Having just worked 12 consecutive days in hospital, I am writing this article in the early hours of the morning. I am crazed with tiredness, which is probably why, although you hear a lot from politicians about the state of the NHS and patient choice, you hear very little about what doctors and nurses think about it. Out of the window of the bleak doctors' on-call room, I can see the brand-new brightly painted hospital, standing out against the background of an urban wasteland. It is one of the government's flagship "new" hospitals, built under the private finance initiative - owned and operated by a disreputable construction company which shall remain nameless. It is miles out of town, built on the cheapest plot of land available in order to keep profit margins up, and with the added benefit that the company can charge staff and patients £10 a day for parking. The original hospital in the centre of town is being redeveloped into luxury flats and a shopping mall.

Last week, one of my favourite patients died. I was paged by a nurse who asked me to come urgently to her ward - Mrs Burrows had become cold and clammy with an unrecordable blood pressure. She was barely conscious, extremely confused and frightened, and was bleeding. She suffered a massive haemorrhage from her intestines. My abiding, awful memory of those last few moments while I was desperately trying to get a needle into one of her collapsed veins so that I could give her a blood transfusion, is that the television was blaring the Emmerdale theme tune at top volume. Not an option anyone would choose.

There were TV sets and telephones available in all the "old" NHS hospitals I trained in, but now, under the banner of better choice for patients, every bed in the hospital comes with an in-built TV, courtesy of PatientLine, the company that hit the headlines earlier this year after installing thousands of sets in hospitals without an off button. If my patients resist the PatientLine reps and decline to sign up for premium-rate television and phone services, they are treated to a repeated loop of adverts for the company on the screen. So much for tranquillity.

The changes happen silently and it's the things that would never occur to you - and clearly didn't occur to the policy makers - which have the most disturbing effects. For six years, I never really noticed when people who had died were removed from the ward. The porters who removed their bodies to the morgue were professional - they took care to be discreet so as to cause minimal upset to families and other patients, who don't like to be reminded that they might not make it. Since arriving at this hospital I have twice seen covered corpses being noisily negotiated past the lunch trolley at midday. It seems to me that when you sub-contract out vital staff, de-unionise them, literally de-value them - the porters have lost their holiday pay and now have to work a third more hours to make the same pay they did under the NHS - the result is a de-skilling and demotivation of the workforce, with consequences for patients.

Before I started working, I was vaguely aware of plans to introduce private investment into the health service, but it wasn't until I dealt with my first emergency that I realised the extent of the takeover. In my first week, I was asked to see a man who had become extremely short of breath. When I examined him I realised that his heart was failing and his lungs were filling with fluid as a result. I gave him some oxygen, ordered a chest x-ray and sent off my blood tests. When I went to look up the results, the computer was broken.

This being a different hospital, owned by a computer company, I thought it would be easy enough to retrieve my urgent blood results. I rang the switchboard and was put through to the company: press one for portering services; two for cleaning services; three for catering services; four for laboratory services; five for maintenance services; six for IT services. I pressed six and got a recorded message. The patient lived, but it transpired the next day that the computer firm who owned and ran the hospital was not responsible for fixing the computer - this had been subcontracted out to another firm.

If I were to meet Tony Blair or Michael Howard at a party, God forbid, I would suggest that they accompanied me on call over a weekend. I wonder how they would react if they came upon, as I did, a man lying still, fully clothed, ashen-faced and obviously in agony in a ward around the corner from A&E, having breached the government target waiting time of four hours. I asked him what he was doing there, but he could only tell me that the pain in his stomach was worse than anything he had ever experienced, and that he would have been sent home but someone had at last looked at his x-ray.

Then he was rushed around the corner and left. I found his x-ray, which showed a clear six inches of black air above the liver, indicating that he had burst an ulcer. A ruptured ulcer is a surgical emergency but the man had not been given any pain relief, had had no blood tests, no blood cross-matched for an operation, no drip in his arm for the fluid he so desperately needed. But he was no longer on the casualty computer, no longer a performance issue.

Choice sounds like a good thing, but there can be no meaningful choice between two things unless one is better than the other. One wonders who would choose the dirty hospital and the long waiting list and the insensitive doctor with the bad shoes. Those for whom choice is theoretical: the people without resources to get to, or live near, the good hospital, perhaps. And personalisation sounds delightful - who wouldn't vote for that? Then maybe my nice, well-spoken, tidy patients could have a clean, respectful, efficient hospital, and the ones who are rude and disrespectful and dirty could go to an establishment which was likewise.

We should remember that it was Nye Bevan, with the support of the Attlee government, who dreamed into life the monument to dignity and equality that is the National Health Service. What is now being proposed, under the auspices of choice and personalisation, is a wholesale betrayal of those founding principles.

The introduction of the choice agenda and the hiving-off of NHS services to various private sector "care" providers represents the most fundamental change the service has endured. And we might notice that, in among all the talk, we will have no say in the real decision: we are not to be given a choice about choice.

· Catherine Blake is a pseudonym.