The NHS is 60 years old on Saturday. Health Editor Barry Nelson asks two insiders whether it's in good shape

IT seems appropriate that Ken Jarrold is almost exactly as old as the NHS, born just a few weeks before this great experiment in socialised healthcare was proclaimed on July 5, 1948.

He's in no doubt that the NHS has changed everybody's lives in this country and is a fiercely loyal supporter, but he believes there is room for improvement.

Today, after spending most of his life managing various parts of the NHS (including being deputy chief executive between 1984 and 1997) he is one step removed from the service.

As an independent consultant who advises NHS organisations, Ken can now take a more detached view. Generally he is filled with admiration for his twin', but thinks there are areas which could improve.

"I think the NHS is a very important part of being British. It is part of our social wealth, not our individual wealth. If you live in an area with a good health service, and unfortunately not everyone does, having access to a cracking hospital is part of what makes your life good,"

says Ken, who joined the NHS's trainee manager scheme in 1969 before going on to chair several authorities, including the former County Durham and Tees Valley Strategic Health Authority.

He is impressed at what has been achieved since Tony Blair swept to power at the head of the New Labour revolution 11 years ago.

"The Government has delivered a fantastic amount for huge numbers of people. Waiting times are much lower than they were, which is a remarkable change," he says. "They have also provided vast resources to the NHS. However, there are still real problems."

In his view, one of the most positive developments has been the introduction of national service guidelines on how conditions such as heart disease, stroke, mental health and diabetes should be treated.

"These frameworks have been really powerful.

Not only have they really improved care but they are one of the few things in the history of the NHS which are supported by doctors and nurses. It means for the first time we have a clinical and a political consensus on how to treat major disease."

Ken is also impressed at the programme of building and renewing hospitals and health centres, particularly the new hospitals at Durham, Bishop Auckland, West Park in Darlington and the extension to James Cook, Middlesbrough.

"Tremendous advances" have been made in terms of NHS staff - not only are there many more doctors, nurses and other health professionals than there were a decade ago, he says, but they are better trained and better qualified.

But he doesn't think everything in the NHS garden is rosy. "There are some bad things.

One of them is the disconnection between most senior people and the front-line staff.

That is because the senior people are being pulled more and more towards a national focus. Their lives are dominated by meeting national targets."

While the culture of the NHS is changing and more personalised care being provided, Ken believes there are still some dark corners.

"There are still places in the NHS where people's humanity and dignity is not respected.

This is particularly true for older people."

And he is also concerned at what he sees as a lack of attention to nursing. "Nursing is the most important aspect of healthcare, but it is hardly ever discussed in the health service. We need to get a real focus back on nursing."

In conclusion, he says: "We need to get back to the idea that the NHS is here to deliver patient care, not to hit targets. We have got to look after patients. I would like to see at least 80 per cent of staff thinking that patient care was the top priority. We are a long way from that."

Liz Twist is head of health in the North-East for the trade union Unison

PERHAPS not surprisingly, Liz Twist believes passionately in the values and principles of the NHS.

"The NHS is one of the things we can be most proud of in the UK. The fact that every person can access it when they need it and it is free at the point of use is something worth fighting to retain," she says.

Liz, who first became involved in trade union activism in 1989, is impressed by the Labour Government's record on investment. "Over the last 11 years we have seen a huge amount of investment in the NHS and that has been really welcome," she says.

However, she emphasises that Unison has not been afraid to disagree with some aspects of the Government's policies on the NHS.

"We have always recognised that the Government has been committed to the NHS. This is particularly appreciated in the North-East, given the legacy of our industrial past."

But she says those who value the NHS should be eternally vigilant against attempts to undermine the basic principles of a tax-funded, free-to-all service.

Unison is concerned about the growing involvement of the private sector in the NHS.

"What people want is really high quality services directly provided by NHS staff. What none of us want is a situation where profit becomes the driver of health services. Let's keep it public and keep it free at the point of need."

The prospect of a change of government worries her.

"People will look back for evidence of what happened when the Conservatives were in power. That is when the NHS suffered and people in the North-East saw some of the worst effects of that. I think people up here are going to be sceptical about the Tories. Can we trust them with the NHS?"

* "Mum told me nursing was over-worked and under-paid" - see tomorrow's Health page.