It's the pride of the nation, but never out of the headlines. Health secretary Patricia Hewitt claims the NHS is in better shape than ever - but last month 50 minutes of heckling forced her to abandon a speech to the Royal College of Nursing. This year the government is spending £83.8bn on the health service - yet the list of hospitals announcing record debts continues to grow. There are 85,000 more nurses than in 1997 - but all we hear about is layoffs, and health workers are marching in London today, threatening industrial action. So what's life really like for the 1.3 million employed by the health service? On Tuesday we asked 35 people - from the cabinet minister to the mortuary attendant, the chief executive to the chaplain - to tell us about their day. How do they spend it? What's the best thing about what they do? And the worst?
Sean Connelly
57, general practitioner
Clifton Street Surgery, Belfast
My day began quietly enough with a coffee over a paper on cardiovascular risk. Surgery started at 9am. Today, my first priority was going through the day's prescriptions. This took 30 minutes longer than usual, as there were over 200 to do. This made me slightly late for a prescribing meeting. As the computers at work were down, I went home for lunch to check my emails. On my return, my first case was a 17-year-old mental health patient with slashed wrists who had been caught trying to hang himself.
No one wanted to know about it. I made eight phone calls, spent until 6pm trying to sort everything out. The Adolescent Mental Health Team, responsible for dealing with such cases, do the best they can. But there's a lack of available consultants. Even the secretary on the urgent messages desk wasn't available until the third try.
My surgery is in the north and west of the city, an area with one of the UK's highest suicide rates. Yet the facilities in place to deal with suicides are appalling. It's just so frustrating. In general I feel equipped to meet the challenges that having a surgery of 9,000 patients in a deprived area of Belfast presents. Availability and accessibility at this surgery are top-notch. Quality indicators are good. Rates of diabetes, strokes and heart attacks are all down on two years ago. Staff-patient relationships are good. But on days like this, it feels like there are barriers put up against solving the problems that exist.
Best thing about the NHS There are high numbers of GPs confident about dealing with patients effectively.
Worst thing about the NHSThe waiting lists are awful.
Patricia Hewitt
59, secretary of state for health
Department of Health, Richmond House, Whitehall
I started the day at 6am with the relentless red box, preparing for a Commons debate in the afternoon. I should have been in Torquay for the Royal College of Midwives' conference. But, because the opposition called for a debate on the health service, I had to be in parliament.
I got to the department soon after 9am. On a normal day there are back-to-back meetings. But, since I wasn't meant to be there, none were arranged. I spent quite a lot of time with Andy Burnham, our new minister of state, talking about the financial problems of the NHS.
I told him about what I saw in Dudley, where they changed the whole system to look after people better in their own homes and stop them having to go to hospital for emergency treatment.
Chris Beasley [NHS chief nurse] came in to discuss improving support for midwives who are asked to change jobs. Then I spent some time with the special advisers and phoned my constituency to catch up on how plans for a PFI hospital in Leicester are progressing. I had half a sandwich and a cup of tea before going over to the Commons for the debate. I do enjoy these occasions. They give you a chance to challenge the Tories about how their policies don't add up.
My father turned up for the debate. He was 89 on Sunday and I'd hoped to squeeze in a cup of tea. But there was only time to thank him for coming before rushing over to Guy's and St Thomas' hospital to meet the chairs and chief executives of the 10 new strategic health authorities. That was so excellent. After an informal discussion, we had dinner together. We talked about how we were going to work as a team to support the NHS through a difficult 12 months ahead. I was really heartened by their absolute commitment to improving patient services. Getting some food was a bonus.
I left at 9.15pm for the wind-up speeches in the Commons. Andy Burnham, in his second day at the department, was superb. During the vote I got the chance to catch up with colleagues. Then I set off to Torquay where I was due to make the postponed speech to the midwives early next morning. My driver said he'd get us there by 2am. I had work to do on the red box and had some phone calls to make. Luckily, I'm very good at catnapping.
Best thing about the NHS The people. Everywhere I go I meet exceptional, committed, interesting people doing extraordinary jobs.
Worst thing about the NHS The financial problems that call for difficult decisions over the next 12 months. Trusts doing so many good things within their budgets are now going to have to postpone improvements. We have to support the minority of overspenders while we make the difficult decisions to turn them around.
Olu Obaru
50, consultant radiologist
King George Hospital, Essex
Put it this way: there was no time for lunch today. I got in at 9am. I saw a patient who couldn't be treated because the back-up facilities that are necessary in the case of complications weren't available; his treatment had to be postponed. Waste of time, waste of money. He wasn't pleased and neither were the staff.
A lot of unplanned cases came in that had to be dealt with. We are short-staffed, so there are always interruptions - you can't plan your day. I saw over 30 patients and in between got called out to help a colleague with an interventional procedure. I was late for a meeting in London about African health issues.
I don't think the NHS stole me from Nigeria, however I would hope that one day it will be a two-way street and people from here can go to work there. I am always longing to go back home.
Best thing about the NHS No matter how poor you are, you will get care as good as that given to the richest man in the land.
Worst thing about the NHS The goodwill of the staff has been eroded. As a consultant, I don't even have a place to park in the hospital. Too much money is spent on managers and not enough on medical staff.
Faye Hughes
35, therapy assistant
Capio Jacob Centre, Sawbridgeworth, Herts
I start work at 8.30am. We take patients from the NHS with severe brain or spinal injuries, or other neurological conditions. I support the physiotherapists with the exercises the patients need. I saw three patients before lunch, with each session lasting around an hour. One woman is recovering from a brain stem stroke and we're hoping that soon she'll be able to speak for the first time in two years.
We get half an hour for lunch and we've got a canteen, but I bring my own because it gets so crowded down there and sometimes it's just good to sit outside.
This afternoon I was assessing someone for an electric wheelchair, to see if they have good enough hand-eye coordination to steer it and get around safely. It's fantastic seeing someone have that independence after spending years sitting still. We do our own repairs on some of the simple wheelchairs, pumping up tyres, tightening up wheels and headrests.
We assess patients probably every other day, but we can't take them all. The NHS doesn't know what to do with these people, but it's desperate to free up beds, and referring people to us is a good way of doing it. There should be a centre like this in every town really.
Best thing about the NHS When the NHS know about us, they do a fantastic job of referring patients to us, but our centres are rare, so often they don't have that choice.
Worst thing about the NHS The wait some people have for wheelchairs is disgusting. They can be stuck in bed getting pressure sores and not able to get out of their rooms and it'll be eight months before they get a wheelchair. That's too long to be stuck in bed.
Mair Watkins
57, senior nurse adviser
NHS Direct Wales, Swansea
I worked 8am to 5pm today. After checking the call centre was adequately staffed and there were no problems, I met my director of nursing at 9.30am to discuss a team member. She needed some extra support, so I assigned her a practice coach. On some shifts I supervise up to 40 or 50 call centre staff across the service in Swansea, Bangor and Gwent, but I have a line management responsibility for a specific nurse team.
A large part of my job involves answering emails about personnel issues, clinical issues, management issues, so I did that next. It can be harder for people to access healthcare these days - because, for example, of the change in the way GPs work and the demand on A&E services. This means this service is in increasingly high demand. We've just taken on a new cohort of nurses.
The type of calls we get are varied - for example, we have had a call in from a nursing home where a patient was whispering over the phone: "I can't talk too loud - matron will hear me." We involved the social services and the care standards inspectorate went into the nursing home. Some people call frequently and inappropriately just to have a chat; there was one of those today. There was also a child with a severe chest infection; an elderly patient who had fallen; an attempted overdose; and a child who had swallowed a penny.
Best thing about the NHS Up until now, job security. A reasonable pension, not excellent. The satisfaction of seeing people improve, and knowing you've made a difference.
Worst thing about the NHS I feel I'm seeing the demise of the NHS. What's not coming into the public arena is that there are a lot of vacancies not being filled. It's obvious the NHS is in dire straits. I don't know how much of it is deliberate, so that they can start privatisation.
John Pollard
Paramedic
Toxteth, Liverpool
My day should have begun at 11am, but extra staff were needed and my team arrived for work at 7am. We spent an hour stocking the vehicle before being called out at 8am on stand-by. Computers calculate these days where ambulances are needed. There are more call-outs and precious few more vehicles available than when I started 12 years ago. Stand-by vehicles are the only way to cover all areas.
At 9am I got a call to assist a 75-year-old man who had fallen down an escalator. Then we got a call to a traffic accident. Afterwards I managed to get a bite to eat.
My next call was a female alcoholic, wasting away on the bed she had been lying on for 12 months. She was severely emaciated, in her own faeces and living with two other people. No one checked all that time if she was OK. We then had another half-hour on stand-by before being called to assist an 18-year-old female four months pregnant who had been trying to escape from her abusive boyfriend, injuring herself in the process. Afterwards we had a call-out to assist a 12-year-old who had fallen down the stairs.
Our next call-out was assisting a student who had phoned NHS Direct after banging his head. They'd advised him to call 999 immediately. It was an unnecessary call - he was fine. Just as we were thinking we might get home early, we got a call to assist a man who had fractured his ankle, walked out of hospital without telling anyone and found he couldn't walk back.
Best thing about the NHS The variety of work.
Worst thing about the NHS There isn't enough time to deal with cases effectively. The emphasis is on meeting targets, not helping people.
Maria Alberts
47, sewing assistant
Queen Elizabeth hospital, Gateshead
I spent a lot of today checking through damaged hospital linen to see what could be repaired. Some of it was theatre greens and drapes - you have to be very thorough checking these, because if there are any tiny holes, the fibres can break off and get into the patient during surgery. We get four huge barrels of linen a day into the sewing room - each one is about 6ft high and 3ft deep, so it's a lot of linen!
As well as doing any repairs we put tags on everything with the ward names on, and we make curtains for the wards and that sort of thing.
This afternoon we had nurses in who needed their uniforms altering. Sometimes you get young girls who want their skirts taken up really short, but I tell them that's not suitable. Our nurses can wear either a dress or trousers, and more of them are opting for trousers - it's more practical.
Sometimes my job feels invisible, but not always. You do meet patients occasionally: if there's someone very big in one of the wards, for example, they might call me up to measure him and then we make a pair of pyjamas that fit him.
One time they asked me to help a patient with severe arthritis who couldn't manage the buttons on his pyjamas. I put Velcro behind the buttons, so they looked the same as everyone else's but he could do them up himself. He was delighted: it made me think, 'I can make a real difference.'
Best thing about the NHS We're a brilliant team. You know what you do is genuinely worthwhile.
Worst thing about the NHS Government-inspired job cuts. In our trust we've got to lose 100 posts and it's going to put a lot more pressure on staff.
Omar Najim
32, senior house officer in ear, nose and throat surgery
Royal General Hospital, Sunderland
I arrived at the hospital just before 8am for the ward round. There were three registrars and five senior house officers. We saw the short-stay side of the ward first - mostly people who had undergone a tonsillectomy, ear or nose surgery the day before. On the long-stay side, there were 12 with more serious problems. There was a gentleman who had a 13-hour operation last week for throat cancer - Sunderland and the north-east have the highest percentage of throat cancer in the country. He had half his neck removed. He is a perfect example of why the NHS needs to be there, and of teamwork. It took only two weeks from diagnosis to seeing a multi-disciplinary team and another two to have the operation.
After that we split into three groups. I went to see two children in paediatrics, while others went to see the pre-operative cases or the boarders - ENT patients in other wards because we don't have enough beds. At 9.15 I went to cover the morning and afternoon ENT casualty clinic. It was fairly busy - I saw 18 patients. Seven had fractured noses; we see them a week later when the swelling has gone down. At mid-day I had a meeting with the consultant over plans to combine the night-shift rota between ENT and urology.That would make the surgical trainees available during the day for more training. At the end of the day, I caught a train to London to sit an exam the next morning at the Royal College of Surgeons for a diploma in head and neck surgery to improve my CV.
Best thing about the NHS It's free to everyone, rich and poor, and is the best medical service in the world.
Worst thing about the NHS It's too politicised, used by the government as a tool for bargaining.
Rachel Richards
28, service manager, medicine
St Mary's Hospital, London
I've got a big job managing 350 staff and a £22m budget, and I start every day knowing there's too much to do and that, unless I prioritise fiercely, I'll never get through it. Today started with a meeting about running a blood clinic in the community, which would mean patients could get the service they need without having to keep trekking into hospital.
Then I had a meeting about cutting junior doctors' hours, which is a big issue for us: under the EU working time directive we have to cut them back from 48 to 40 a week by 2009 and we have got a lot to do. Today we were talking about using physicians' assistants to free up the doctors' time.
I had my sandwich while reading about a new endoscopy clinic, and my final meeting of the day was with a group of neurologists to talk about how to reduce waiting lists - the maximum wait at the moment is 13 weeks but we need to bring it down further, to 11.
Best thing about the NHS We've got a fantastic health service in this country; compared with almost every other country in the world, it's doing an amazing job.
Worst thing about the NHS The poor public perception of this fantastic service. It's really demoralising. But the last two years have seen huge changes, and they have almost all been in the patient's interests.
Iain Johnstone
37, mortuary manager
James Paget Hospital, Great Yarmouth
My day started early, with my five-week-old daughter Ella waking me up to be fed at 4.20am. I went to work at 7.30am and spent 15 minutes dealing with emails and another 15 finishing my article for the Association of Anatomical Pathology Technologists. It's for a bereavement conference in London and deals with issues around tissue removal.
Then my staff came in. Normally there are five of us - Darryl, the deputy manager; Maria, the senior technician; Phil, the trainee technician and Emily, the administrator. But today we were two down because of training. Then we went to prepare four patients for postmortem. We do dissection for the pathologists. It was quiet for a Tuesday. Normally we have seven or eight. There was a probationary policeman in the viewing gallery and I talked him through the death and postmortem protocols.
I didn't have time for a break. The phone was constantly going with calls from funeral directors and relatives wanting to book the chapel of rest. I had no lunch because the Parkinson's Disease Society called to ask if I could accept a patient who had wanted to donate the brain and spinal cord. A courier came from London and waited while I removed them. I don't mind giving up my dinner hour for that.
I wrote a health and safety report, then a funeral director came in to collect two patients, and I invited him out to wet the baby's head. Then I set another patient in the chapel of rest. After that I had to work on a "gap analysis", looking at what we are doing versus what we should be doing, based on the Department of Health's bereavement policy statement When a Patient Dies. Then Maria and I put together some bereavement packs for relatives.
At about 4.30pm we had had a chat over coffee, and I said thank you to my staff as I try to do most days because I have a motto: if you're good to your staff, they'll be good to you. At 5.30pm, I left to pick up my son, Adam, who's two.
Best thing about the NHS It's a family environment, at least in my trust. We're like-minded people who do a good job and work hard.
Worst thing about the NHS The bad thing is politicians playing games to score points.
Lesley Bacon
58, consultant in sexual and reproductive health
Lewisham Primary Care Trust, Lewisham
I was in the office by 8.30am dealing with paperwork, post and emails. Then I drove to one of our health centres for an administrators' meeting where we discussed overcrowded clinics, which happen because we have a walk-in system and because there is a huge and growing demand for our work. Then it was back to the office, where I dealt with some urgent HR problems with contracts.
For lunch I had a couple of sandwiches on the hoof because from 1.30 until 4pm I was teaching GPs and practice nurses They have protected learning time which they use to keep their skills up to date; this time it was about long-acting reversible contraception (injections, coils, implants) and about taking sexual histories from patients. Then I had a bit of a break before another clinic at 6.30, but used some of it to try and get a quote for shredding some of the 80,000 medical notes we have because we're not electronic like hospitals and have no room to store the old ones.
The clinic lasted until 9.15. It can overrun badly but it wasn't too busy tonight. We saw 22 patients requiring contraception, screening and treatment for infections, pregnancy tests and gynaecological examinations. Our clinics are getting busier each year - the service carried out nearly 52,000 consultations in the past 12 months. I suppose I probably see about 3,500 patients a year.
After the evening clinic, I do some more paperwork and keep trying to arrange locum cover for everyone who's on maternity, sick, study or statutory leave. Half our work is after 5pm or at weekends and covering that relies on a series of people working part-time. It often means stretching our staff very, very thinly - the usual NHS thing of asking as much as possible for as little money as possible.
Before I go to bed, I'll deal with some more emails. It's 10.30pm now and I have 94 to go. I hope to be done by midnight.
Best thing about the NHS As far as our department goes, the best thing is the strong teamwork and the confidential service. Young people in particular can come in without worrying.
Worst thing about the NHS Bureaucracy - fighting your way through the system. You generally feel that there is someone, somewhere, who's got the answer to your question, but finding them can be very difficult.
Ian Whitaker
48, consultant orthopaedic surgeon
Leeds District General Hospital and Clifton Park NHS treatment centre
I had a very pleasant day in the district general hospital. At 8.15am I saw the four patients who had come in for elective surgery for hand problems such as tendon repair. They all had local anaesthesia and everything went as well as we could have hoped. It was a very normal list.
We finished operating at about 12.45, saw the patients again and discharged them. After lunch I did administration, dealing with GP referrals and patients' inquiries. The number of tasks increases, mostly in relation to the regulation of doctors as a result of various high profile cases. We have to audit our work, which is no bad thing, but it takes time.
Our whole surgical team is seconded to an independent treatment centre. This has been quite a divisive issue in the NHS, but in York we have got a pretty good model which will be copied elsewhere. Being away from the hospital, the ever present worry of infection is significantly reduced. There is not the same movement of patients and over-crowded corridors. There's green space and car parking. The patients like it and because it's de-centralised, it gives us autonomy. We see it as a clinical facility for our patients rather than a threat.
Best thing about the NHS The patients
Worst thing about the NHS The management
Janet Davis
59, pharmacy technician
Russell's Hall Hospital, Dudley
I leave the house at 8am to make sure I can get a staff parking space. They have started charging patients £5 to park, so if you're not early, you have to pay too. There are two of us in the pharmacy, but someone was off ill at the Guest hospital down the road, so I was sent over to cover. Normally, we process around 100 prescriptions a day. I've been in the NHS for 26 years and we used to make up creams, powders, capsules, suppositories, the lot. Now, there's nothing fun to do. Everything's bought in from outside firms. There are new drugs every month and you have to keep on top of what they are all for. Recently, technicians have been allowed to train to check prescriptions, something only the pharmacist was qualified to do before. So now I make sure none of the drugs a patient is being prescribed will interact badly with each other.
I was helping with an eye clinic and then a genito-urinary clinic at the Guest, where there were a lot of outpatients. I was also filling containers with liquid nitrogen, which they use on the wards to burn warts off. My day finished at 5.15pm, although we often run a late-night service which is supposed to be open until 7pm but tends to last until 8 or 9pm.
The pharmacists are under a lot of pressure because of the sheer volume of prescriptions, but it means we're treating more people and treating conditions we didn't even know existed 10 years ago.
Best thing about the NHS More patients are being treated and they are not being kept in hospital as long, so there is less chance of them catching anything.
Worst thing about the NHS The waiting lists are long and there's a terrible shortage of beds. They're closing smaller hospitals down and building on the land, and losing beds because of it.
Judi Greenbank
48, school nurse
Plymouth
Today was a study day. I'm doing a two-tier course on public health development and leadership. But a typical day starts with me going to one of my schools and having a meeting with the headteacher about any pupils with health concerns. I'm responsible for six primary schools and one secondary school.
I've been a school nurse for 11 years and before that was a hospital nurse. A couple of days ago, for example, I went to a primary school and met the deputy head. At 8.15am, I met some parents and children. I tested the hearing of a five-year-old girl and found she had fluctuating hearing loss. I'll re-test to see if I need to refer her to audiology. Then I saw a mother about her son who doesn't like using the toilet.
About 9.30am I went to a secondary school, where I met a boy who's having a rough time at home. I spent a lot of time with him. At 11.30am I went to an inter-agency meeting with the secondary school's special educational needs co-ordinator, who is also the child protection officer, her deputy and a primary-care liaison officer who is mental-health trained.
A lot of my dealings with secondary-school children raise mental health issues. We had a list of about a dozen cases, including children on the child protection register, and some with special needs in terms of mental health or behavioural problems. The meeting went from 11.30-1pm and there was a lot to discuss.
At 1pm I drove seven miles to the office of my manager, who is on holiday, and dealt with her post and other issues that needed to be looked at. At 2-ish I went back to my office and spent two hours doing paperwork.
Best thing about the NHS The commitment and camaraderie are amazing.
Worst thing about the NHS Wanting to give the best to clients (I have clients not patients because mostly they are well) but not being able to because of lack of resources.
Katherine Cotton
28, staff midwife
King's College hospital, London
My shift started at 7.15am, and as I arrived in the delivery suite a woman in labour was just being admitted. I spent the morning in a delivery room with her and her partner. It was their first baby so they were very anxious and apprehensive. I'd never met them before, which is how it works if you're a staff midwife in the hospital as I am, but you do develop the skills that allow you to build up a rapport very quickly.
It's an extraordinary privilege, being with someone when they give birth: you never get used to it, no matter how many births you've been at. This labour was very straightforward: the woman decided to use the birthing pool, which helps with pain relief, and she had a little boy really easily. She and her partner were completely thrilled; it's an amazing moment, to be there when a new person arrives in the world.
Afterwards there was all the usual paperwork to complete, and you've got to keep a close eye on a mother for the first few hours after delivery in case of a haemorrhage or other complications, but you also try to give them some space together with their new baby.
I also helped the mother get her baby feeding, because the more skin-to-skin contact there is and the earlier you get breastfeeding established, the more likely it is to continue.
Best thing about the NHS The NHS supports people through very significant moments of their lives, like birth; I like to think we do that very well, and certainly from my point of view it's wonderful to have the chance to go through an experience like birth with them.
Worst thing about the NHS A hectic day when you're just so under pressure that you can't give the service you'd like to - and you know that a couple's experience of having a child might be blighted as a result. Fortunately, those days are few and far between.
· Interviews by: Andy Bodle, Lawrence Booth, Sarah Boseley, Emma Brockes, John Carvel, Lucy Clouting, Aida Edemariam, Leo Hickman, Paul Howlett, Stuart Jeffries, Lucy Mangan, Joanna Moorhead, Stephen Moss, Helen Pidd, Ian Sample, Matt Seaton, Luke Waterson, Rick Williams
