Christina Patterson: Here's my prescription for the NHS

What patients need is nurses who do their job, doctors who do their job and people to train these people to do these jobs well

Dear Andrew Lansley. Everyone seems to be making a very big fuss about a £100 billion bailout of a country that used to be a tiger and is now a drowning rat, but £100bn is less than your annual budget. A hundred billion doesn't go very far at all these days, which is why, even though your department was protected from cuts in the budget, and mentioned in those scary posters of David Cameron pretending to be a baby, you're looking for ways to cut costs. I know you're keen on consultation and I know you don't like bureaucrats, and I thought, since I don't have any professional expertise whatsoever relating to the NHS, you might like some advice from me.

I was interested to see that you called the White Paper that you published in July, Equity and Excellence: Liberating the NHS. I thought equity was something you released from your house in order to go on a cruise or build a conservatory, but I've just looked it up in the dictionary and it says it means "founded on the laws of nature", which sounds easier to achieve than equality. Excellence sounds excellent. And I thought it was very interesting that you thought that the NHS needed liberating. It reminded me of when John Simpson liberated Kabul in a burqa, though that, it's true, didn't work out that well.

In your White Paper, you say that health professionals "will be free to focus on improving health outcomes", which certainly sounds like a good idea, though I thought that health professionals were meant to be improving health outcomes already. I wondered if perhaps the people who were meant to be improving health outcomes were instead doing things like addressing envelopes and making card file systems, which you might have thought was a waste of their time, not to mention, in quite a lot of cases, a very expensive medical training, but it turned out that they hadn't. It turned out that other people had been doing these things, but that they wouldn't be doing them for much longer.

You will, you say, be "phasing out" Strategic Health Authorities and Primary Care Trusts. I wasn't, to be honest, sure what they do, but I think, from your White Paper, that what they do is a bureaucratic process to do with getting drugs and services. I don't think you want them to do that any more. I think you want the doctors to do the bureaucratic process to do with getting drugs and services, as this will support "frontline services". Perhaps you want the Strategic Health Authorities and Primary Care Trusts to see the patients instead?

GPs, you say, will now be organised into big consortia, which reminds me of Consignia, which was a new name for another state-funded national service, though it didn't last very long. But I think, from what you say, that a consortium is more like an emporium, because it's all about "enterprise", "tailoring" and "choice". It's also about the "redesign of patient pathways". I didn't know that you could get your pathway redesigned if you were a patient, though I did know that you could get your kitchen redesigned if you were Prime Minister, and if the new kitchen is anything like the old kitchen, filmed on a website called Webcameron by a woman who was put on the civil service payroll, and then taken off it, then I'd like my pathway like that kitchen.

When you said that your White Paper was "a bold and exciting vision for the future", I felt a bit embarrassed for you, and I wondered if you'd been spending too much time listening to the Deputy Prime Minister, who also says things like that, though I was brought up to believe that it wasn't really up to you to say if something you'd thought of was bold. But now I have to admit that it does sound quite exciting, because the new chair of the Royal College of GPs has said that she thinks that patients might start demonstrations outside doctors' surgeries because the changes to the NHS are so bold. She thinks that patients, who don't all earn £120,000, which is the average salary of a GP, might start shouting at doctors with nice cars like BMWs who aren't letting their patients have drugs that might save their lives.

Before the bold, exciting vision, I imagine that the GP could shrug his shoulders and say that he was very, very sorry, but a nasty organisation called NICE had said that the drug the patient wanted wasn't cost-effective, and so it had been decided that the NHS wouldn't fund it, and he, of course, would have made a different decision, but sadly, he couldn't. But now NICE is like a cycling Scandinavian monarch, and the GP is like Kim Jong-il. He may not have any experience with budgets, or finance, or drug companies, or clinical studies, or weighing up clinical studies, or weighing up clinical studies with budgets, but it doesn't matter because he has been handed the power. He has been handed the power because the GP "best understands his patient's needs". He may also, when the patient hears that he can't get the drug he wants because the doctor's consortium has decided not to let him have it, understand his patient's need to bash his BMW.

I have to admit, Mr Lansley, that I quite like the idea of people bashing BMWs, probably because I can't imagine what it would be like to earn £120,000, which is almost as much as you. But the thing I'm not exactly sure about is how getting patients to bash BMWs, or shop around between different consortia, or rate GPs' practices like hotels on TripAdvisor, or getting GPs to make financial, scientific and managerial decisions they're not trained to make, will make "health outcomes" better.

I like shopping, and I like booking holidays, and I like a bit of excitement. But when, for example, you find a lump in your breast, you don't necessarily feel like doing lots of shopping, and you don't necessarily feel like booking a holiday, and when, for example, you find that five of the six appointments that you've been told have been made, to work out if you've got cancer, and if so, what kind, haven't been made, and the sixth one has, but at a clinic you've never heard of, and not the one you've been told to go to, and when you wait for weeks for the results of a mammogram, and the consultant is then sent an X-ray of an ankle, and you get letters about your appointments after your appointments, which you miss, you might feel that there are times for excitement and other times when you'd prefer to avoid excitement. You might think that things that other people call bureaucracy, and think are boring, aren't.

And if, for example, after an eight-hour operation, after which you can't even move to pick up the phone, you wait for three hours for someone to clear up the pool of blood in which you're lying, and when they do they huff and puff and look fed up, and so do most of the other nurses who are meant to be looking after you, and who seem to wish that they were anywhere else but with people who are very ill and who they don't seem to like, you might think that what patients need isn't choice.

You might think, Mr Lansley, that what patients need is receptionists who do their job, and secretaries who do their job, and nurses who do their job, and doctors who do their job, and people to train these people to do these jobs well. You might think that what patients need is care, and calm, and kindness.

If you like the buzz of business, go and work in it.

Yours, Christina Patterson

c.patterson@independent.co.uk; twitter.com/queenchristina_