Trust is tricky one for NHS casebook

HOW confident are you that the NHS is better than it was twenty years ago? Until fairly recently, I would have said that it was different in many ways, but just as good as it was before prime minister Thatcher's reforms.

Now, I'm just not so sure that the service of which Brits used to be most proud, is admired or trusted as much as it was. And I'm not sure why this should be so.

Nobody should doubt the additional money spent on the service over recent years. Nor has there been a drop in skill levels of medical, nursing, and all the other specialists working in the NHS.

And anyone can see that huge advances in medical science have lengthened lives, cured or coped with conditions that previously killed or made life not worth living, and allowed infertile couples to have children.

So why are so many people now uneasy about the NHS? After a stay in hospital, most patients, or their families, are full of praise for the staff who cared for them, yet the feeling lingers that hospitals aren't the safe places they used to be. Everybody is scared by the thought of being infected by a bug in hospital. But there has always been the risk of cross-infection.

Forty years ago, my own mother, a nurse, contracted three separate infections and was taken straight from the ward on which she worked to an isolation ward in an infectious diseases hospital. So why is there such suspicion hanging over hospitals nowadays compared to the trust invested in them when my mum was nursing?

Most people don't change their GP unless they move out of the area covered by his or her practice. In any other service area, this would be proof of satisfaction with the quality of service provided. Yet it's a common complaint that GPs ain't what they used to be.

It's not that people have lost faith in their family doctor's medical ability. It's the way his or her service is delivered that's compared unfavourably with the way it was when Tannochbrae's Dr Findlay was even more of a TV icon than ER's Dr Carter is now.

Yet what right have we to demand that our GP is always on call? Working conditions for most people have improved immeasurably, so why shouldn't GPs be able to get weekends off? There's a shortage of GPs at present, but it's as nothing compared to the future shortfall feared by some NHS statisticians. So it's in our interest if health boards try to make the job as attractive as possible.

Why is there a shortage of GPs - and hospital consultants, too, for that matter? Medical schools in Scottish universities still enjoy a high reputation, and there's no shortage of very bright school leavers competing for a place in them. It's been known for years that the temptation of higher salaries, and just as importantly, better working facilities, cutting-edge technology and undreamed of research opportunities in America, have proved a magnet for graduates and top doctors alike.

So what are the newer reasons for quitting the NHS? Some doctors have told me of their frustration at the form-filling and bean-counting that now supplies us with the information showing whether hospital A has achieved its annual target of hip replacement operations, or if consultant B has a quicker turnaround of patients.

My own theory is that the missing consultants were simply fed-up with being over-worked and generally disillusioned with life in Scotland. Don't forget doctors, much more than most of us, see the results of the deterioration in the social conditions of people left out of our consumerist, post-industrial community.

We ask a great deal of doctors, community nurses and social workers. Coping with our less mannerly, more impatient and more demanding public behaviour is wearing and morale-sapping.

My other theory is that the proliferation of statistics and tables on NHS performance have robbed the most human service of its humanity, and to what end? Accountants rather than doctors and other professionals make the operational decisions and determine priorities. This results in the minority of people who have to be treated in hospital having very varied experiences, depending on whether their treatment is elective, or emergency, their hospital's target for waiting times, and national targets for dealing with their particular condition.

The vast majority of doctors would prefer to make their decisions about treatment based entirely on the individual patient's needs. Patients prefer to be treated in the same way. It's time to call a halt to the tyranny of targets.

PRISCILLA'S HONESTY IS BEST POLICY IN FIGHT AGAINST AFRICAN POVERTY

I MADE a new friend this week. Sir David Steel met Priscilla and me as we discussed the speech she had delivered to the Conference on African poverty held in the Scottish Parliament this week.

Just a touch ruefully, I felt, he pronounced us two of a kind. I hope he's right, because she's a cracker.

Priscilla's an opposition member of the Zimbabwean parliament. She doesn't have a begging bowl in her bag when she talks to people in the richer northern part of the planet. She's as brutally honest about the South African government's failure to help Zimbabwe build a proper democracy as she is about the World Bank, the International Monetary Fund and other international financial and aid organisations' practice of only speaking to governments rather than parliaments and opposition parties.

I've learnt a lot from this conference. . . let's hope that the G8 leaders can learn as much at their Gleneagles get-together.