Andy McSmith: Flat on your back in a mixed ward, you see another side to the NHS

I have discovered a quick route into hospital. All you need to do is to ring up and say you're having chest pains.

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Last Monday night, I experienced a mildly uncomfortable stabbing sensation in the lower left rib-cage. When I woke and found the pain was still with me, I thought I had better make a doctor's appointment to have it diagnosed. I did not anticipate that, within an hour of making the call, I would be in the casualty ward of Lewisham hospital in south-east London, bearing a doctor's letter.

Over the next two days, I was penetrated with needles in arms and stomach, separated from a phial of blood which went off for a laboratory test, wired up to strange bits of equipment, put through a fitness test, until I emerged, dazed by the sunlight on Thursday morning, feeling a bit sheepish. All I had was a mild case of angina. I now hold a piece of paper which proves that I am not due for a heart attack for at least a year.

In autumn 1999, Alan Milburn, the new Secretary of State for Health, decided to ease up on Labour's silly election pledge about waiting lists, and told the NHS to put heart conditions at the top of its priorities, a decision which obviously had an effect on me.

It makes medical sense, because even people in their twenties can die of heart attacks. While I was wired up on the ward, my wife was at a dinner party where there was a guest who had had a triple heart by-pass at the age of 45. But like anything else to do with NHS, this sensible medical priority – for which I am deeply grateful – has its political side. Heart disease, like cancer, is an ailment from which middle-class people cannot escape, and the NHS desperately needs its middle-class customers.

It is easy to mock the immense bureaucracy necessary to run an organisation as big as the NHS. From my own brief experience, I do not think it is inefficient at the micro level, but if it was managed like Microsoft, I doubt whether the well-off could be persuaded to use it.

The basic organisational unit is the ward, and the three wards I saw were tightly run operations where every patient and every task is somebody's responsibility. The problems seem to begin when one ward must speak to another. I was dealt with quickly by casualty, but ceased to be their patient when assigned to the medical admissions ward.

Unfortunately, that was full, so for seven or eight hours I was nobody's responsibility, waiting, bored stiff, on a trolley until a houseman and a porter arrived to hold a rather bad-tempered conversation about whose fault it was that I was still there. Yet I was lucky, because a rowdy night in the pubs can push waiting times to 11 or 12 hours.

The following day, when I was settled in a ward, a doctor insisted I had my heart rate measured while I was on an exercise machine. The treadmill was somewhere else, and the rules did not allow me to walk to it. It had to be brought to me. So I was kept in for two nights when I should have been for only one, and for all I know, someone in a worse state was waiting for my bed.

I suspect the untold reason the well-off will always opt for private care is that in a public health service, hell is other patients. The service throws the self-sufficient and curable into the same room as the terminally ill.

In casualty, I spent hours beside an old man, certainly lonely and possibly with mental problems, and who had come in complaining of phlegm in his chest. The staff did not see this as an emergency, but could not bring themselves to turn him out. The result was a confrontation lasting hours. When food was served, he refused to eat but kept coughing to prove he was ill. Later, he wanted to urinate but refused to walk to the lavatory and stood by his trolley, demanding help. This drama was interrupted by another, when staff battled in vain to save the life of an 87-year-old-woman.

One night an elderly woman kept up a monotonous moan, accusing staff of maltreating her and claiming she was dying. A grumpy old man in a bed near mine rolled over and shouted: "Fucking well die then!", for which he was told off by the night sister. I should add that I came in close proximity to at least 40 patients, of whom there were about four who created trouble.

Labour has spent five years trying to prevent the flight of the middle-classes into private care, fearing the NHS will be left as a graveyard for the incurable. Government strategy is to make sure the public service is as well funded and efficient as any private hospital can be. But the NHS can never compete with private hospitals' freedom to hand-pick patients, and in our spoilt consumer culture, those who use money to shield themselves from life's unpleasantness when they are well will feel entitled to do the same when they are sick.

Maybe, instead of all those glossy photographs we see of smart, smiling nurses with happy patients, we need to be reminded more often that hospitals are places where there is sickness, sadness, suffering and death. They also alleviate pain and save lives.

Andy McSmith's novel 'Innocent in the House' is published by Verso at £7

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