More theatres, equipment, beds, nurses ...

The chief executive of one NHS trust has worked out a wish-list of what his hospital needs

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University Hospital Birmingham NHS trust is typical of many run-down inner-city hospitals. Many of the buildings are decades old. Effective delivery of services is hampered by the fact that it operates on two sites in south Birmingham: Queen Elizabeth Hospital in Edgbaston and Selly Oak Hospital a mile and a half away. It employs 5,500 staff and serves nearly half a million people.

For its chief executive, Mark Britnell, an extra 9 per cent on his budgets would make the difference between the hospital functioning as it should and the constant, battle to stave off breakdown.

"I have worked in Australia and the US, and compared with them the NHS is always working at the very margins of its capacity. A hospital should be working at about 83 per cent capacity to allow for peaks in demand. We are always working at 96 or 97 per cent capacity and that leads to breakdowns and more cancellations, more trolley waits and more delays in A&E.

"The trust has a £270m annual budget, so 9 per cent would equate to about £24m. I think to get down to 83 per cent capacity I would need an extra 100 beds."

Mr Britnell said the NHS had been "pretty lacklustre" in its development of information technology. "I would invest some of the money in something called the Electronic Patient Record, which is an online version of a patient's medical history. It is a valuable tool that means I can keep track of what is happening to patients. Getting this right will mean that I can hold clinicians to account for their performance.

"I would also spend it on more theatres and more equipment. There is a real bottleneck in diagnostic imaging so I would want to buy more scanners.

"I would also want a new linear accelerator to deliver radiotherapy treatments, which are a vital part of cancer treatment. They cost about £750,000 but they also have to be housed in a massive lead bunker because of the radiation."

Earlier this month, Alan Milburn, the Secretary of State for Health, gave the go-ahead for a new £305m hospital rebuild, the first in Birmingham for over 60 years. By 2008 south Birmingham should have a new, purpose-built, 1,185-bed hospital in which to continue pioneering liver and heart transplants. The trust is the main research institute in the West Midlands. In January its liver unit became one of the few hospitals in Europe to have carried out 2,000 liver transplants.

In the fallout from the Bristol heart baby deaths, surgeon Mr Bruce Keogh is pioneering audit and quality techniques that will see heart surgeons' performance opened up to public scrutiny and could become the model for comparison of doctors' performance across the UK.

The trust is easing its nursing shortage with staff from the Philippines. "That's OK as a short-term solution," Mr Britnell said, "but there are more nurses in training than before who will graduate in the next two years, so I would use some of the extra money to employ them."

NHS trust performance statistics published this week revealed that many elderly patients who are well enough to be discharged were forced to stay in hospital because of a lack of suitable nursing or residential accommodation or help at home.

"I think society seems to have overlooked the massive demographic time bomb which is going to go off over the next decade. As a nation we are living longer and there will be more of us in the 70, 80 and 90 age groups where the bulk of medical care is delivered. I would spend some of the money on more community and intermediate care places for the elderly so that they are not stuck in hospital."

Additional reporting by Robert Thickett