Doctors' leader Dr Sandy Macara is optimistic about the future of the NHS.

When the National Health Service (NHS) first began, the centre of health service activity was the local Hospital. Consultants were the demi-gods that strode around the wards dispensing wisdom, while nurses wearing elaborate bonnets, acted as their handmaidens.

Nowadays, family doctors have more say over what happens to people with illnesses, while some nurses are now able to diagnose and prescribe treatments to their own patients.

BBC correspondent James Westhead looks at how this future NHS is already starting to take shape.

Partnership between professionals has become the watch word. But I believe that in the future patients will become the key decision makers in the NHS, while the medics will become our advisers on what healthcare treatment option to take.

New technology

The main reasons for this change are to do with new treatments, new technology, and the changing face of UK society.

Patients are using the Internet to find out about diseases

Medicine in the twenty-first century will continue to develop, and further progress will be made in combating cancer and heart disease. Genetics and genetic screening will also be more common - with even foetus's being scanned for defects - and possibly even personality traits.

Keyhole surgery will become the norm - with computers mapping a patient's body and guiding the surgeon's laser to the exact point needed. Indeed, some operations could be performed by computers on their own - with doctors monitoring the situation in case of an emergency.

Information technology will also have an effect. With the growth of data sources like the Internet, patients will find themselves with just as much information, and possibly more, than their family doctors and practise nurses.

Access to information

Already many GPs have told me of patients walking into their consultation rooms armed with sheaves of documents they've pulled off the Net which list the latest developments to do with their particular condition.

Genetics is the way of the future

At the same time it will be easier to find out which doctors have the best success rates. In fact, some people may be able to diagnose their own diseases - using computers that provide rapid analysis of symptoms and analysis of blood and urine samples.

With more information about the standards of care available to them, patients will expect to have more choice over the type of treatment they can receive and where they receive it. Because of this, doctors and nurses will become more like guides to patients, offering them advice on the different treatment options available.

Former health civil servant Dr Geoffery Rivett defines a new kind of healthcare.

Big is beautiful

Two other changes will have an impact on the shape of the NHS. Medical experts now believe that high standards are best maintained in regional centres of excellence.

That, combined with the philosophy of providing more care in the community, will mean that many smaller hospitals will close and a network of larger regional units may be established.

The other factor is the growing number of elderly people living in Britain and the consequent increase in the diseases and chronic conditions that afflict that section of society.

Future assured

It has become almost a party game amongst health analysts and professionals: guessing what the National Health Service will be like in the year 2048.

The fact that it will still exist, excluding the possibility of a natural or man made disaster, is, however, no longer raised as a serious question.

It is now assumed that the principle of a tax-funded health service, free to its citizens, and offering care for all conditions and diseases, is firmly embedded in the British psyche.