FROM Dr Jim Hall's window he can see the walls of the new heart unit rising brick by brick and the cardiologist is longing for the day when the North-East's largest heart hospital can expand into its new accommodation.

Once the extension is fully open - in March 2003 - the cardiothoracic team at the James Cook University Hospital, formerly South Cleveland Hospital, will be able gradually to increase the number of heart bypasses it can perform, from 1,200 per year to around 1,800. At the same time, the number of angioplasties (unblocking furred-up arteries by using a tiny balloon) will rise from 600 to 1,050.

It is expected to take another two years before the targets can be reached, but Dr Hall is hoping that the Teesside team can repeat their remarkable achievement back in 1993, when the heart unit opened to complement facilities at Newcastle's Freeman Hospital.

"We hope we will hit the ground running, rather like when we started work here. Back then, we hit our predicted full capacity within two years and then we went on to exceed the capacity," says Dr Hall, who is part of the UK's top performing heart unit.

The cardiologist was delighted when Health Secretary Alan Milburn unveiled his ambitious plan to revolutionise services for heart patients in April 2000 - because he knew it would mean more resources for the hard-pressed Teesside unit, serving an area with some of highest levels of heart disease in the country.

Mr Milburn, a personal friend of photographer Ian Weir, whose premature death prompted The Northern Echo's campaign, was galvanised into action when he realised how badly the UK performed on heart treatment, compared to the rest of western Europe.

Accepting The Northern Echo's call for an eventual three-month maximum wait for a heart bypass - the figure suggested by heart specialists themselves - the Health Secretary introduced the National Service Framework for Coronary Heart Disease, a blueprint designed to inject millions of pounds into heart services and save the lives of 20,000 heart patients over ten years. The ultimate aim is to ensure that, by 2008, no one waits more than three months for a bypass.

Sure enough, after an exhaustive round of negotiations with local health authorities and primary care groups, in July last year, Dr Hall was able to announce an £18m expansion plan at South Cleveland.

Apart from more operations and more staff, the cash will pay for more operating theatres, extra catheter labs, 59 more beds and a remodelled and slightly larger coronary care unit. The expansion on Teesside mirrors the expansion in other heart units across the UK.

The Freeman Hospital in Newcastle is expanding in order to carry out around 1,300 bypasses, instead of around 900 at present, elsewhere a completely new heart unit is opening in Wolverhampton, while major capital investment has been approved in Bristol and at Papworth.

According to a Department of Health spokesman, the big push is already having an effect, with the National Service Framework's target of an extra 3,000 heart operations by April 2002 being met a year early. By September this year, the Government expects the number of cardiothoracic surgeons to increase from 182 to 198, while the number of cardiologists goes from 467 to 546. By 2003, the Government has said it will be spending an extra £230m a year on cardiac services.

Dr Hall would love to wave a magic wand and move in to the new accommodation tomorrow but - echoing the Government's gradualist mantra - he knows it is going to take time to turn things around. In the short term, the unit has seen a modest increase in medical, nursing and support staffing which has enabled the unit to treat more patients even before the new, improved unit is open.

The latest figures for the Northern and Yorkshire region are encouraging, showing a dramatic fall in the number of patients waiting more than 12 months for a bypass, from 192 at the end of December to only six at the end of March.

While the number of patients waiting between nine and 11 months has continued to hover around 200 since the end of June last year, the policy of speeding up treatment for urgent cases is clearly paying off.

Across England, there has also been a substantial dip infor more than 12 months. At the end of March, 670 were waiting more than 12 months for a bypass, compared to 1,076 at the end of December 2000.

Dr Hall is philosophical about what can be done in the short term. "The total number on the waiting list is static at the moment and it is probably the best we can hope for just now," he says. He is also uneasy at the length of time that seriously-ill patients are still having to wait, while in places like Holland, France and Germany, patients in similar need are treated almost immediately. "A lot of our urgent patients are waiting four months which is too long and we are unhappy about that," he says.

Once the new unit is open, the target will be to get everyone operated on within 12 months and to get urgent cases treated in less than three months.

Patients often ask when they are going to see a dramatic change. Dr Hall can only explain that the NHS supertanker takes time to turn around. "It takes time to build the extra hospitals, the extra wards and train and recruit staff but the good news is that progress is under way and we are moving forward," he says. It won't be until the extra capacity comes on stream that the South Tees team will be able to make, what he calls "dramatic inroads" into the waiting list.

Dr Hall is very positive about the future and believes that the massive publicity about heart disease has helped raise awareness of the problems.

"Patients and carers are playing an increasingly important role in what we do. Communications in general are improving," he says.

During Alan Milburn's visit to the Middlesbrough hospital this week, he visited the heart unit and met doctors and patients. Encouraged by the sight of the construction work going on, the Health Secretary was cautiously optimistic about the future.

"Clearly, this all takes time but progress is under way. No one should be in any doubt that it is my determination to give my country heart services which are up with the best in Europe."

Earlier that day, he told Radio Four listeners that increased NHS spending meant that the UK was now very close to matching western Europe's average spending on health. "This new unit is going to make such a difference. It is going to be a life saver that will bring immense benefits to so many people." And, barring an unprecedented electoral shock, Mr Milburn may get the chance to finish what he has started.