When I was an art student in the early 1960s, I fell ill with meningitis which developed into ME, and I was admitted to my local hospital for several weeks. The ward was a Nightingale design in a wartime hut and the regime represented excellent care. The responsibility for this rested with the ward sister to whom I owe, if not my life, certainly my sanity and happiness during that painful period. She was a delightful woman with calves like Guinness bottles. She attended to me beyond the call of duty and, on the first day that I was beginning to walk any distance, she took me on her day off to her own home and gave me a lovely non-hospital dinner.

During this time, new curtains were allocated to our ward and the ward sister chose them, with the chief doctor backing her hurried choice. I lay in bed, imbued with art-school values, knowing that what was needed was a woven design so that those in bed could have the benefit of the design quality - as well as those outside.

Oh no, dear, they said when I revived enough to sit up and tell them so, We cant have those because the works department haven't any samples.

Eventually, as I lay in bed looking at the wrong side of a poorly printed fabric, badly drawn and shoddily made (too few hooks and inappropriate tape), I also knew that darling sister, who was good at pretty well everything else, was no good at choosing curtains. By then I had been kicked out of my cosy and curtained position, which was reserved for the very sick up by her desk, and been sent down to the convalescent end with the geraniums and the outlook and a set of faded reproductions of Degas ballet dancers lent by the still active Red Cross picture service. Some other wilting dame was occupying sisters attention now, but the seeds of a book had been sown, even though its gestation and growth took 35 years.

Today those huts at the hospital have been rebuilt as single-storey wards with bedded bays. The architecture is good, albeit rather ordinary, and the wards are very hot in summer. They look out on to grassed banks, frequently mown, and car parks stretching as far as the eye can see. The landscaping is utterly uninspired, the allotments having long since been banished. Ward windows are fixed so that they open only a few inches (necessary for todays security).

Wards inside are dominated by radio and television from which there is no escape; headphones are seldom compulsory and, in the childrens ward, video games and loud television mean that even children regaining consciousness after an anaesthetic are denied peace.

Hierarchical discipline is out of fashion and the days when sister wore a hat like a sailing ship and exerted discipline over staff - at the same time as serving the meat and two veg - have long since gone. Personal responsibility has replaced it, which may not be the best way to run a ward where the people have a short stay under conditions of intense personal discomfort.

The interior design was specified by the architect and, while a fairly good job was made, it displays poor knowledge of daily hospital life, no inspiration, and certainly no delight. When any refurbishing is done, the decor is chosen by the nursing staff who, while they are good at pretty well everything, are not necessarily great at choosing curtains.

There is more choice and a greater variety of food than in the old days, when if you were something weird like a vegetarian the diet was cabbage, cabbage and more cabbage. But it is unlikely a carefully cooked egg could be provided when a sick patient felt like it.

It would be unlikely that sister could take a patient home for a meal today because of the insurance implications. Supposing that patient got hurt and decided to sue; supposing there was a question of assault or abuse?

Safety first, said the headmistress in The Prime of Miss Jean Brodie. But safety does not come first, answered the impossible but inspired Miss Brodie.

Goodness, truth and beauty come first.

The technical aspects of medical and nursing treatment have improved and changed since the 1960s and most patients stay in hospital for only a short time. In some ways, the caring and hotel aspects have not kept pace with the technical.

The gratitude patients feel for having received free treatment and the strong national affection for the NHS are expressed strongly in satisfaction surveys, and rightly so. But if we question this gratitude we hear about aspects patients feel could be improved.

Patients generally expect that the treatment they receive should be the most appropriate for their medical condition; they would choose good medical and nursing care above better food in an attractive ward. We hear it in the stories they tell about their hospital stay: wonderful staff and treatment, such a pity about the poor food, noise and dinginess. In a prosperous country at the beginning of the 21st century this is not a choice the NHS should have to offer and it is often an unnecessary choice.