Observations on the National Health Service

Until recently, I never questioned the conventional view that the NHS is in permanent crisis. Eight months into my first pregnancy, however, I cannot fault the care I have received. My north London hospital is a patchwork of Victorian buildings and postwar tower blocks, but the staff are genial, efficient and forward-looking. At my first appointment with a midwife, I made a glib comment about home births, assuming this option was unavailable. Not so: the midwife was keener on the idea than I was.

As an Irish citizen, I know how expensive pregnancy can be. My friends back home routinely pay between E1,500 (£1,060) and E4,000 (£2,800) for the same quality of care I enjoy gratis on the NHS.

The improvement in antenatal and post-natal care in the UK is Labour's best-kept secret. In 2001, for example, £100m was spent on more than 200 maternity units nationwide, providing new birthing pools and single rooms for women in early labour. Since 1997, 700 more midwives have begun working in the NHS. Increased support for breastfeeding mothers is now written into the NHS Plan.

These improvements have not happened by accident; they are the result of targeted investment by the Treasury.

They also reflect a change in attitude at the Department of Health, which now makes a genuine effort to view pregnancy and childbirth as natural events rather than medical problems that need to be rigidly managed.

Even better, the Sure Start scheme is delivering enhanced services to the UK's most deprived neighbourhoods: Domino care (home visits from midwives); community parents; workshops on infant first aid; as well as advice on fitness, nutrition and language development.

Unless you are an expectant parent, you may not have heard the good news. Does the government fear that all this investment could sound like old-fashioned redistribution? Or are the media ignoring it for fear of sounding Pollyanna-ish?

Although basic maternity care is free in Ireland, childbirth there is still very managed. One friend was urged to fix a date in advance for the birth - her consultant prefers his patients to deliver on Mondays or Wednesdays, as "that's when he's in the hospital".

Intervention rates are high and midwives in public hospitals are not allowed to attend home births. If you want a home birth, you hire your own midwife, at great expense. As for a water birth, forget it, unless you can supply the pool. In short, if you want patient-led care in Ireland, you go private.

Our minister for health and children, Mary Harney, once boasted that Ireland is culturally closer to Boston than to Berlin. When it comes to our pay-as-you-go healthcare system, she is right.

Irish patients pay for visits to the GP or the A&E department and for a stay in a public bed in a public hospital. Pregnant women and those on extremely low incomes are exempt from charges. Those who can afford it - roughly half the population - take out private health insurance. A premium of, say, E12 a week allows you to swap a long queue for treatment in the public system for a slightly shorter private queue.

The NHS has its problems, but it is nowhere near collapse. To suggest otherwise is both defeatist and dishonest.

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