'The NHS is in the middle of the biggest hospital building programme in its history', according to Health Secretary John Reid.

There will be 15 new hospital developments worth a total of £4bn, it was announced. The NHS Plan had a target of 100 new hospital schemes open by 2010. More than 40 are already built.

The new hospital developments are mostly funded by private finance initiatives (PFIs). They have all been approved by their strategic health authorities. The developments are:

• Bedfordshire and Hertfordshire (£880m)
• Hillingdon Hospital, Middlesex (£271m)
• Leicestershire Partnership NHS Trust (£52m)
• Maternity and Children's Hospital in Leeds (£204m)
• North Bristol and South Gloucestershire (£310m)
• North Mersey Future Healthcare Project (£1008m)
• Northwick Park and St Mark's, London (£305m)
• Papworth Hospital NHS Trust, Cambridge (£148m)
• Royal National Orthopaedic Hospital Stanmore, Middlesex (£121m)
• Sandwell and West Birmingham Acute Trust (£591m)
• South of Tyne and Wearside (£50m)
• Southend Hospital, Essex (£100m)
• Taunton Surgical Centre, Somerset (£75m)
• Tees and North East Yorkshire NHS Trust (£73m)

The redevelopment of Great Ormond Street Hospital for Children (£225m) is also included in the DoH list. This is not a PFI scheme — it will be funded with £75m in public capital and the rest through charitable donations.

Twenty NHS trusts have received Health Secretary John Reid’s support in bids to become foundation trusts. The trusts are:

• Aintree Hospitals NHS Trust
• Barnsley District General Hospital NHS Trust
• Birmingham Heartlands and Solihull NHS Trust
• Birmingham Women’s Healthcare NHS Trust
• Burton Hospitals NHS Trust
• Chesterfield and North Derbyshire Royal Hospitals NHS Trust
• East Somerset NHS Trust
• Frimley Park Hospitals NHS Trust
• Gateshead Health NHS Trust
• Harrogate Healthcare NHS Trust
• Lancashire Teaching Hospitals NHS Trust
• Liverpool Women's Hospital NHS Trust
• Newcastle Upon Tyne Hospitals NHS Trust
• Nottingham City Hospital NHS Trust
• Royal Bournemouth and Christchurch NHS Trust
• Royal National Hospital for Rheumatic Diseases NHS Trust
• Southend Hospital NHS Trust
• South Tyneside Healthcare NHS Trust
• West Suffolk Hospitals NHS Trust
• Wrightington, Wigan and Leigh NHS Trust

South Devon Healthcare NHS Trust was refused permission.

The successful trusts now have to apply to the independent regulator of NHS foundation trusts, and could change status in one of two periods: either November 2004 or February 2005.

In making the announcement, John Reid confirmed his plan to have all trusts go foundation by 2008. To help this cause, three star-rated mental health trusts will be able to apply for foundation trusts status in the next wave.

There are currently 20 foundation trusts in operation.

Smoke-free working, wrong blood accidents, medical research and an upward trend in HIV infections are the main topics of a report by Sir Liam Donaldson, the chief medical officer (CMO).

On the state of public health is an independent report on aspects of the nation's health. The 2003 paper makes the following points:

• There should be a smoking ban in work and public places. A chapter titled 'Going smoke free: the economic case' shows that it would improve business for the hospitality industry, rather than harming it as the pro-smoking lobby argues. Another chapter, 'Smoker's face: beauty is only skin deep', describes the ravages of smoking and passive smoking, including wrinkles, damaged blood vessels and bad skin colour. It also criticises the fashion industry for not distancing itself from a habit incompatible with beauty.

• The national blood transfusion service faces a shrinking donor pool and has seen a growing number of 'wrong blood type' accidents. The CMO has asked every hospital to review its procedures and to manage stocks efficiently.

• Although England does well in medical research, clear career structures and better rewards would help clinicians combining research and practice.

• HIV infection rates, which have been relatively low in England, are rising. The number of people diagnosed has gone up by 126 per cent since 1996. Many cases concern people infected through heterosexual sex in countries with high infection rates. It was also noted that around a third of those diagnosed do not know they have the condition. The report says safer sex must be promoted and the infection must be identified earlier.

The National Institute for Clinical Excellence (NICE) has been criticised for costing the NHS too much money.

The claim is made in the British Medical Journal by York University’s professor Alan Maynard. In the article ‘Challenges for the National Institute for Clinical Excellence’, professor Maynard says ‘NICE has yet to mature into the efficient prioritisation mechanism that is required to ensure the best use of NHS resources.’

He also claims that NICE should take more account of the cost of its recommendations and blasts some of its decisions to make certain drugs available on the NHS as ‘essentially arbitrary’.

He recommends the body should:

• Be handed its own budget to fund new treatments
• Advise on the withdrawal of existing ineffective/inefficient treatments — there is too much emphasis on new technologies
• Focus on more than clinical and cost effectiveness
• Get NHS staff — ‘who bear the burden of translating NICE guidance into practice’ — more involved in the selection process of new technologies

Professor Maynard believes that his recommendation to hand NICE a budget and ‘require it to fund all its advice within that expenditure envelope with allocations to trusts to fund its recommendations’ will not be received favourably by the pharma industry as: ‘they would make rationing tighter and potentially shrink its UK market. Such a reversal of NICE's current propensity to be the marketing arm for companies would have political consequences and requires careful management.’

In response to the article, chief executive of NICE, Andrew Dillon said:

‘Although our recommendations make a big impact on patient care, the cost of the technologies we recommend is marginal (around 0.1 per cent) on an NHS budget which exceeds £60bn.’

The quango cull will cause 6,000 job losses but will free £500m for the NHS.

Almost half of the DoH's arm's length bodies will be dissolved, reducing the number from 38 to 20. There will also be a 25 per cent reduction in the staff of 25,000.

The main changes are:

• The Mental Health Act Commission will be abolished. The Healthcare Commission is to be responsible for regulating care of people detained under the Mental Health Act.
• A new regulatory authority for fertility and tissue will take on the work of the Human Fertilisation and Embryology Authority and the proposed Human Tissue Authority.
• The National Institute for Clinical Excellence (NICE) will link standards on the prevention and treatment of ill health. This is currently in the hands of the Health Development Agency, which will be abolished.
• The Commission for Patient and Public Involvement in Health (CPPIH) will be abolished. More efficient arrangements will support and advise patients' forums. This has raised comments from the Consumer's Association: 'If the government is serious about promoting patient choice, it's contradictory to remove their voice.'
• The National Patient Safety Agency will support independent ethical reviews of research that could affect patients and take the lead on hospital food, cleanliness and safe hospital design. It will also be responsible for national confidential enquiries from NICE.
• NHS Estates will be abolished.
• The Health Protection Agency will assume the role of Public Health Laboratory Service and the National Radiological Protection Board, which will both be abolished.
• A new Blood and Transplant Authority will encompass the services provided by the National Blood Authority and UK Transplant, which will both be abolished.
• The NHS Litigation Authority will be reconstituted to oversee the proposed NHS redress scheme and manage financial compensation nationally. It will also take on the functions of the Family Health Services Appeal Authority, which will be abolished.
• A new health and social care information centre will reduce burdens on the frontline by coordinating information requirements across a wide range of bodies. The centre will retain some of the information-related functions of the current NHS Information Authority (NHSIA) which will be abolished, and take on the statistics work of the DoH.
• The national programme for information technology will become an executive agency for three to five years, incorporating the IT functions of the NHSIA.
• A new NHS Business Services Authority will replace the NHS Pensions Agency, the Dental Practice Board, the Prescriptions Pricing Authority and the NHS Counter Fraud and Security Management Authority, which will all be abolished.

The chief executive of the health thinktank the King's Fund, Niall Dickson, welcomed the cull — apart from the abolition of CPPIH — saying 'The NHS has been drowning in an alphabet soup of acronyms.'

A crown court judge who criticised an untidily signed medical report has himself been told off for perpetuating a fallacy that doctors have bad handwriting.

Judge Gareth Edwards QC accepted the report at Mold Crown Court, but complained that he could not tell who had signed the report. 'I have said time and again that is not a signature. A signature that cannot be read is not a signature. They are not worth the paper they are written on if you cannot say which doctor has signed it.'

His comment angered Cardiff GP Amanda Kirby: 'This is a fallacy that has become an urban myth. If the doctor can show it's the same signature again and again, then it shouldn't be an issue.'

'Compared to lawyers or dentists, doctors are no worse or no better than any other profession.'

However, research published by the British Medical Journal in 2000 confirmed that doctors have worse writing than other healthcare workers. And the UK Central Council for Nursing claimed in 2001 that scrawled prescriptions threatened patient safety and made nurses' lives difficult.

The General Medical Council advises doctors to keep their reports and prescriptions legible.