'We're pedalling hard just to keep standing still'

The diggers and skips at Selly Oak and Queen Elizabeth hospitals, which together make up the University Hospital Trust in Birmingham, are a sign of hope. It was here that Sharron Storer, the furious partner of a cancer patient, harangued and embarrassed the Prime Minister, blotting the perfectly planned launch of his 2001 election campaign.

But Tony Blair knows that hospitals like this one will play an altogether more decisive role in the next election. If they flourish, the chances are that he too will flourish. But if they fail, so, surely, will he.

Billions of pounds in extra funds have been pledged to the health service, and targets, initiatives and reform programmes fly out of Whitehall with wearisome regularity.

Is it working? The answer, in this top-performing trust, is yes – and no.

A year since The Independent on Sunday last visited, the three-star trust has cut waiting times for admission to a maximum of nine months. There's a five-week wait for minor surgery and a 10-week wait for 96 per cent of cancer patients. A&E waiting times for upwards of 86 per cent of patients were four hours or less. In the past year, 350 extra staff have been employed – doctors, nurses, physiotherapists, radiographers and cleaning staff. Satisfaction rates among patients are up. And there's been a £14m capital investment – £4m in neurosurgery, where the wait has halved to a maximum nine months, £1.3m in the bone marrow transplant unit, and a small amount to A&E.

"That corridor you walked down is the bone marrow unit," Dr Prem Mahendra, the consultant haematologist, tells me. "It's the thoroughfare for hospital traffic and really it needs to be an integrated unit with special air filtration, so it can't be an open corridor." Dr Mahendra needs more nurses and anotherconsultant. Now, she and her colleague are on 24-hour call on a two-month loop.

On Tuesday, neurosurgical consultant Jonathan Wasserberg will perform his first operation in a new theatre – courtesy of Gordon Brown. "Things are better," he says. "We have had extra money to do extra work to get our waiting lists down." His department meets the Government's target. But not his. "We have only come up to where we should have been a long time ago. But we are just holding that up by pedalling fairly hard. We have still got to be talking further expansion."

That means more staff and more training. But Mr Wasserberg is worried the Government does not seem to understand. "We need a plan, not just a target."

Forcing existing consultants to work harder "is not a solution in the long term", he insists. He's talking about Alan Milburn's row with consultants over a new contract the Government is threatening to impose upon them, which includes changes to working practices.

The A&E department run by consultant Mr Javid Kayani is surprisingly calm: no more than a four-hour wait; value for money. The bean counters would be delighted, but Mr Kayani is not. "How many people have a four-hour slot in a day?" he asks.

He has his own ideas. Why not end the "waste of time" that is NHS Direct and dispatchits 600 nurses to short-staffed A&E departments, saving £200m? Why not develop social services so that an old lady who has a fall can be taken home by someone who'll check the lights, make her a cup of tea and ensure there's milk for morning?

He feels ignored, but he'll stick to his job: "The look of sheer gratitude when you take away someone's pain and fear ... That's something Alan Milburn doesn't understand."