A glaring gap persists between the vision for the NHS and the daily reality Is HSJ turning into the Daily Mail? The aggressive mid-market tabloid has been running a relentless campaign to highlight what it calls the 'Third World' nature of the NHS; only two days ago its front page labelled the service 'the sick man of Europe', and it regularly carries stories regaling readers with patients' abysmal experiences.

This week, we do the same. Two HSJ staff who recently underwent surgery in NHS hospitals describe standards of care that are patently inadequate - indeed, they border on insulting - for a 21st century healthcare system (see pages 30-31). Roy Lilley's observations (see letters, page 22) of a family member's treatment at a third hospital reinforce the message: for a system whose very survival depends on continuing public support, this level of service is downright reckless.

Unlike the Mail, we do not highlight these cases to lobby for the NHS to be swept away and replaced with something more acceptable to that newspaper's political outlook. We simply want to remind the service's managers of the glaring gap that persists - one year into the NHS plan's 10-year programme - between the vision they have embraced and the daily reality patients endure. Many places, not just these three, need to pull out sharply from a nose dive.

Soon, very soon, the public will want to feel that such shoddy care is a thing of the past.

They will need to sense the momentum of change from which the three institutions we describe appear stubbornly, cravenly immune. Without that, ministers and managers may cite whole compendia of statistics to prove targets have been met, ticking as many boxes as they like, but people will remain resolutely unconvinced. Money will be part of it, but staff attitudes - to themselves as much as to patients - will be as important.