My uncle was admitted to a London teaching hospital with cancer of the prostate and lung, and placed on an orthopaedic ward.

His medical care was dislocated and the doctors cavalier. The confusing pile of papers that passed for his medical notes went missing for days. His pain control was casual. His nursing care was rushed, delivered by staff who did not have an adequate command of English. Once they insisted this frail, dying man had been 'sent home yesterday'.

I saw nurses 'wash' their hands by putting their fingertips under a dribble of water. A lone nurse did a drugs round, leaving the trolley open, unlocked and unattended.

Used dressings were dropped and left under a bed. An elderly man pleaded for a bedpan, eventually fouling his bed and the floor. He sobbed with embarrassment.

I endured filthy lifts and stinking public toilets. The food was inedible, the phones went unanswered.

The hospital was a dysfunctional mess, teetering on the dangerous.

My cousin's letter of complaint was dismissed as she was 'not his next of kin' - his wife. His file noted that he lived alone, widowed for 10 years. Finally came a few standard excuses masquerading as a grudging apology.

Reluctantly I contacted the chair - I felt I owed it to my uncle's memory.

The chair amazed me. They were truly sorry, sincere and honest. This was someone on top of the issues with a mastery of detail, a decent person with a passion for excellence. Why, then, is the hospital in such a mess?

With overwhelming frankness, the chair admitted to being crippled by a shortage of money and hobbled by a senseless Department of Health. The medical mafia focused on teaching and themselves, and were semi-detached when it came to change, co-operation and patient focus.

The trust had seen no 'new money' of substance, and what there was got subsumed by the demands of day-to-day debt.

The NHS needs four things:

Calm water: no new initiatives but a time for politicians to under-promise, so that the NHS may overperform.

Realistic workforce planning:

dismantle the royal colleges and cripplingly long training. Build a workforce we can sustain, re-skilled around technicians, focused on patient needs, not specialisms or status.

Realisation that a totally publicly-funded system costs lots of money. The NHS needs a shed-load of solid cash - now - not distracted managers bidding for niche fads and small change.

Understanding that you cannot run the world's largest administration with less computing power than most corner shops. The roll-out of the NHS IT strategy has slipped and is an abject mess. The 'national strategy for local implementation' is an oxymoron destined to infect the process with decision-sclerosis.

A private partnership would save more money and lives than piddling concordats with private hospitals.

This is my 22nd year in and around the NHS. The service is probably no better than the day I joined - a desolate observation from a loyal, but despairing, fan.

Roy Lilley Surrey See feature, pages 30-31.