Posted Sunday, May 1, 2005; 12.03 GMT
The risk of MRSA is "absolutely something I weigh up in admitting an elderly patient to hospital," says Sam Everington, a physician in the deprived east London neighborhood of Bromley-by-Bow. Since the elderly are especially vulnerable, "I would say: 'Look, part of me wants to admit you to hospital, but the risks are very great and I can treat you at home with high doses of antibiotics.'" Tony Field, 65, a retired financial adviser, learned about those risks the hard way. He contracted MRSA through bedsores while awaiting an operation in a Birmingham hospital five years ago. "The hospital was absolutely rife with MRSA," he says. "As a result, I've lost the whole of one thighbone."

Losses to the NHS are also crippling. The National Audit Office estimated five years ago that hospital-acquired infections cost the NHS as much as $1.9 billion a year in prolonged hospitalizations, and that 15% of cases could have been prevented simply by ensuring better hygiene. The issue has generated heat in an election campaign where the three main parties are competing to outdo each others' promises of largesse for the NHS.

The Conservatives say they will increase health spending by $65 billion a year but would spend much of that money in subsidies to patients who opt for private treatment. The Liberal Democrats advocate tax rises to fund health checks and better personal care services for the elderly and disabled. Labour is wooing voters with still shorter waiting lists and, by 2008, the pick of any hospital for their operations. The delivery of all these grand plans depends on the continuing health of the British economy, of course, and on the ability of the NHS to put any additional resources to good use.

On the ground, some patients already report improvements. Cummings, evicted unceremoniously from his hospital bed during the flu crisis five years ago, also remembers waiting up to a month to see his local physician. Now, a new practice has opened near his home. "It's a vast improvement," he says. "It's newer. It's modern. They've got a younger team of doctors. By and large, you can get to see a doctor within a week." The reason: Labour has given the NHS enough money to hire 27,000 more doctors and 79,000 more nurses since 1997, offering higher pay, flexible hours and child-care facilities.

The country's health-care infrastructure is improving, too, albeit slowly. Four years ago, Bedford Hospital, 100 km north of London, became a symbol of decline when the door of a temporary mortuary, brought in because the main one was often full, couldn't be opened. Corpses were instead laid out beneath sheets in the hospital's chapel. Images of the makeshift morgue provoked public outrage, and the episode helped prompt a policy shift toward giving hospitals greater responsibility for day-to-day operations. "Nobody wants to have a crisis," says Bedford's chief executive, Andrew Reed, who joined after the mortuary scandal. "But if you do have a crisis, it means everybody wants change and it makes the process of implementing change easier."

Bedford has since built new cardiac and ear, nose and throat departments, a new cancer unit, and a $13 million pathology building, and added 56 new beds, 60 additional nurses and 12 new specialist doctors. Last year, it earned three stars, the maximum possible, in the Healthcare Commission's performance ratings, up from zero in 2002. Patients even gave its food top grades.

Customer satisfaction is high across the NHS, according to a survey of patients who used its services last year: three out of four rated their personal care as excellent or very good. Yet when the public is polled, they are more likely to be critical, consistently registering dissatisfaction with the system as a whole. The fact is, the NHS has got better faster than the public's perception of it. While the government struggles to persuade voters to recognize its achievements with the NHS, many refuse to applaud. In a face-the-public TV session last week, an audience member argued with Blair that his 48-hour target for seeing a GP made things worse because doctors refused to accept appointments made more than two days in advance. Blair later admitted that some targets were "too crude."

The task of making the NHS more efficient and responsive is still monumental, and the funding that's made recent progress possible won't go on rising forever. Though he's more satisfied with his local health service, David Cummings seeks private care when he needs a specialist. "Yes, the NHS is improving," he says, "but we still have a long way to go."

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