One of the waiting-room herd

A COLD breeze was blowing down the canyons between the jumbled buildings of St Mary's Hospital, Paddington. A similar wind of change is meant to have passed through those same canyons and corridors some time ago. More than six months have passed since Mr Major's Patient's Charter, intended to make NHS hospitals more accountable to the people who pay for them, was brought into effect.

Eager to see both this great change and one of the hospital's consultants, I arrived at the Outpatients' department at St Mary's a whole half-hour early for my 1.30pm appointment. The receptionist, a pleasant enough long-haired young man, seemed faintly surprised to see me, but took my letter, consulted his computer and gestured to a chair. I settled down to read the colourful brochure, 'A Charter For Patients - Our Aims', that the hospital had sent me with my appointment letter.

'Outpatients,' it announced, describing one of the major aims striven for since April of this year, 'will be seen within 30 minutes of their appointment time.' So the 'appointment time' was not in fact an appointment time, but an approximation. Still, 30 minutes more would not be long to wait.

Already a trickle of patients had found their way through the confusion of buildings and corridors and were standing, silent and hopeful, by a now empty reception desk. I returned to a study of the cheery leaflet.

'All staff,' it went on, 'will wear name badges, so that patients and visitors know who they are.' It was difficult to check this, since no staff were present. The group waiting dumbly by the reception desk had now grown to about a dozen, mainly elderly people, who were standing holding their letters towards an empty space with expressions of hopefulness and resignation, as though waiting was something to which they had long become accustomed.

'Sit down] Over there] Until the receptionist comes]' The order came from a person in a green overall walking briskly across the room. There was no name badge, so it was impossible to guess whether this was a nurse, orderly, sister, cleaner, baby snatcher or bogus doctor. Indeed name badges, as far as I could see from my visit, were still in the land of pious hope.

The group by the desk shuffled obediently and silently to various seats and began to gaze at the walls. 'Sit down,' commanded the green-overalled one to the few who had not yet yielded. I searched my optimistic pamphlet to see any plans for future provision in the Patient's Charter of the words 'Please', or 'I am sorry there is no one here to help you yet', or even 'Do sit down, sir, we will be with you shortly', but the pamphlet, like the patients, was dumb.

1.30 pm came, and went. 1.45 came, and went. The room now held around 30 people. Human beings in an unusual state of vulnerability, largely elderly, some foreign, waiting for the confirmation of their fears, the lifting of their dread.

If the appointment was not to be kept within 30 minutes, 'patients will receive an explanation and an indication of how long they will have to wait'. No explanation came to any of us. An hour after my appointment time, I asked the receptionist for one. Again with an air of faint surprise he checked, and said he thought the consultant would be coming soon. 'It's amazing how many people never turn up for an appointment,' he said.

'Sit down]' commanded another overalled person. 'It's not your turn, luv]' said the green one to an old lady who had come over, worried that, being hard of hearing, she might miss her turn.

What were we, this small bundle of worried people, being given orders rather than service, condescension rather than courtesy? Certainly we were not clients. I had begun to feel remarkably like a cow waiting hopefully with its herd to be milked. We had become objects. We had been named patients because our function was passively to exercise patience.

It was a familiar feeling, that of the cattle yard. Many times I have sat in GPs' waiting rooms for an hour or more while a receptionist, under the impression that she is auditioning for the Comedy Store, loses her lists, our notes, and all sense that those waiting have a right to either privacy or adult status. Once I fell into conversation with my neighbour. 'It's funny,' she said. 'I never have this problem at the vet's'

Back in St Mary's, it was 3pm. A few old magazines lay on a side table. A few read. Most of those waiting were like the frail old lady at my side whose blue, blank eyes gazed only into her own thoughts. I seemed luckier than most, for an hour and a half after my appointed time my call came.

I wondered how single parents managed, those with dependent relatives, demanding employers. Still, there was no word of explanation, let alone apology. Once I was half undressed the consultant appeared, shadowed by two students - the first beings wearing name badges I had seen. He was efficient, sympathetic, speedy. The interview lasted 10 minutes.

On my way out, past the rows of those still waiting, patient as monuments, I asked a green-overalled figure whether it was usual for appointments to run an hour and a half late. She looked at me with great reproof. 'He has been operating,' she said. It was, of course, however impressive, no answer.

Hospitals are only now beginning to collect the necessary data on whether the Patient's Charter is more than a woolly hope. David Blunkett, Labour health spokesman, says that even where there seem to have been improvements in the NHS, like the reduction in patients waiting two years for an operation, there have been matching worsenings in service elsewhere.

'Unfortunately, your experience is not unique,' he said. 'The signs are that real improvements are not being made.'

No resources are necessary for courtesy or explanations. These are small things which would have transformed that anxious waiting room.

The NHS is usually excellent at treating the severely sick, but at its margins it is prone to falter. My waiting-room colleague in my GP's surgery had found her vet's surgery courteous because she was empowered by a direct payment of cash. In the NHS too many staff act as though their clients are the recipients of charity. Mr Major's idea of a Patient's Charter was meant to address that mistaken impression. It is going to take a lot more than a few glossy

brochures.

(Photograph omitted)