Lucy Chapman reveals what's really happening to patients in the government's flagship hospitals

The new University College Hospital towers above me as I stand waiting for my friend to finish work. It is a shaft of gleaming white and green, dwarfing the surrounding buildings. Both of us being junior doctors, when we finally sit down, the conversation turns to work. My usually mild-mannered and politically neutral friend is incensed. "Lucy, I can't believe it - they've put the cleaners in charge of the hospital!" Interserve, a company formerly in charge of cleaning in the old hospital, is now part of the consortium that owns and manages the new one, in partnership with two construction firms, Balfour Beatty and Amec. This consortium is one of many currently building and running 78 hospitals across the UK under the government's private finance initiative (PFI) scheme.

As a medical student I trained at UCH and the Middlesex Hospital. Both were in a state of disrepair after 20 years of underfunding and neglect. There was no question that investment was needed. The new hospital, which opened last June, is the London flagship rebuilt under PFI, and was designed to replace both existing facilities. Anyone who has been following press reports will already be aware of some of the issues surrounding UCH: the hugely overbudget cost, that it has fewer beds than the hospitals it was supposed to replace, the management wheeze of saving money by putting cancer patients up in hotels rather than on the wards and, latterly, the move to advertise for patients. What you won't know - unless you know a doctor or a nurse who works in one - is how the new ownership arrangements and management rules that PFI brings with it can affect your care once you become an NHS patient in a PFI hospital. Many doctors can tell stories of experiences similar to the ones my friends and I have had.

UCH is the hospital where a doctor I know, attending to a young man with a broken arm in casualty in the middle of the night, could not find any plaster of Paris. The young man was in terrible pain, and you don't need much medical training to know that the treatment is prompt replacement of the bone fragments to their correct position, and application of a cast to keep them there. This is not the sort of problem that can wait until the morning, but the A&E manager told my friend that there was no plaster in the hospital: "No, there isn't any and we won't be taking delivery of new stock until tomorrow afternoon." Why not, my friend wanted to know. Because it was not efficient to get in extra supplies at night, the manager said.

It will be obvious to any reader who has ever been to hospital that this sort of thing can happen anywhere and does. Inefficiency, administrative errors, lack of equipment and infuriating red tape are by no means the preserve of privately run hospitals. The difference is the system of priorities. In a conventional NHS hospital someone would be sent to find the plaster, even if that meant getting it couriered in, or going in a taxi to borrow it from another hospital - because the bottom line is treating the patient. Doctors are used to running, begging and negotiating with nurses, bed managers and radiologists to get the necessary treatments for patients. What we have not been used to is a manager flatly refusing to allow us to treat our patients adequately.

Another doctor I know was stuck between two auto-locking doors in a corridor in the new building. Trying to go the quick way to get to a patient in A&E, he found out too late that his swipe card allowed him in but not out. He was on call for the night, and the acutely unwell patient had been referred to him for assessment and admission. As his pager bleeped insistently, he rang the helpdesk from his mobile phone to explain that he was the doctor on call and needed to be let out urgently.

"I'm sorry, doctor, you don't have authorisation to get through those doors," said a bored voice at the other end of the line. "Can you look at the rota? My name is there. I need to be downstairs now." "We don't have access to the rota - you can go to the office between 11 and 12 tomorrow." "I really need to get out now; there's a very unwell patient in casualty. Can someone let me out?" "Sorry, doctor, the company that deals with ID cards is not on-site, and we're not authorised to release you." Eventually, security guards arrived and had to break the doors to override the system and let my friend out.

My friends involved in these two incidents did not report them officially. This is not unusual: the reporting procedures in hospitals are so time-consuming, and so often lead to such complex cycles of blame, that doctors are very reluctant to embark on them.

Cost-cutting and corner-cutting in relation to patient care and working con-ditions at the new UCH have quickly be-come infamous among medics. A single trainee surgeon initially looked after patients across the full spectrum of surgical conditions admitted each night at UCH, and another junior doctor covered all of the surgical in-patients already on wards at the Middlesex Hospital. With the move of in-patients from the Middlesex to UCH last autumn, the hospital trust managers tried to get rid of the second on-call doctor, leaving just one senior house officer (junior doctor) to care for all surgical patients admitted to UCH overnight. This includes patients in general surgery, orthopaedics, vascular and plastic surgery, and urology admissions - and the same doctor was on call to see and assess emergency patients in casualty, deal with trauma cases and be available for operating theatres.

The loss of the second on-call doctor in charge of in-patients left the remaining junior doctor responsible for a further three floors full of surgical patients - approximately 150 more people, more than doubling their workload. If two patients become acutely unwell at the same time in different parts of the hospital, no single doctor can treat them both. There was a stay of execution in late autumn, when the junior doctors concerned re-fused to continue working under these circumstances - on the grounds that the arrangement was endangering patients - and forced the reinstatement of the second on-call doctor, at least for the time being.

The latest expense-saving plan believed to be under consideration is to shave £70,000 from the annual mental health bill either by axing one or more of the medical staff covering the wards, or doing away with psychiatric services for medical and surgical in-patients. Instead, people who become depressed, suicidal or psychotic would be wheeled back to A&E for assessment.

A hospital owned and operated by a private consortium is loyal first to share-holders, not to patients, and it shows. At a northern PFI hospital where I myself have worked, we had to admit patients over-night in near-total darkness: the power to the wards had to be cut for several hours a day, for fear that the generators keeping the life-support machines going in intensive care would fail. It must have been odd for the patients to be admitted by someone they could barely see. But it could get worse for them (and me): in one case, I realised the next day that the patient was yellow from liver disease - something I simply couldn't see in the dark. At the same hospital, in an emergency situation, I had to take a haemorrhaging patient's blood three times in an attempt to get it cross-matched for transfusion - and each time the lab denied receiving any blood samples. The lab was a long way away in this vast hospital, so the blood bottles had to go in a chute. There was a problem with the chute but no one could help, because "if it is a problem with the chute, that's owned by a different company". This company, I later discovered, did not offer an out-of-hours service.

My opposition to the privatisation and fragmentation of the National Health Service is medical. My experience of PFI, and that of my medical friends, leads me to the conclusion that the management of hospitals, supplies, deliveries and support services is being conducted according to the priorities of profit-making organisations. And further, that the privatisation of basic facilities and support services, the unseen infrastructure of the health service, poses a serious threat to the quality of patient care and to the safety of patients on the wards.

The bottom line is no longer medical effectiveness; it is cost-effectiveness. As far as I can see, at the new UCH - the modern template of an NHS hospital - there is enough money for shiny windows, for an advertising budget, and for more managers to push through political targets; and enough money to guarantee generous profits for the consortium. What cannot be afforded, not without an almost continuous fight, is the cash to find plaster of Paris when it is needed, to have the people available when necessary to authorise releasing a doctor from an auto-locking corridor, or to pay a bare minimum of two junior doctors overnight to cover the surgical wards full of patients. Costs are being cut where they won't be evident to the public, at least not until it really matters. This is the "choice agenda" in action.

Lucy Chapman is a pseudonym. The writer is a junior doctor who works in an NHS hospital

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