Editor-At-Large: My blueprint for a better, cheaper, health service

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What kind of National Health Service do you want? We're the rarely-consulted consumers, the front-line fodder for the NHS – but this cash-eating monolith (which gobbles up a sixth of all public spending) appears to operate to please its bureaucrats rather than the patients. The Prime Minister David Cameron has said he will not cut key services, but hasn't decided how much will be allocated to achieve that goal. For starters, £250m will be saved by cutting NHS management, but his ultimate goal is to cut wasteful admin by a third and save up to £20bn. How to do this without compromising health care?

Mr Cameron and his Chancellor George Osborne should forget about money-wasting reviews and investigations into why the NHS is run so inefficiently, and start asking you and me – the people who use it. Instead, we're offered surveys and forms about our "experiences" after they've happened. That's too late. In service industries such as shops or hotels, the customer is always right. Sadly that attitude doesn't apply to the NHS, where something as basic as visitors parking has been turned into a money-making scheme to balance the books.

Nothing else sums up the high-handed attitude of the NHS more than the fiasco over "summary care records". Last week a three-year study of the scheme was published in the British Medical Journal. It found that although 30 million letters had been sent to the public telling us of plans to download our intimate medical histories on to a new computer system, less than 1 per cent had written back to opt out. This doesn't prove how keen we are to trust our medical records to another hare-brained IT project, but – more likely – we chucked the letters away without opening them because we didn't know they were coming or couldn't understand what they meant. Now, millions of medical records are being downloaded without consent.

I got the form, telephoned a call centre, and was told to complete a form which they would post. It didn't arrive, but luckily I downloaded one from the website. Since then, I've heard nothing, I might as well have turned it into a paper plane and chucked it out of the window. The study into the implementation of summary care records shows that this ambitious scheme is four years behind schedule, and is part of the £12.4bn grandiose plan to update the NHS's IT systems. The Department of Health admitted last week that the system for opting out of SCR "needs reviewing". Well, that will be more cash wasted, then.

The National Patient Survey for 2009, which involved 2.2 million members of the public, found that one in five had to wait more than two days to see a doctor (a worse situation than the year before), and one in four can't book a doctor's appointment more than two days in advance. Both these simple requirements are part of the "improved" GP contract, which resulted in average earnings (including bonuses) of around £106,000. Incredible, isn't it? Do you know of any other profession (apart from top executives in the public sector) whose pay has risen by up to 40 per cent in five years? More than half of the public want GP surgeries to be open longer and on Saturday mornings. Over a quarter of us want to be able to see the GP after 6.30pm on a weekday.

In our busy world, these are simple and understandable demands. Plans to open health centres in supermarkets won't meet our basic requirement – which is for an NHS tailored to our needs, not the needs of doctors and NHS executives trying to run medical care like a shoe factory or a manufacturing plant.

The biggest problem facing the NHS is what to do with an ageing population who shouldn't be in hospital at all, but should be in sheltered accommodation or special nursing homes. Think tanks are competing to offer suggestions for Mr Osborne on how to balance the books. One such, the Reform group, says that £20bn could be saved if the NHS paid less, sacked some staff, and limited free treatments. I don't agree. What the NHS needs is twice as many nursing and care staff at lower levels who are paid a decent wage, and a third fewer top brass. Finally, health centres are there to serve us, not the other way around.

Small talk: Women of the world, let's show this size fascist

It was business as usual one sunny morning last week when I wandered around Debenhams' flagship store in Oxford Street. I love shopping in an environment where the size of my backside (14-16) is normal. This store has delivered huge profits to the diminutive dress designer to the stars Julien Macdonald. His trashy and outrageously gaudy range occupies a large area, but I saw few takers for his sequinned synthetic shifts or shiny shoulder bag featuring a Welsh flag... Perhaps this is a result of his unfortunate comments about ordinary women. A judge on Britain's Next Top Model, Mr Macdonald told an interviewer that catwalk models are "size six to eight" and "you can't have a plus-size girl winning – it makes it a joke". Debenhams, unlike Mr Macdonald, understands its market. It says that 42 per cent of customers are within this size range, it's used size-16 mannequins, and chosen disabled models. It has just announced that in future it will be showing pictures of models that haven't been airbrushed. The Designers at Debenhams range, created by Jasper Conran, Betty Jackson, Matthew Williamson and John Rocha, as well as Mr Macdonald, has been a huge success, so it will be interesting to see what happens to the Welsh windbag. I hope shoppers operate a boycott until he recants.

Unwelcome summer guests

Two reasons not to visit London this summer: first, the BNP leader, Nick Griffin, is planning to honour the Queen with his presence at a royal garden party in July. As an MEP, he was eligible for tickets. Wouldn't it be fantastic if everyone else invited decided to stay at home?

Another unwelcome visitor is Sarah Palin, who's extending her knowledge of foreign culture with a trip to London. She wants to meet her "political heroine" Maggie Thatcher. But, as has been pointed out, Palin has a long way to go before she can emulate Mrs T.

Palin would be better broadening her pitifully narrow vision of the world by soaking up some Shakespeare at the Globe, visiting the British Museum and enjoying the National Gallery.

Why I am now an Olympics fan

I've been pretty uninterested in the 2012 Olympics but two things changed that last week. First, the exciting news that Stephen Daldry has been appointed creative director of the opening and closing ceremonies. Anyone who's seen Billy Elliot knows you leave the theatre completely inspired. I'll be tuning in with high expectations. The second event that whetted my appetite was a visit to an ingenious temporary restaurant erected on the roof of the Westfield Centre, next to Stratford International Station. This is a brilliant collaboration between architects Carmody Groarke and the owners of Bistrotheque. They've constructed Studio East Dining – a star-shaped pavilion in scaffolding and polythene that gives diners a jaw-dropping view of the Olympic site. What a place to eat.

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