My first-hand experience of the NHS at its best - and the limitations of the market

I have achieved a lifetime's ambition and become a pin-up. Recently I fell off a bike and broke an arm so badly that the X-rays are on show at the hospital that carried out the miraculous repair work. I am told that young medical students stare at them for hours. Of course they are admiring partly the work of the brilliantly accomplished doctors, but there is no getting away from it: they are gazing approvingly at a pin-up of me, or a part of me, or the pins on a part of me.

I have achieved a lifetime's ambition and become a pin-up. Recently I fell off a bike and broke an arm so badly that the X-rays are on show at the hospital that carried out the miraculous repair work. I am told that young medical students stare at them for hours. Of course they are admiring partly the work of the brilliantly accomplished doctors, but there is no getting away from it: they are gazing approvingly at a pin-up of me, or a part of me, or the pins on a part of me.

I am awestruck too. I experienced the NHS at its best. Several highly skilled surgeons were immediately available to carry out a challenging two-hour operation.

The single problem I encountered was an outbreak of MRSA in the ward where I briefly stayed. The infected patient was quickly removed, but the ward remained cordoned off for some time because it could not be properly cleaned. I was told that the delay arose because the ward staff had to contact a hospital official responsible for liaising with the private cleaning company. The official then got in touch with the cleaning company to arrange for a cleaner to arrive. My experience confirms recent reports suggesting that the number of cleaners and the hours spent cleaning in hospitals are much less than they used to be.

This does not necessarily mean that there is a direct link between the contracting out of cleaning services and the spread of MRSA in hospitals. But no one can credibly claim that the contracting out has led to cleaner, more hygienic hospitals. The Government and other political parties promise to improve hygiene, but they are powerless to do so. Contracts between hospitals and cleaning companies do not end when an election is held.

The same problem applies to the privatisation of street cleaning. In most European countries, voters turn out in large numbers to kick out councils that fail to keep their streets clean. I discovered this on holiday last year in a sparklingly clean part of Spain. I was told that a few months before, voters had changed the local council largely because their streets had become dirtier. In Britain, voters do not bother, partly because a change of regime would make no difference. A new regime inherits the contracts with private companies agreed by the previous administration or the one before that.

The debate about the role of markets and the private sector in the provision of public services is at the heart of the divide between Tony Blair and Gordon Brown, the cause of significant tensions within the Liberal Democrats and, to some extent, the Conservative Party as well. In my view, Mr Blair and Alan Milburn are rightly restless in their search for ways of improving public services. Some of the Brownites are wrong when they argue that the stress on the need for further reforms detracts from the Government's existing record.

Voters have the right to expect public services of the highest quality. They are able to go shopping seven days a week and yet cannot go to a GP at the weekends or visit a library with the ease that they can pop into a bookshop. Although I had excellent service from the NHS, others still experience bureaucratic nightmares. Public services need further reforms as well as the high level of investment.

More precisely the Health Secretary, John Reid, has good cause to change the criteria for funding hospitals, placing more emphasis on rewarding those that perform effectively, even if the policy is proving difficult to implement. The principle should be widened to vary the wages of staff depending on performance. The cost of living in different areas should also be taken into account when deciding on wage levels in public services.

I see no problem with extending the principle of co-payments if that meant paying some cash to see GPs at more convenient times. But I do not see how other "market-based solutions" being proposed somewhat vaguely by Mr Blair and others solve anything at all.

The more detailed internal debates within New Labour are anyway more fluid than is realised. To take one example, the Blairite Stephen Byers agreed with Gordon Brown - and not his old friend Alan Milburn - about the need to place limits on the freedoms given to foundation hospitals, most specifically on the amount the hospitals could borrow. This is more than a rigid ideological debate between Blairites and Brownites, and quite often has as much to do with the introduction of coherent policies.

Here the onus is on Mr Blair and Mr Milburn to show in detail how their ideas for expanding the role of the private sector will work. Already there are practical problems with the foundation hospitals. Some are calling for their powers to be extended so that they can borrow more to buy in more services from the private sector. I bet they are. They would then be able to borrow heavily in the knowledge that no government could allow a hospital to close.

There are also tensions surfacing about the running of these hospitals. In one case the regulator has called for the dismissal of the chief executive of a hospital, but the board of the hospital insists that the executive should stay. The Health Secretary is not getting much of a look in, although in theory he could sack the regulator if he is not happy. The lines of control are blurred, as they are in the running of the railways, where a regulator, Network Rail, private companies and politicians all seek to pull the strings.

As far as I can tell, further plans for an expansion of the private sector in the NHS threaten to have the same impact as the cleaning contracts, creating more work for lawyers, accountants and administrators. And yet if anything goes wrong, the Government will get the blame, even though it ceases to be directly responsible.

The same problems apply in a different way to New Labour's proposals aimed at creating "independent" schools. If they are truly independent of any elected body, locally or nationally, they will find ways of selecting the best pupils, harming other local schools. If the Government intervenes to prevent them from taking on the brightest kids in the area, they are not really independent at all.

The preoccupation with "market-based solutions" places a supposedly left-of-centre government in the perverse position of being unable to expose the failings of the previous right-wing administration that sought similar remedies for the failings of the public sector.

At the same time, the projection of this argument within the Government - Smart, Shiny, Modernising New Labour versus Vote-Losing Old Labour - is an open invitation to the voters and the media to regard anyone who questions the virtues of the private sector in any circumstances as backward looking.

The argument needs to be reversed. I am a pin-up thanks to a better-funded NHS, but I could have been a very ill pin-up if I had caught MRSA as a result of outdated contracting-out policies that were implemented in the old, old days of the 1980s.

s.richards@independent.co.uk