Advances in technology and treatments have largely shaped the development of the NHS in the last 50 years. Health Reporter Mike Waites looks at what changes patients can expect in the next 50 years and the challenges facing the NHS.

Five decades of the National Health Service have seen a complete transformation in the quality and range of treatments available to patients. And the pace of change in the next 50 years could be even greater.

In 1948 hospital patients often spent many weeks on stark wards dating back to the Victorian era; antibiotics were only slowly becoming available; while use of computers not to mention procedures ranging from organ transplants to test tube babies were many years away.

Nowadays increasing numbers of people are being dealt with as day patients at hospitals, medicines have hugely reduced the impact of infectious disease and medical developments seem never ending. In the future more and more patients previously treated in hospitals will be dealt with at local medical centres while recent developments like the cloning of Dolly the sheep point the way to advances which were once the stuff of science fiction books.

The pace of technological change was recognised only yesterday by the Government with the go-ahead for major spending on cutting-edge equipment. Problems of course remain, not least how the country is going to be able to pay for ground-breaking treatments.

The NHS was founded on the principle of free care for all - but prescription and other charges were introduced almost immediately and, with spiralling costs of hi-tech care in particular, the debate is growing about charging for more services.

GP Dr Gavin Craig, chairman of the Bradford Local Medical Committee, will be one of those at the forefront of changes in coming years as decision making shifts to family doctors and primary care staff. He said hospitals were likely to concentrate more on hi-tech, specialist treatments while more health services would be offered locally.

Nursing specialists would increasingly take on more duties in areas such as diabetes and chiropody while GPs would return to treating disease in an increasingly complex workload.

"I would hope we are going to move down the line of appropriate care being given in appropriate locations," he said. "In Bradford it will mean a reconfiguration of both hospitals to provide high-level quality care for more complex areas.''

Dr Craig said a number of issues needed to be debated, not least rationing of healthcare.

New treatments and technologies would be developed over the next 50 years but many would be expensive and he could envisage an NHS concentrating on core activities with other services on the periphery.

"It is impossible to deliver a service where everybody's wishes and expectations with regard to health are met, and central government needs to address this so that providers do have some support from the centre to say no.''

Bradford's director of public health, Dr Dee Kyle, said just as there had been unimaginable improvements in health and healthcare in the last 50 years, there were bound to be many more in the next 50.

New illnesses would develop while improvements in treatments would prolong life for many- but that would create further challenges to continuing care and resources.

"No-one could have foreseen the development of replacement hips, but as people's lives are greatly extended more people are going to want such things as these," she said.

Advances were likely to be dramatic in the field of genetics.

"Scientists will probably be able to predict before we are born what we are likely to suffer from and when we're going to get it," she said.

Con Egan, chief executive of Bradford Community Health NHS Trust, was born three months before the health service was created - his mother paid the midwife seven shillings and a tanner.

"Nobody wants to get ill but if they do they like to think they would get the best treatment available and that money wouldn't come into it,'' he said. "We will never get things completely right but we have got to keep making them better."

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