Queues for loos in hot and airless cancer ward

Tony Blair got a ticking-off from a patient's angry relative at Queen Elizabeth Hospital in Birmingham last year. In the Haematology department, conditions have not improved. Cole Moreton reports in our series monitoring government pledges to the NHS

The day Tony Blair got an ear-bashing outside the Queen Elizabeth Hospital was one of the few memorable moments of the last election. When Sharron Storer heard the Prime Minister had come to visit she stormed downstairs to confront him, leaving her partner lying in a bed on the bone marrow transplant ward. The place was a disgrace, she raged at Mr Blair as the media crowd watched on. "They're understaffed," complained Ms Storer in front of the cameras. "They've got terrible facilities. The toilets are appalling. Dr Mahendra and her team of nurses and staff are doing their best but you're just not giving them the money to make the facilities better."

"We are, actually," said Mr Blair, visibly astonished at being ambushed by a real person in this way. "You are not," countered Ms Storer quickly, before telling him how her desperately sick partner, Keith Sedgwick, had waited 18 hours for a bed. The cancer sufferer had been made to wait in a corridor, despite being highly vulnerable to infection.

A year later Mr Sedgwick has had his bone marrow transplant and the ward is about to be moved and modernised at a cost of £1m. Dr Prem Mahendra, consultant haematologist, is still there at the head of an overstretched team that somehow manages to give ultra-modern treatment in a wing of the building that has hardly changed since 1938. Back then, when the hospital was opened by the present Queen's mother, it was promised to "obviate long and anxious periods of waiting". Treatments were less sophisticated and far cheaper: the site on what was then the edge of Birmingham offered "an abundance of pure air and all available sunshine, important elements in the treatment of disease".

There is precious little sunshine coming through the closed and obscured window of the room in which Scott sits. The air is fetid. The 32-year-old has finished radiotherapy and chemotherapy courses to eradicate cancer from his body, and yesterday he received a transplant of stem cells from his sister. These will help him to start producing the white blood cells he needs to become well again. The tube through which the transplant was done is still taped in place, disappearing into his body just under the collar bone. Scott is in isolation, and should be breathing filtered air.

"There are fungal spores in the air which you and I can breathe without harm," says Dr Mahendra. "But for people like Scott whose immune systems are compromised they can lead to life-threatening pneumonia." Unfortunately, the air filter system for this 20-year-old unit has broken down. "Some of the rooms are boiling hot all the time, and they cannot open the window."

The new ward will be sealed off from the rest of the hospital, but it will not open until the autumn of next year. In the meantime patients and staff must make do. Somebody has painted a leaf border high up on the wall, but Scott's cramped room still looks and feels like a Victorian prison cell.

"I'm managing to eat, but the food's not great," he tells the consultant. "I just want to go home really." It will be some time before that is possible. Transplant patients may have to live here like this for up to three months or more.

The "en-suite" toilets in the seven isolation rooms are for use with bedpans. "If patients fail to understand that, or forget, they get blocked and we have a problem with sewage overflowing," says Dr Mahendra. There is also a main ward with 15 beds, mainly for patients with leukaemia or other cancers of the blood who are not having transplants. These are served by one male and one female toilet, a bath for each sex, and a single shower. "In the morning at about seven there is sometimes already a queue outside the shower," says Dr Mahendra. This may be less important on other wards, but people who are being treated for leukaemia are so vulnerable to infection by bacteria they have to gargle with mouthwash every six hours."

The haematology ward will not be part of the new transplant unit. Its patients will have to put up with the present facilities until a completely new site opens in six years' time, combining the Queen Elizabeth and Selly Oak hospitals. Neither is there much chance of expansion in the short term for the day room, where every one of the 12 armchairs and three beds are taken up with people giving or receiving blood through tubes. Sometimes it gets so crowded they have to stand while they're waiting. Downstairs, where Dr Mahendra and her colleagues hold their clinics, the outpatients department is little bigger than a domestic living room. Its low ceiling and weak neon light are depressing.

Dr Mahendra was the only consultant when she joined this unit in 1998. The 42-year-old lives within walking distance of the hospital, which is just as well because she is on call every other day. "Other units that are busy as this have four or five consultants," she says. "Here there is Dr Charlie Craddock and myself."

The unit carried out 49 transplants in her first year, but 101 last year. It receives patients from all over the West Midlands, and is already full to capacity, so she has very clear ideas about how to spend some of Gordon Brown's millions. "If you come back in a year I hope we will have another consultant, the new transplant unit will almost be open, and we urgently need to expand the outpatients facilities." That may not be possible. Space has run out all over the hospital, but the number of leukaemia patients continues to rise. "We will have 30 beds when the new site opens. I am beginning to think that will not be enough."