If three people can find out what is wrong with the NHS in 26 days,

IT has almost become a mantra in the NHS that when anything goes wrong, waiting lists grow and targets become unattainable, they can blame it all on a lack of funds. It's a wonderful excuse for the complacent. It covers everything, doesn't it?

Yet it is blindingly obvious when you are a hospital patient that one or two things could be sorted out with simple common sense, which should not be an expensive commodity, and isn't in any well-run organisation.

If only they would ask us, the patients who spend long hours in hospital wards watching doctors, nurses, consultants and administrators bossing everyone around and treating each other and us with equal contempt, we could tell them how to sort it out.

Why is it when you go to the A&E department with a broken nose that you wait for hours for a nurse to look at it, then refer you to a doctor who knows nothing of noses only to put out a search party for someone who can cope? Isn't there a doctor in the house?

Why can't they employ someone with a little general medical knowledge in A&E who will point patients in the right direction as soon as they come in?

This is not wasting money but saving it, and probably saving lives. It also strikes at the heart of the problem with hospitals, the ghastly pecking order which ordains who does what, apparently without any regard for the patient.

Yes, it might well cost millions to alter this mindset, but in the meantime it is well worthwhile to draw attention to these absurdities.

Whereas in most walks of life the customer is always right, the reverse seems to apply to the NHS. Patients are paying customers after all, even if the NHS enjoys the ultimate sanction of killing us off if it doesn't like us.

We should take our hats off, therefore, to Mr Alan Mil-burn for inviting three experts on customer relations from Virgin Atlantic to look at ways of improving its attitude to patients. Although Mr Milburn was very quick off the mark in leaking this initiative to the Press some time ago, it will be interesting to see which pieces of advice he chooses to adopt and which to ignore when he announces his plans for the NHS next Thursday. The report of the three-man team who completed their task in 26 days over an eight-week period the speed of light by NHS standards - has been on Health Department screens for more than a month now, giving adequate time for conservative elements to dig their heels in.

One question which puzzles me as a patient is why it is, when you have waited for months for an endoscopy test, a CT or MRI scan, a barium enema or an X-ray, you find yourself hanging around in an almost empty department with one or two members of staff and no sense of urgency.

(I had to wait four months before being diagnosed with cancer of the colon.) SURELY these expensive pieces of equipment, probably funded by voluntary donations, should be in use 24 hours a day, and not just in office hours on weekdays? A stroke patient I know once had to wait an hour while they warmed the scanner up. The Virgin team know about expensive pieces of equipment and keeping jumbo jets aloft, so they understand the difficulties.

Whenever I have mentioned this to hospital staff, I've been shrugged off as incurably naive. Don't I realise you need nursing staff to carry out these tests and they are simply not available at all hours of the day? According to my GP, however, this excuse will not wash. He has been beseeching his local hospitals to allow him to use idle colonoscopy and breast screening at weekends, providing his own nursing staff.

But the NHS, so mired in bureaucracy, will have none of it. My doctor says he trusts no one in hospitals because they are all pushing their own barrows.

It's all self-interest and no team work.

There are numerous perfectly soluble problems in the NHS which are obvious to an outside observer but apparently not to its administrators. Why do nurses so often have to waste their time distributing food when this could be done better by someone less expensively trained?

Airline food may be a joke, but hospital food is no joke. If Richard Branson treated his customers like Alan Milburn does, he would be out of business overnight.

"As with airlines, retailers or hotels, contracts must reflect the 24-hour, seven-days-a-week nature of the work," says the report.

"Domestic staff have to feel part of the team, not second-class citizens.

They often have more contact with patients than any other staff but receive the least training and rewards."

There should be more choice of food. "While airlines can and do run out of the most popular choice due to lack of stowage space, hospitals can simply call on reserve stocks," says Virgin.

"Patients cannot express an informed opinion on the quality of their anaesthetic but they certainly can on the food they are served."

Why aren't new hospitals built in places with more room for car parks, an easy way of winning customers as any supermarket knows?

Why is it so difficult to find your way around a hospital with inadequate signposts and no distinction between front and back of house?

WHY hasn't the NHS caught up with modern communica-t i o n s ? " A patient who banks by telephone, books holidays or shops on the internet, whose work and personal communications are dominated by mobile phone and email will be frustrated by an NHS who can only offer communication by letter, with appointment times that are dictated, not negotiated," says the team from Virgin.

Anyone who has spent any time in hospitals knows these things, of course, but they apparently have not dawned on those who work in them. Now that they have been pointed out in straightforward terms by people who know how to treat their customers, will they pay any attention? Don't listen to the excuses about lack of money.

It could be cheaper in the long run.

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