Page last updated at 11:36 GMT, Wednesday, 12 November 2008

Scrubbing Up: Your comments

The BBC News website is launching a weekly column where leading clinicians and experts outline their views on health topics.

In the first, "Scrubbing Up", England's Chief Medical Officer Professor Sir Liam Donaldson explains why he believes the NHS could learn some lessons in customer care.

Read the column

The following is a selection of the comments we have received:

Deciding on the best treatment for a patient is not like going into a shop and picking a product from a shelf. Providing care is based on individual clinical needs which can be very complex. Simple measures to improve patients' experiences can make a difference to how they feel about their care but there is far more to health care than business principles alone. Whilst agreeing that patients want and deserve a high quality experience in health care, that must include high quality outcomes, not just superficial smiles and hotel services. Part of achieving this positive, quality experience is ensuring patients and staff feel valued, work in partnership, and their concerns recognised.
Dr Jonathan Fielden, Chairman of the BMA's consultants committee

No, the NHS do not get Service culture. I train BA staff in customer service and there is a gulf in perception between the way NHS staff and commercial staff interact with clients. You can even see it in the dental service where private practice has almost resolved this issue and the staff are client focused and take a pride in the way they interact and anticipate needs. What a glaring irony that you will be treated well when shopping, flying or with a tooth ache and not when you feel awful and are at your most vulnerable.
Adrian, Windsor

As a radiographer in the NHS for most of the last ten years I can honestly say that the number of staff I have seen treating patients with disrespect are in a tiny minority. the vast majority, often working in very difficult situations - short of staff, too many patients booked into too little time, insufficient space to guarantee patients privacy, etc (usually the same for doctors too), do an excellent job. so our patients tell us. I'm not sure the private sector places its staff under similar high ratio of patients per staff member. it is unfair to make comparisons when conditions are often very different. It is also demoralising for clinical staff to see often highly-paid managers parading around seeming to do very little. At a time when we are seeing lots of examples of '..lions being lead by donkeys' in WWI, maybe its time to lose a few managers and replace them with clinical staff
Ed Beaumont, Shrewsbury

I'm a student nurse, and we're constantly taught the idea of patient-as-king. And rightfully so, as some workers in the NHS (who may be politely referred to as 'old school') do, sadly, not share this view.
Henry Munroe

In our local hospital medical treatment is good but administration is completely shambolic. Records are lost, clinics always run late - it is not worth considering turning up earlier than an hour after your appointment time - and the whole place is chaotic. One day I shall invite the chief administrator to our college enrolment day where we handle double the number of folks that attend for a day's worth of outpatient appointments far more efficiently - something we do once a year using staff who don't normally do that sort of thing. If we can do it, they certainly could, if they could be bothered.
Megan, Cheshire

My wife recently was asked by letter to telephone a hospital to make an appointment for a minor surgical procedure. Every time she rang the number given she got a voice mail response. As a community worker in the NHS herself, she has some difficulty making calls during the working day. It subsequently transpired that the particular hospital appointments clerk always leaves the phone on voice mail so that when they ring back, they have control of the call. In any private business this would be a real invitation for a customer to ring your competitor rather than await your call back at your convenience.
Roger Holmes, Frome

I have been a "customer" of many hospitals and found standards to vary between departments even in the same location. Best care came from those which had been refurbished, were airy and pleasant. Perhaps if you give staff pleasant working conditions, and don't leave them over-run, they will have time for a friendly hello! The same applies to shops where staff are friendly in Waitrose but grumpy in Primark. I don't blame them!
Flash Bristow, London UK

I have had very limited experience of the NHS but what experience I have had was a joke. a long wait for a minor problem, treated in a patronising manner by everyone except a very senior doctor who could tell I was not a moron.
Jonathan King, Edinburgh

I have just undergone a major operation for bowel cancer. I now have a wound which requires a dressing change every other day. The district nurses who do this are unfailingly caring, punctual and polite. However, I go to hospital to see a doctor once a month. He invariably runs at least an hour late, appears to care little about my condition and is abrupt and sometimes condescending. The NHS can be very good or very bad - it's all down to the individual.
Michael Ayres

It is a valid debate and certainly cases of aggressive behaviour by NHS staff are deplorable. However the picture painted by Liam Donaldson is flawed in that the NHS has scarce resources that (by that definition) have to be rationed. For better or worse the basis of current NHS rationing is appointments which means customers can not always have what they want, when they want. And as a taxpayer I am not prepared to commit to the unlimited funding that would be required by an un-rationed NHS.
Chris N, Reading, England

Compare my experience in a Brussels hospital where I had a heart-valve replacement under the Belgian health system. After it was decided that the operation was necessary, my cardiologist turned into a white-coated customer service agent and took responsibility for making the arrangements for booking me in. He even phoned to apologise that the operation had been postponed by one day because of an emergency. I felt I was being treated as someone special by all concerned, and I am forever grateful for their kindness and concern. It makes such a difference as Sir Liam has pointed out.
John Lancaster, Brussels

Can you really apply market forces ? If I don't like service in a shop I can go elsewhere - I obviously don't have that option with the NHS. This once again the CMO going for flashy style over substance. Why not come up with real reforms that mean people get the drugs they need instead of paying. Let's not forget we're dealing with the upper echelons of the NHS - who thought it was a good idea for a surgeon to tell GPs how to deliver services.
Dom, Sheffield, South Yorkshire

I read with interest the comments and agree with many but no one mentioned the belligerent and intimidating attitude that many patients display to staff. I think most NHS staff are helpful and kind, but some reflect attitudes that are equally as common outside the NHS. There seems to be a lack of respect for other human beings per se.
Kate Berriman, Bridlington

If GP's and hospitals were paid for actually seeing patients there would be no waiting times, surgeries and outpatients would be open 24 hrs. The payment is too far away from the delivery. John Lewis customers go privately their service is fine.
Simon Price, Newport

I am a recently retired nurse and health service manager. About 4 years ago, while being interviewed for a post at a large Liverpool hospital, I was asked if I were successful, what would my priorities be. I responded by saying that number one would be to improve the patient experience, upon which the Chief Executive Officer said that this was not an objective that kept him awake at night. I didn't get the job! Things haven't changed much.
George Scuffham, Malaga, Spain

Whilst i do not like the idea of patients being called "customers" I do agree with the sentiments of the writer. I work in the NHS and have patient contact. I and many of my colleagues believe it is a major part of our jobs to treat patients with respect, consideration and how we would like to be treated if we were in their shoes. I do however have some colleagues who treat patients with contempt, impatience and disrespect. This attitude needs to be addressed and maybe seeing "patients" as the kingpin in the whole NHS system should be taught to nhs employees.

Well, it's probably true that there are plenty of examples in the NHS where "customer care" is lacking. However, my son is a medical student and it's gratifying to see how much effort is being expended in training him and his colleagues to be patient-centred. It bodes well for the future.
Chris Alexander, Chester

I recently attended hospital for radioactive iodine therapy. The treatment room was situated adjacent to the waiting room and everything that was discussed was audible to those in the waiting room including name, address, age, GP occupation, living arrangements. When I had received the treatment I was asked to sit in the waiting room again for 10 minutes, where other patients waiting for a different treatment sat and the nurse said "I will just turn this chair around to make sure no one sits next to you." I was unlikely to put anyone else at risk for 10 minutes following swallowing a tablet that would not have been dissolved. I felt there was a total disregard for my privacy and dignity.
Mary, Hertfordshire

I would be happy just to be able to see a doctor when I need to. I am a patient at a newly-built polyclinic and in order to try to make an appointment with a doctor there is a complicated system whereby the patient phones the surgery where a receptionist arranges for the GP to phone the patient back. The patient then speaks to the GP on the phone and the GP decides if the patient needs to be seen or not. Not only does the patient have to wait around for the phone call from the GP (which may arrive when it's not convenient eg there isn't anywhere private to talk in confidence) but it means that the patient feels unable to ask all the questions etc which you would in a face to face consultation. At this particular surgery I think the GPs are keen to earn as much as they can with as little patient contact as they can get away with. Considering the megabucks GPs now earn since the new GP contract it seems like a pretty inadequate service to me.
Janet, Chippenham

I am a veterinary surgeon of 8 years and there are definite parallels with the veterinary profession. We are continually striving to offer top quality "customer" service and most of the time provide a service above what the "customer " expects. However at no point is our clinical judgement or choices influenced by purely financial gain. We have found that providing good customer care whilst not compromising on the quality of care has revolutionised the way people perceive us and the way we work day to day. Sometimes I feel there is a definite need for the NHS to open themselves up to a lot of the aspects of customer driven care.
Richard, Bristol

The problem with the NHS is the perception that it is 'free' because we are not charged at the point of use. This gives rise to a high demand and consequent rationing by staff of finite resources on the basis of clinical need. There is no 'customer' in this model and the 'king' is clearly the doctor rather than the patient. Many of us would go private if we weren't already paying for the NHS through taxation. Adult dental services in England are now largely outside the NHS and offer a greatly improved customer experience.
Matt Hartley, London

I used to work in the hospitality industry, but moved to the NHS 5 years ago. I am constantly amazed at just how antiquated the Health service is in terms of its attitude. Part of this is down to medical staff, and partly to managers. The term 'patient centred' is bandied about in meetings, but seems to be soon forgotten. The NHS is target driven, and patients are seen as products, not customers.
Peter Guberg, Southampton

I don't think people in the UK have any concept of how far behind other European health services the UK is. I have just spent 8+ years experiencing the Swiss health system. I get bad service from a consultant, I choose another one. I get appalling service from a klinik, I complain and something is done about it. My general doctor's practise was open 7am to 10pm every day of the year. They had their own laboratories, X-ray suite, etc; results and consequent treatment discussed before you left. Written reports from all medical professionals. Repeat prescriptions by the year. Waiting times for consultants, MRI scans, specialist care usually 2 or 3 weeks max. They are organised on the Bismark principle, not Beveridge. When I was in South Africa they were organised similarly and I'd rate them superior to UK. It's time the UK changed from Beveridge style to Bismark style.
John Bentley, Lancaster

I had a letter asking me to ring the hospital to 'negotiate for an appointment', so I rang the number given (appointments desk) and explained why I was calling. They put me through to the clinical dept (why ask me to call the appointments team if I have to talk to the clinical team ?). The clinical team would only resolutely say that they don't deal with the issue for which I was referred, and that I need to talk to the appointments team... It's a recurring theme - medical service good, customer relations appalling, communications poor.
Mark, Wakefield, York

Professor Sir Liam Donaldson should get out more and go shopping in a variety of places and he will find that 'Customer Service' depends on human emotions. It is actually a more pleasant experience to be met by some sour faced, miserable sod who is having a bad day than some 'plastic' person who pretends to be nice to you. Please let us not follow the American example...Have a nice day y'all.
Philip Mook, Macclesfield

I am a NHS consultant and completely disagree with this suggestion. In a shop, you are only there for a few minutes, and the interaction is expertly designed to separate you from your money as rapidly as possible, at the same time as giving you a good feeling about the experience. In a medical setting you are having you're actual needs met and the relationship needs to be a more realistic one, even if you do not come away with a warm feeling, and it is a relationship which could continue for many years. It is providing an personal service rather than a commercial one. The shops do not have anything to teach us about how to do that.
Richard Polley, Manchester

It is interesting that the comparison is made with John Lewis, the success of which seems to be related to staff being 'partners' in the business. Too often in the NHS, the views of frontline staff (both clinical and managerial) are ignored in the rush to implement the latest Department of Health initiative or target. Badly treated staff treat clients/customers/patients badly.
Keith Gunning, Darlington

I work as a nurse in an emergency department - i can just imagine some of our 'customers' going into John Lewis and behaving the way they feel it is appropriate to behave in a hospital - vomiting on the floors, spitting, swearing, disrupting the department, upsetting other patients and assaulting staff. Lets see how the shop staff respond then - its not always easy to be nice and 'smiley' when someone is calling you everything from a pig to a dog and is trying to break your arms!!!!!
Emma , Bristol

Our local doctor's surgery has recently introduced a system whereby patients, when arriving for their appointments, must tell the receptionist in front of a packed surgery the reason for their visit before they will allow the patient to see the doctor. This must be extremely embarrassing for a lot of people. Is this the norm or does anybody know the reason such a system exists?
E Travers, Slough

I am a medical student and genuinely feel that I and everyone in my year work incredibly hard in difficult circumstances so that one day we will provide the absolute highest standards of care and professionalism. It is so disheartening to read articles like this as it does not reflect how medicine is practiced or as far as I am concerned any health care professionals attitude to patients. As you point out the NHS is a rock of our society but if you want top quality doctors rather than them going to the private sector whether it be medicine or business they also deserve recognition for what they do.
John White, Brighton

What a refreshing viewpoint. Treating the patient as a customer, how very brave. And how long some of us have been waiting for this. Being treated for cancer in what was supposed to be a local centre of excellence felt like being in a sausage machine. My time was regarded as totally unimportant, it was ok to make me wait for three hours or more to see an oncologist (every time a different one, of course) and if an appointment changed it was not necessary to tell me, the patient. So please, bring on customer care ASAP.
Irene, Harpenden

We have two doctors' surgeries within 400 yards of each other in our town. The staff at the larger of the two are very much like the receptionist mentioned in your article. The staff at the smaller practice are the complete opposite and treat you like a person, not a problem. Guess which one the local PCT want to close?
Alan, Southampton

Having been to thousands of surgeries around Essex, Herts and London, I am sorry to say the number of really wonderful reception teams can be counted on one hand. Most are so-so, OK or average. Worryingly there are also some so dire no one in their right mind would register to put up with the way they speak to people.
Senior Medical Rep, East Anglia

Do you think patients get the "customer care" they deserve? This is an over simplified question and the answer is, depends! The big problem is that the NHS is free 'at the point of care' and some people have given little or no contributions to its running. In a shop, this type of customer is a 'shop lifter' and is prosecuted! So for the moment comparing the NHS to SHOPS is futile.
Jimjam, Devon

I am a Locum Consultant and I would suggest a (hopefully) new cliche': "the patient is my employer"
Ruggero Ama, Oxford, Oxfordshire

I agree with the comments above, people should be treated with dignity and respect throughout their treatment. In hospitals there are many notices about missed appointments and the cost to the NHS, what about the time spent waiting to see a doctor or consultant where they can't be bothered to start on time or a form needs to be signed etc, what cost to the country and perhaps a self employed person or someone else who does not get paid to sit in a hospital for 3 hours waiting for a consultant or more normally his understudy see them in an often dirty room with people walking in and out with no privacy. Also why can't appointments be made to suit the customer after all he is paying through his taxes!
Michael Tidmarsh, Colchester

It's not often, if in fact ever I have said this about a public figure's comments: but I could not agree more. Whilst NHS 'patients' might not be handing over the cash as and when they are treated they are paying a good slice of their salary to a service that should be providing them with top class service. I am happy to report that in my area at least this message seems to have been getting through- in particular with GP's (hospital doctors do still seem to be on some strange never ending ego-trip) and real care is given to the whole consumer experience at our practice and out-of hours!
Helen, Widnes

I have an ongoing medical condition which means I have seen my fair share of NHS staff. I have been treated badly by some staff, particularly in my local GP. However, others have been so helpful and kind. I think that it is important for NHS to realise that being polite and kind to the patient is also important for the patient's health. Because I often have bad experiences with the staff at my GP, I am often reluctant to go back and delay making appointments - which often sees something that could have been treated quickly turn into something more serious.
Alice, London

I really agree with Sir Liam's points. I think medical professionals should be trained in people skills and in how to treat patients with respect. In their busy working lives and with the complexity of modern medicine it's very easy for Doctors to forget that they're dealing with an individual who is likely to feel vulnerable, confused and anxious - yet very often medical staff compound problems by being brusque, talking jargon and not taking the time to ask patients if they have any questions or worries. Training in 'customer care' need not be a gimmick - it could actually make a huge difference to people's healthcare and their experience of using the NHS.
Daniel, Leicester

I have to spend long periods of time in hospital and I've noticed a real improvement in the way that staff approaches patients - with, of course, the odd exception. Unfortunately, the NHS infrastructure will never truly allow for good 'customer care'. For example, when patient space is partitioned by only a curtain, there's never going to be any real privacy (particularly when having personal discussions with doctors). Hygiene is always going to be difficult when 12 patients have to share a toilet/shower on acute wards. Having other patients' bodily fluids being spilt on your bed/furniture never feels particularly 'customer care' orientated and probably never will. I have just been admitted twice to the NHS hospital in Cardiff in the space of 10 days. I have always made a point of being a compliant and undemanding patient. On the first occasion, the staff were kind and polite, very human and took the time to explain delays and so on - in short they created an atmosphere of care backed up with a feeling of discipline, wisdom and order on the ward. On the second occasion, in a different ward, they were rude, mute, slow and uninterested in any form of decency in their interaction with patients. I discharged myself (with the usual warnings and form signings) from this ward as I felt that this atmosphere, created by these staff, was slowing my recovery. In short, it comes down to leadership within the ward, as it does in any similar working environment.
Stephen, Oxford

I am a psychiatric nurse working in an older people's assessment unit in the North of England. As a staff team we strive to respect the elders under our care. As you can imagine the client group are from all walks of life and inevitably of different classes. The staff group mirror this group in pretty much the same way. I have found, at times, that respect is interrupted when someone learned or eccentric in their ways is admitted on the ward. Difference is not embraced easily. I am not saying this as a criticism of colleagues but simply trying to point out that a lot of one's way of interacting with other's may be to do with the fundamental issues of upbringing, manners taught, decorum, personal idiosyncrasies and exposure to difference. Customers also work from the self same dynamics. Therefore the question is not about control but more about how we can respect each other meaningfully. Only then would care be imbibed on both sides.
Susanna Donovan

As an unhappy NHS worker, I can only say that customer care will never improve while some staff run riot and managers are too cowardly to discipline them. The NHS, uniquely, has no redundancy policy and staff with permanent contracts are virtually untouchable. One rotten egg can seriously disrupt an office. In some NHS workplaces there are two or three. Unless policy changes and managers, crucially, find the guts to enforce the new rules, nothing, and I mean NOTHING, will improve.
Jeff, Coventry

No - patients don't get the care that they deserve. I have to argue everytime I want a doctors appointment - I can't ring up in the morning (I work) and therefore need to prebook. Not unreasonable you might think, but every time they tell me to ring in the morning, I explain that I can't. They tell me that there are appointments available but I can't have one as they have to be kept for people who can ring in the morning.

I can't agree more with your correspondent! The NHS should obviously provide good customer care to her clients the taxpayers. However there are certain differences between John Lewis and for example a GP practice (or a hospital or midwife clinic etc). Dealing with complex situations (a heart attack, bereavement, depression, loss of a job) take time, compassion and empathy. Also, we try to prevent diseases which might occur in the future (smoking cessation for instance). So, perhaps, John Lewis could, or perhaps should take a bit of responsibility as well: are their sales persons going to ask their clients if they really can afford that expensive make up or maybe they should save that money. Or, ask an obese client that he might be better off with an exercise bike then a new large tv. Or ask a homeless person in their shop, listen to their life story and feed and cloth him. Just a thought.
Dr Gerard't Hart, Plympton

I'm a London Paramedic. Patients certainly get good quality care from me and my crewmate, judging by the number of thank yous we receive each day. But patient's experiences are variable, in a well funded NHS hospital with well trained and motivated staff its pretty good. In a privately run care home it's often minimal and we in the NHS end up having to pick up the pieces when such "care homes" can't change catheters or pick up those who have fallen over. Patients as customers-laughable! As tax payers patients rightly expect free access, they couldn't afford anything else anyway and unlike a customer can not simply walk away and go elsewhere. Keep high street values out of our NHS, they don't belong here. I doubt any of these top NHS financiers work weekend night shifts like me.
Michael Gribben, London

I used to work in medical offices in the States; if I or my colleagues had done to me and my friends and family what I have witnessed NHS workers doing we would have been sacked on the spot. You're right it is the little things that make all the difference and its is those little humanising touches that are largely lacking in my experience of the NHS - I am not a human being, but a number, who is expected to obey without question, and who is little more than an inconvenience to the nurse, doctor, or receptionist on duty. I's very sad - because a few little changes would solve the problem almost overnight.
Alexis, London

Couldn't agree more. For all their dedication, the medical staff are let down by cynical and unsympathetic administrative and support staff. In or circle, the 'Doctor's Receptionist' is shorthand for someone who couldn't care less for the customer.
Nick Gordon, Milton Keynes

My partner & I recently visited our doctor together as we had made a pact to improve our life styles & health. He is seriously obese (around 12 stones to lose),I am also obese (around 3 stones to lose) & smoked. Our doctor was totally disinterested. Told me I should go back in a week to see a nurse about giving up smoking. She told us that they did not have any kind of obesity clinic to help us. She could refer my partner to a dietician but that there was little point as he'd only be told what he already knew & that we all need to eat less yummy foods & eat more healthily. She told him to come back in a month or two if he wanted to & she'd see how much weight he'd lost then she maybe able to medicate him to assist with his weight loss. How will she know how much weight he has lost - she never weighed him?! She asked if he wanted to weigh himself but he knew from past experience that the scales in her surgery would not weigh up to his weight. When I weighed myself she did not even get up from her chair to see what my weight was but took my reading as correct. Seems that we're on our own - so far we're doing pretty well but what do we do if we begin to struggle more, we have no back-up at all. This is not how to treat people who are making a concerted effort to reduce their likely burden on the NHS, surely?
Susan Newson, Devizes, Wiltshire

Instead of this phoney customer care that the CMO advocates let's go for a true business model and give the customer choice. Give patients a fixed amount of money to spend per year. If they do not go through the amount they can keep it in reserve for future years or even offset it against their tax liability for the current year. This will give patients ownership of their own health. At the moment there is no incentive to look after your own or your dependants health since in theory you are covered from the cradle to the grave.
Philip, Kent

I can't agree more. I have worked in the NHS for a long time, yet my jaw drops when I here the contempt and general rudeness of many staff. I know some people have "difficult" jobs, but so do folk in the private sector - and often with a lot less job security and power. The rude Doctor's receptionist is, of course, a cliche - but a cliche that is, as far as my experience informs me, grounded in truth: my Doctor's receptionist is rude, bordering on aggressive and, frankly, unfit to serve vulnerable people.
S.Foley, Manchester

The issue is not with the medical staff doctors, nurses, radiographers and physios etc. they always treat you with respect. The issue is with the army of receptionists, clerical and admin people you have to deal with prior to seeing the health care professional. They are the staff are easiest to compare to receptionist in hotels for example, yet you would not expect to be treated as your article describes in the Hilton. I had a situation where the receptionist was effectively making clinical decisions to prioritise who saw the doctor and when. Having been refused treatment by an osteopath as my condition required urgent surgery, I was told I needed to wait 2 weeks for an appointment with my GP, as in the opinion of the receptionist my case was non urgent, one MRI scan later I needed urgent spinal surgery.
Steven Ball, Ely - Cambridgeshire

My experience of the provision of healthcare in both my local hospital near Keighley and in hospitals in Leeds and Bradford have been excellent and the same applies to my doctors surgery.
Patrick Connolly, Keighley, West Yorkshire

The obvious reply to the "You don't expect to be seen early, do you?" remark is "Not if my previous visits are anything to go by - I doubt if I'll even be seen on time." The arrogance of the medical profession astounds me.
Steve, Southampton

The clinical patient care in the NHS is probably the best in the world. But, the experience of a less than friendly receptionist is unfortunately more or less the norm. Patients are treated as cattle. They are customers, the supermarket queue argument is disingenuous. I have worked with the NHS for 35 years and had experience of trying to develop a patient centred philosophy both in the design of buildings and how people interact. The Patient Focused/Centred experiment in the USA failed as it did here. Repeatedly I have said that a friendly smile and prompt attention from the non-medical staff is the key to overcoming the natural tensions of people visiting hospital. This does not cost anything and makes a huge difference. Look at the way the private sector works, it's easy. Telling people what is going on is also very important. So far as action is concerned, write to Lord Darzi, write to your local Health Board and Community Health Council. Do not argue with the receptionist.
David Clarke, Swansea

I think that for the amount of money that is poured into the NHS and the salaries of the consultants, it isn't unfair to ask for a little courtesy and to be seen as close as possible to our appointment times. I attend hospital clinics regularly and have never yet been seen within an hour of my appointment time. This means I and thousands like me need a whole morning or afternoon for a hospital visit of which about 7 minutes is spent with the consultant. These people do an amazing job saving lives, carrying out complex procedures and keeping up groundbreaking research. You'd think the customer service side of things would be the easy bit...
Beht, Newcastle

Receptionists are the worst. There are signs all over the local HC saying "confidentiality is important" "privacy blah blah". Yet the receptionist routinely gives out confidential info to all. She even gave out my condition, treatment, to someone who was not the patient. They know they can't be sacked. They and their union "look after their own" and the fact their complaints service is run by and funded by the same people who run the service itself is just further proof it is a closed shop. The complaints service serves as an early warning to their PR machine and a chance to contain class action lawsuits. These people have jobs for life with no incentive to improve. I don't know if the same types are employed by private health as i can't afford to find out. It's sad that the only way to improve the health service owned by all of us IS TO SUE IT!
Timmy Potter, London

My relatives are undergoing a traumatic time as a result of one of them having a stroke. The points raised in this article are very pertinent. In the main, the professional attitude has been condescending, at best, and down right rude, at worst.
Bernard Smart, London

A while ago I trapped my thumb rather badly in my car door, as I was putting a frost protector on my wind-screen. By morning it was swollen, bloodied and very painful, so I phoned for an appointment to see my GP. I was told all the appointments were taken for that day and the next day, so it would be three days before I could be seen. The attitude person telling me this was cold and uncaring. Not satisfied with this, I called in person at my GP's surgery, and unveiled my injured thumb to the same receptionist with whom I had just spoken on the phone. After nearly fainting when she saw the injury, she agreed that it warranted an emergency appointment. I was then treated by my own GP within half an hour. I reported the incident to my GP at the time and he was appalled. I hope that receptionist got a severe reprimand because that was 'customer service' of the worst kind.
Ray G, North Hampshire

I have just retired after 42 years of full time nursing in the NHS . I'm ashamed to say it certainly IS true that a great many medical and nursing staff have a very condescending attitude to patients .Freud said that when money changed hands from patient to practitioner it put the patient-medical relationship on a correct footing, or words to that effect . Yes, I do whole heartedly agree that the attitude should be "The patient will see you now doctor. "
Keith Kettlewell, Yate , South Gloucestershire

I'm sure we're all in favour of NHS staff treating all their patients with respect and consideration (and NHS staff have a right to expect that in return, which they often don't get). However the primary concern of the NHS should be to provide the very best possible clinical care for all patients. Nevertheless, the petty dismissal made by the receptionist in your article isn't acceptable under any circumstances.
Christopher Slater-Walker, Watford

Customer service has to come. I work for a "Mystery Shopping" agency and the NHS would do well to use one of these companies to monitor their patient (customer) experiences to see areas where they can improve the patient experience. More so the NHS where their customers are probably in a varied state of some stress.
Philip, Wales

I'm just a small cog in the NHS. However, I and my co-workers do strive to give the best care experience possible. After all, one of the main reasons you join the health serves is to make people feel better! Besides staff attitude, there's at least three other reasons why patient/worker interactions sometimes fall down. Firstly, departments/wards can be very busy places. How would shop workers feel if half their visitors needed help trying on the clothes? This workload, does reduce patient/staff interaction time, and no doubt lowers the overall experience of the patient. Secondly, some patients attend in poor mood. It's very difficult to impress someone who is determined to be unhappy!!Thirdly, sometimes comments said in jest, just don't come off. The reported comment about waiting could easily be such an example. Re-read the paragraph, thinking that you're favourite comic saying it! It can come across very differently In today's hospitals, any staff which deliberately insults patients, would soon be reprimanded! The rest of use just won't allow it. In my experience, such problems are far more common in GP clinics than hospitals. And most GP's are after all private businesses contracting to the NHS. So, does the private sector really have that much to offer? I'm not convinced!
David Chambers, Newark

I am a doctor and think the level of service provided by the NHS is generally poor. This is because of public service mentality and employee power: job for life; impossible to sack anyone due to strong unions; people being promoted to their level of comfortable incompetence; bum on seat so job filled; very little personal accountability. Job applications are also "fair and transparent" so ability to perform the job is not such a priority as using buzz words and having a favourable demographic. Socialism at it's best!
Andrew, Cardiff

Customer care? What about staff care? When was the last time anyone whinged on about the fact that the doctors and nurses don't get the respect they deserve from the patients? We are out there on the front line, studying, working, trying to save lives and all we get is "it's not good enough". Every few months it seems there is some initiative or target we are expected to meet to improve our care, and while I do agree that improvements in some areas are necessary, can we at least be recognised for the good work we all do every day, trying to help all the sick and injured rather than criticised for not being as good as John Lewis? ps. I would like to see a store attendant struggle to maintain the airway of a drunk and aggressive patient 2 minutes into the start of their shift knowing they have another 13hrs 58 min to go.
Nikki Whittington, Harwich, Essex

Sounds like your friend was treated poorly by the receptionist indeed. I doubt this does not happen occasionally in the private sector though. I can recall the odd grumpy staff at the supermarket and the unhelpful salesperson. Deal with the situations in the same way, try to help the staff improve, and if they are unable to, replace them. Patients are not customers, technically, the government is. That's also why the government decides what treatment the patient may have. In addition to this, doctors do not have a duty to provide treatments which are deemed unsuitable (much unlike a clothes store which will sell almost anything they get paid for), and in fact have a duty to not harm patients. Antibiotics for viral infections, herceptin for her2-negative breast cancers (ie, most), many forms of 'alternative medicine' are but a few examples of what the patient can't demand, rather unlike the traditional customer. Of course all healthcare professionals will agree that NHS should provide good quality. Doesn't mean there is agreement about how this is to be delivered. Making the experience nicer for patients is of course a good idea. How much extra will be set aside for NHS to buy the silver trays, goblets, etc? Isn't much money after all, compared to how much has been wasted on PFI. Or how much has been saved by slashing the money spent on junior docs (equivalent to a 40% cut in their salaries). Sincerely, Not a salesperson.
Peter Persson, London, UK

I am a practising NHS Consultant and totally agree with the viewpoint. Staff inductions should really incorporate a customer care session akin to M&S. Only yesterday I was in "discussion" with a staff member about changing how a service was organised to improve patient experience. This change was minor [carry a phone not a bleep] but the whole focus was on "staff" rather than the patient. I sometimes wonder if the NHS exists for the benefit of staff rather than the patient!
J R Hartley, Somerset

I have a very good GP with a very good attitude but a very bad booking system to the point that I can only see her if I write a letter to her expressing how important my problem is. With the government putting more emphasis on the statistics rather than the individual, it's easy to forget we're not just a number. And sorry, but given the choice I'd rather that the NHS spent money on life saving equipment rather than goblets and silver trays.
EW Lindley, Birmingham

I'm an NHS manager, and also a patient. My experience as a patient has been less than perfect in secondary care. The surgeon seemed unable to answer my questions directly, there were mistakes in follow ups, and such a lack of info I was left in limbo. I involved the patient advice liaison service, and that ended up with everyone getting annoyed with me. I eventually had surgery, but was not made aware of what would be actually done till the day of the operation, and THEN, they were far more invasive than I had been led to believe. A nightmare from start to finish... Appalling. I was made to feel like a cog in a machine. And as an NHS worker I KNOW that there are so many dedicated workers who value their patients and care for them deeply....
Carol Hill, Oxfordshire

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