HEALTH care - whether provided by the NHS or your local BUPA hospital - has traditionally operated on the basis of trust, admits Alan Maynard. Trust that your doctor knew what he was doing and was doing it properly.

In the last few years, that trust has taken a hammering. There have been a catalogue of scandals - the Bristol heart surgeons, Harold Shipman, Richard Neale - which have undermined our faith in doctors.

Then there were the scares over BSE and foot and mouth, about which there are still questions that have never been answered, says Prof Maynard. Small wonder public faith in the health services and the Department of Health itself has been undermined.

"There's a joke that goes, there's nothing wrong with the NHS, it's all Shipmanshape and Bristol fashion," the Professor of Health Economics at York University and Chairman of York Health Services Trust says, neatly putting his finger on the crisis in public confidence.

The controversy over the MMR vaccine could be seen as a direct consequence of that - and he fears it could have terrible consequences.

The arguments about a possible link between the vaccine and autism, although based on a small study, do need much more careful assessment, he says. But even so, he firmly believes the benefits of the vaccine far outweigh any possible risks.

"If you don't have it, the risk is greater," he says. "Do you really want your child exposed to measles, ill health, and possible death? The best advice we can give at the moment is take the MMR vaccine."

If he says it, it's worth listening. Prof Maynard is no Government jobsworth who will parrot the official line. If he believes something is wrong with the health service he will say so.

And while there is much that is good, there is plenty that is wrong. Bed blocking, delayed operations, A&E waiting times, nurse and doctor shortages, an often inefficient bureaucracy.

So what is the cure for the NHS? Simply throwing money at it?

He doesn't think so. That could simply lead to 'drunken sailor' syndrome, he jokes - where everybody in the health service is happy, but not enough gets done well.

He says the real cure may be simpler - acting smart. What the health service needs, he says, is a system for properly measuring the quality of treatment at hospitals and GPs' surgeries, so the data can be used to improve the way things are done.

The fact it is not already happening drives him wild. He says the data is being collected, and has been collected for years - but no one is using it.

Hospital statistics reveal mortality rates for individual hospitals and even consultants. Figures for a hospital in Coventry were picked up on recently, which showed mortality rates following heart surgery were high. So what did the hospital do? "It changed its admission criteria so it didn't take very risky patients." Great for hospital managers and consultants, whose mortality rates fell - but dreadful for seriously-ill patients, who had to be sent elsewhere.

It shows how simple statistics can be distorted to nobody's benefit, and it's not good enough, says Prof Maynard.

Patients have a right to know, before they put themselves in the hands of a hospital or doctor, what quality of treatment they're likely to get, he says.

That means having access not only to information about outcomes of treatment such as mortality rates, but also to information on admissions policies, and how the health or well-being of patients improved or did not improve at a particular hospital or GP practice.

"When I go and see my GP, I hope he is going to get it right. But I have to put a lot of trust in these people," he says.

"And when I'm facing heart surgery, I should have the right to know what the mortality rates are, and what the admissions criteria are. People always say 'the operation was nice, the consultant was charming'. But how long do you go on saying: 'The operation was a success, the consultant was charming, unfortunately the patient died?"

He is not attacking the medical profession: but rather the system which stifles proper analysis of the quality of treatment given. "Ninety nine point nine per cent of consultants are working their butts off doing a good job," he says. "But to err is human. Everybody makes mistakes. The question is, how do you learn from them?"

He insists it is not that difficult.

Private patients of York District Hospital consultants who do private work at the Purey Cust fill in forms before and three months after surgery to evaluate success in terms of their social, psychological and physical well-being. Those same consultants don't have this sort of routine patient evaluation of their NHS practice.

"We need it across the board," says Prof Maynard. "We need systematic evaluation." Similarly with GPs. Following up a patient's care doesn't just mean asking him to come back in three months then saying 'oh, you look all right'. Most patients are reluctant to complain, say if they are in pain or feeling low.

There needs to be a better system of measuring the quality of treatment. That is why health academics in York have developed a system of questionnaires designed to follow a patient's progress.

It includes simple questions for patients (often elderly) to fill in themselves at each visit. They are asked to rate their difficulties in looking after themselves, getting around or carrying out everyday household tasks, and to estimate their pain levels and whether they are anxious or depressed.

He says that can be particularly important for elderly patients. Many live alone and, if simply discharged from hospital without proper follow-up care, can get depressed or anxious.

For many, a simple question, sympathetically asked, such as 'How are you, Mrs Smith? Feeling a bit gloomy, a bit low?' could open the doors to a multitude of problems causing stress, anxiety or depression - and yet it's something that by and large simply is not done, even though it is well known that stress and depression can hinder a patient's recovery.

It is easy to see to see why such simple human aspects of health care can be forgotten when doctors and nurses are rushed off their feet desperately trying to meet the latest Government target on waiting lists, he admits. And there are no easy answers.

But some things are so simple to put right.

"There is a new and very high tech concept in health care," he says significantly: pausing until I ask what?

Washing hands, he says. It may seem obvious: but the sad fact is health staff are often so rushed off their feet they don't have time to take simple hygiene precautions such as washing their hands between seeing patients. The consequence is you can go into hospital to get better and end up getting worse because you pick up an infection. It does happen: and it shouldn't.

"If I were a patient, I would want staff to be washing their hands and asking about whether I was depressed or not," says Prof Maynard.

So would we all.

Updated: 11:28 Tuesday, February 12, 2002