Mary Dejevsky: The NHS doesn't have to be in such turmoil

In corridors and wards, high-tech machinery is left anyhow. Trolleys and linen are piled against walls
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Not so long ago, it was simple. You felt unwell, made an appointment with the GP, received a referral to a consultant and - eventually - went into the local hospital for an operation. This was a time when girls wanted to be nurses, boys wanted to be doctors, and a fearsome matron presided day and night from her desk at the end of each ward.

All right, so times have changed, and much of the change is for the better. Girls can grow up to be doctors and boys to be nurses. There are elaborate machines, such as MRI scanners, and sophisticated drugs, such as Herceptin. Most of us are living longer, and - all credit to this government - epic waiting lists are becoming a thing of the past.

I doubt, though, that I am alone in being thoroughly confused about why these changes have been attended by such turmoil as persists today in the NHS. Perhaps, given the latest news about ward closures, postponed operations, and projected staff shortages, government ministers are not entirely clear either. Or, if they are, it is only because they do not realise how mixed are the messages reaching us, the patients. So here, from one small corner of the capital, is a rough balance sheet drawn from my experience over the last half year.

A brand new GP surgery opened recently not five minutes' walk away (good), and there were vacancies (even better). But there were not many vacancies (bad), because the practice had been transferred en bloc from about a mile away, leaving the original patients with a long walk or bus journey (worse). You have no choice about which doctor you register with or see, as "everyone sees everyone" (bad; what was that about patient choice?).

The receptionist has twice (out of three times) made mistakes with the time of my appointment (poor training, substandard computer?) and there is only locum service in the evenings or weekends (no comment).

GPs and GP surgeries are one of the big beneficiaries of the extra spending that the Government has poured into the NHS. They are also most people's first contact with the health system. So why is there so little consistency of service? Why is it all so amateurish, and why does "out of hours" care veer from patchy to non-existent? Who, when all is said and done, is responsible for agreeing a contract that gave GPs a generous pay rise and permitted them to work civil service hours?

The doctor from Milan who cost the NHS £5,000 to fill in for an off-duty GP in the Highlands may be an extreme example, but his journey is still a waste of public funds. How come shifts and rotas are part of the job if you work in public transport, tourism, or even the media, but not for the gatekeepers of the NHS?

If their present pay and conditions remain the same, I suspect that GPs may not be in such short supply by 2010-11, despite what the latest leaked NHS document forecast. I question, too, whether there will be a shortage of nurses. The last I heard, there were hundreds of newly trained British nurses unable to find a job because cash-strapped hospitals had cut recruitment. And while I hate to dent the popular image of nurses as angels working for a pittance, compared with teachers, social workers and, yes, journalists, they are no longer badly paid.

Nurses' pay is where another portion of the Government's extra money has gone, and an excellent use this was, too. With higher pay, though, should come greater self-respect, and improved standards in the discipline, hygiene and care departments. I have recently been horrified to see nurses arriving and leaving hospital in their uniforms with maybe a grubby jacket flung over. No wonder there is a hygiene problem if they go straight on duty from the street, the train or the bus.

A professional salary should also remove the "need" for NHS nurses to moonlight for private agencies, which then charge hospitals a premium for re-employing their own staff. These nurses are essentially two-timing their main employer, and tired nurses make mistakes. Between the agency fee and their pay, they are also expensive to employ. Resort to agency staff should never have become routine.

The NHS, I accept, is in transition, and the contrast between our outdated Victorian hospitals and their shiny new, privately financed replacements is bound to be extreme. At least - the Government would say - new hospitals are being built. Yet recent visits to two venerable old hospitals and one brand-new one left surprisingly similar impressions.

Regardless of the building's vintage, there seemed to be a casual, lackadaisical quality about the ancillary staff that suggested a crew without a proper captain. There seemed to be little check on who came and went; out of office hours, an indifferent porter - or no one - might be on duty. Visitors and others are left to wander around at will. Appointment times may look exact on your card, but you are still left waiting for the best part of the morning or afternoon, even if your notes have been delivered to the right person.

In corridors and wards, high-tech machinery is left just anyhow. Trolleys and linen are piled up against walls, blocking rails installed to help the less mobile. Toilet facilities for visitors are, almost without exception, poorly signed and maintained. Luton and Dunstable hospital may be slaying bugs by the billion with its Post-it reminders and liquid soap. But I was at another hospital where the self-same provision was passed by more than 50 people just in the time I was there - and steadfastly ignored.

The greatest differences between old and new are the cavernous public spaces - who cleans these modern monstrosities? - and the echoing sense of emptiness. At a time when many patients are scandalously crammed into mixed wards and others are having their operations cancelled, what is the sense in this gigantism?

If this were all the NHS was about, the Government would be in even greater trouble over the health reforms than it is. The reason why so many Britons are misty eyed at the very mention of the NHS is what lies beyond the poor management, indifferent maintenance and sloppy service. Almost everyone has a story.

Mine is that my husband was admitted to one of the eminent old hospitals on the appointed day, treated expertly, and discharged five days later, trained and equipped to administer an advanced (and expensive) treatment for his Parkinson's disease. He can e-mail the doctors and consult a specialist nurse if need be - and no one demands a credit card or private insurance policy. We can only give thanks that such expert treatment is the rule, and ask why so much public money has been lavished on support structures that remain stubbornly substandard.