We all suffer from a terminal disease called 'life', says York Health Trust chairman Alan Maynard. Properly resourced, the National Health Service could and should do better: but we should not expect it to work miracles.

Staff in York NHS Trust were very busy this last financial year. They spent more than £138 million of taxpayers' money treating 60,000 in-patients and 195,000 out-patients. The mental health services provided over 8,500 episodes of care. In addition to all this hospital care, community care staff visited thousands of households.

Despite these superb efforts by the staff, the public and the Government want more and better quality services for the local community.

Since Christmas we have opened a new endoscopy unit and also a new Accident and Emergency facility. By the autumn the re-development of the entrance area of the district hospital will create better waiting facilities plus new shops. We hope a start will have been made on the first floor re-development which, over some years, will improve the inadequate ophthalmology facilities and transform surgical care generally.

All these are welcome developments - but we still want to do more. Successive governments have sought to 'economise' on investment and 'squeeze' practitioners to do more. As a result of some false economies, the physical environment is run down and doctors and nurses have to work in sub-standard facilities. The recent planned investments have begun to tackle this backlog.

York hospitals provide high-quality emergency care. The city attracts bright and able doctors and the nursing staff perform heroically in wards where patients would benefit considerably from higher staffing levels. But more resources are needed to ensure more civilised and effective patient stays.

The performance of the York NHS Trust in providing elective care will be improved. Elective care is for conditions which do not kill but which cause considerable disability, in terms of pain and discomfort. Examples of this are surgery for cataracts, which restore sight, and surgery for hips, which enable people to walk again, free of crippling pain.

At present patients have to wait too long for such care in York. Properly resourced, we can do better.

Crises of confidence in some medical practitioners outside York have made the local doctors even more aware of the need for them to be open and systematic in the appraisal of their practices.

Doctors and all staff are making increased efforts to reduce hospital-acquired infection by the better use of well-tried and tested techniques such as washing their hands! By giving staff less stress and more encouragement, patient care will be improved by better exploitation of their skills.

While acting 'smarter' will help us better spend new and existing funding, hard choices will remain. These cannot be dealt with by the local hospital alone. The new Primary Care Trust employs primary care staff such as GPs and community nurses and has the budget to fund them as well as all local hospital care. But neither GPs nor hospital consultants can be efficient without good working relations with the local councils in York and North Yorkshire.

These organisations have some profound challenges to resolve. At present there are about 40 patients in the district hospital who do not require health care and would be better cared for in residential or nursing homes. Some of these people have 'blocked' hospital beds for months, and reduced the hospital's capacity to treat other needy patients waiting for care. There are 30 elderly mental ill patients in Bootham who need care in homes, not in the NHS. These problems cause distress to patients, their carers and our staff. Their resolution requires funding and a supply of homes with places to take them.

However, funding for such needy cases will use cash which can fund more hip replacements, more cataracts, shorter waiting times in the Accident and Emergency department, even cleaner wards and new "wonder" drugs. Should we spend any available money on elderly people 'blocked' in beds in the district hospital and Bootham, or reduce waiting times for out-patient visits and in-patient care?

Or should we spend our limited finances on improving car parking facilities which cause such frustration and anxiety for patients and visitors?

The ever-present problem is that the pot of available funding is limited and all health care demands cannot be met. We are all suffering from a terminal, sexually transmitted disease called life! Death is certain. The role of the NHS is to delay death and improve the quality of life as much as is possible. But how should the competing demands for more and better services be prioritised?

The starting point in the prioritisation process is evidence: what do we know about the best treatments and the best ways of techniques for patient care? A remarkable amount is known about the best way to treat patients although sometimes turning that into best practice is slow.

For instance, there is good evidence that universal hearing screening for newly-born babies is more effective and cost effective than screening by health visitors.

We know flu vaccinations for the elderly and NHS staff are cost effective. Unfortunately, all too often, what we know is not translated into practice.

To make sure this happens, doctors and managers must work more closely and openly with patients and the public in making difficult choices about who will get care, and who will be left in pain and discomfort, and ultimately who will be humanely cared for until they die.

Such discussion should be more open and better informed than now when 'crises' and alleged 'scandals' often waste time and resources, which might be better used to improve patient care.

None of these challenges are new or unique to York. Patients are right to expect better and prompter care.

All local NHS staff, regardless of whether they are a doctor, porter, secretary, speech therapist or a nurse want to provide better and faster care.

Everyone needs to better understand each other's frustrations and priorities, and work together to "do it better".

"Instant miracles" should not be expected but planned and significant improvements can, and must, happen. The role of NHS staff is to mitigate human pain and misery and regrettably the supply of this sometimes seems infinite.

- Alan Maynard is Professor of Health Economics at the University of York's Department of Health Studies. He has been involved in local NHS management since 1983 and was appointed Chairman of York NHS Trust in 1997.

Updated: 10:40 Thursday, April 12, 2001