisation Agency national programmes director Janice Nicholson said the introduction of treatment centres, which separate elective work from emergency facilities, had been a 'wake-up call to the NHS to think about doing things differently'.

She told the agency's national conference in Manchester: 'I think the principles of the treatment centre can be applied anywhere... Anything that is done within a treatment centre can be done in a hospital environment. What we are trying to do is pull together good practice and demonstrate how it can be done.'

Since the programme was introduced in February 2002, 27 centres have opened, with a further 19 still in development. Five of these are expected to open in the next three months.

Ms Nicholson said the lessons from the centres that were up and running demonstrated that new ways of working were more important than bricks and mortar.

'It is not about buildings, It is about how teams work together, how they use care pathways, how they work with their local health economy, how they use evidencebased practice and develop new ways of working.

'Having a building saying that it is a treatment centre may be important for the local health economy, but it is the principles and what is going on inside That is important, ' said Ms Nicholson.

Department of Health elective care programme director Alan Perkins told delegates that some centres had already managed to convert existing facilities into centres by adopting new 'protected' ways of working.

'Some places have needed new buildings. Other places have adapted ways of working, with the emphasis on short-stay care and done it within existing facilities - but just re-badged them as a treatment centre, [protecting] them from the rest of the hospital and from having emergency admissions.'

Mr Perkins said he was working closely with the Modernisation Agency to ensure that its scaling down from April next year does not jeopardise the treatment centre project.

'The way [the agency] has been able to support the treatment centre programme - and day surgery in particular - probably will not exist in the same way in the future. So we are trying to work very closely with them to make sure we bridge that modernisation so we do not lose the impetus we have built in short-stay elective care, ' he said.

Health minister John Hutton described the introduction of treatment centres as one of the most important reforms to shape the NHS.

The centres - which are expected to have carried out almost 160,000 extra operations by the end of next year - have brought about a 'radical reform' of the NHS because of the 'brilliant work of NHS staff across the country', Mr Hutton told HSJ.

'We have treated 80,000 patients in treatment centres so far and that will be nearly double by this time next year. It is really moved on pretty quickly and it is one of the most important reforms that is currently taking place in the NHS, separating emergency and elective work.'

And he argued that if the Conservatives won the general election the reforms could be left unfinished. He said it was up to the public to safeguard them.

'It is the public that have ensured these reforms take place in the NHS. It is up to the public to ensure that this reform process is completed, ' he said.

Less is more: the agency's future

The Modernisation Agency must become a smaller and more local organisation, national programmes director Janice Nicholson told HSJ.

'We are moving into a new sphere, but I am not fazed by it.That is the right thing for the Modernisation Agency to do. It started a process and to get to the next level of transformation needs a lot more local involvement, ' she said.

'For me it was set up to get people to think about modernisation and do things differently.What we have done over four years is planned some of the best ways to transform the NHS.We also recognise that to deliver that there needs to be a lot more local involvement in the change. It is important that the Modernisation Agency goes through this evolution and goes to the next stage of its life.'

The exact structure of the new body is still unclear, but it will have only 150 staff compared to the current 760.Ms Nicholson said current employees would have one of three options: apply for a job with the new body, apply through the 'matching process' to work locally on modernisation, or apply elsewhere in the NHS.

'There are a lot of jobs that are going to be put in place working across all the health economies.

So the Modernisation Agency has been working with strategic health authorities and primary care trusts to identify what sort of roles are required to help them to do service modernisation locally.

That will vary depending on local need.'