'Higher expectations can't all be delivered'

Justin Gaffney, 30, is a sexual health nurse at St Mary's Hospital, Paddington, in west London, and he tells a familiar tale: there simply aren't enough of them. "We are short of staff. Changing that takes time and in the short term it creates lots of pressures, people get disgruntled and lose their enthusiasm and seek their opportunities elsewhere or in a different profession altogether."

All the nurses on the hospital wards are overworked, he says. And yet expectations are rising higher and higher. The Government's announcement that nurses would take on enhanced roles has filtered through to the patients. But the money hasn't.

"Patients have been given the idea that nurses are all-singing, all-dancing – but the reality is that the majority of us are not. They have much higher expectations now than can be delivered." It is a theme, he says, that runs through the Government's dealings with the health service: the money is announced but it doesn't get to the people who need it.

Few nurses in London can afford to buy a place to live. The Government launched a scheme to help. The small print made it clear the offer was only available to the under-30s – precisely the people who haven't yet settled in a particular hospital or area.

In Mr Gaffney's own field, patients were delighted by £43m funding. But by the time two big national projects were funded, he says, all that was left was £3m to share out between every hospital trust. Ultimately, he says, "the Government has good ideas but they don't check whether they'll work at ground level".