Sitting in the Emergency Admissions unit of an NHS hospital the other day, I found myself in awe of the skills, sensitivity, commitment and selfless efficiency of the staff involved. This applied equally to those who were medical, support, admin or porterage team members. One could not escape the conviction that somebody had hand-picked every person with immaculate care.

As somebody who has long preached that culture is everything in an organisation, it was all grist to my mill.

The following day, I sat in a general ward and looked on in depressed disbelief at the contrast.

The admin staff were as good as ever: polite, caring, and accessible. And the doctors too did their level best to engage with patients and visitors. The problem lay, very obviously, with the standard of nursing.

Half of the nurses were clinically obese. All of them looked scruffy. None of them were what you could call remotely bright, motivated or concerned. Their manner and general attitude were wrong. Any patient over 70 was treated with zero respect. In the hour or more I was there, I witnessed three separate instances of patronising verbal abuse of elderly patients.

As I exited the ward, I saw a notice proclaiming that its staff had ‘met all the targets set by management’.

Ah yes, management.

The folks who had organised the parking for visitors in such a way that, from 10 am to 4 pm, they would have to cruise around for up to 20 minutes looking for a space. The people with Big Hair and clipboards who’d installed a payment system so complex, the queues at each machine were 5-6 people long all day. Almost as long, in fact, as the queues in the various hospital shops and cafes.

The hospital as a whole was obviously over-staffed. But not enough of the vital staff were of a calibre necessary to create an outstanding service.

As any American will tell you, hospitals run by private insurers and providers are not the answer. And as anyone over 55 in Britain will attest, a return to full State ownership isn’t the answer either.

The answer is to staff the NHS with those who have a calling. To support it via community-based mutualism, so all the staff and local people are Members. And to have the institutions run by people who maximise patient value and minimise waste…uninfected by business jargon and civil servant bollocks.