Not all doctors, nurses and teachers are doing a good job

We are not going to get better schools by telling everyone that they are doing a marvellous job

Some other poor sod, it turns out, has been living my nightmare. This recurring horror-dream is that it is late at night and one of our daughters seems, suddenly, to have flu - but we're not sure. Her temperature is high. We make the night trip to the local hospital, and sit there among the drunks and the addicts waiting to see a doctor and explain that we want to be certain it's not meningitis. It takes hours to be seen, and nobody wants to know. Finally, a harassed medic turns up, takes a few tests and makes the wrong bloody call. The rest is photos on a shelf.

Some other poor sod, it turns out, has been living my nightmare. This recurring horror-dream is that it is late at night and one of our daughters seems, suddenly, to have flu - but we're not sure. Her temperature is high. We make the night trip to the local hospital, and sit there among the drunks and the addicts waiting to see a doctor and explain that we want to be certain it's not meningitis. It takes hours to be seen, and nobody wants to know. Finally, a harassed medic turns up, takes a few tests and makes the wrong bloody call. The rest is photos on a shelf.

Until 18 months ago, we would have found ourselves at the Whittington Hospital in north London. That's where the parents of Jacob Fogg, who was just under two, found themselves earlier this year. The way the Foggs remember it, they went to casualty at around 8.30pm. At 9.10pm, and only after pushing to the front of the queue, did they manage to get a nurse to administer Calpol and Ibuprofen. Then there was another period of waiting, during which the Foggs, now desperately worried, agitated for their son to see a doctor. According to them, a nurse told them to stop being pushy. By now a rash had appeared on the boy's back.

At 11pm, a doctor examined Jacob and did some tests. At 3am, with the tests showing no signs of meningitis, the doctor - despite the rash - said that he thought that Jacob had flu - and it was agreed that the child would be best off going home. At 8.40am, Jacob was clearly weaker; he was taken back to the Whittington and meningitis was diagnosed. From there he was transferred to the Great Ormond Street Hospital, and he died at 4pm.

Those parents, as far as I can see, did everything they could. They saw the danger to their child, and acted upon it. They met delay, rudeness, bureaucratic ineptitude and - in the end - a wrong diagnosis. I cannot for the life of me understand why they were not rushed to the head of the queue, and why - once a rash was discovered - treatment with antibiotics was not begun. People rarely die of antibiotics.

In the wake of the Fogg case, there was plenty of theorising. In the regional evening paper, one of that growing breed of commentators who specialises in instant outrage said that it was all Tony Blair's fault. Had there been a great deal more dosh put into the NHS three and a half years ago, then there would have been more nurses on duty and the original doctor would have been less tired and made a better call. "If it seems simplistic," he wrote, "that's because it is simple."

If something seems simplistic, in my experience, however, it is usually because it is simplistic. Most of us who have many dealings with the NHS in these parts know where we would least like to end up on a Sunday night in casualty. There are some fine departments at the Whittington, but when the chips are down, I would far rather be at the Homerton over in much-poorer Hackney. It's clean there; the nurses are less brusque; people seem to know what they're doing; the patient appears to be important.

In the last week, we have had the first reports of the CHI - the new Commission for Health Improvement. In its criticisms of a number of hospitals and health boards, including the Oxford Heart Centre at the John Radcliffe Hospital, the CHI identified a series of problems that were not primarily resource related. In the case of Oxford, the whole operation was "dysfunctional". The Centre was "on its knees and riven by internal conflict". In other words, some patients there may well have been dying partly because of bad management.

As yet, I have not heard the argument coming from the various "named and shamed" health institutions that most of their problems were down to money. But we certainly have heard it this week with the publication of the latest school league tables, and the noise has been coming from the teaching unions.

In the first place, they say, the league tables are flawed by their measurement only of exam results and not of the million intangibles that make a good school. Second, many of the high-achieving schools are in some way selective, and therefore the results are not comparable. Third, among those doing best are schools that got more money because they embraced well-funded specialisms. And fourth, those schools doing least well were often in areas of extreme deprivation.

There is a grain of truth in each of these objections, and it would be silly to deny it. Parents should indeed look for other qualities in a school beyond academic achievement; but would you want to send your kids to an institution where their chances of attaining the minimum necessary qualifications for low-grade clerical work were less than one in five? I don't think so, no matter how good the breakdancing is. The Liberal Democrat education spokesperson, Phil Willis, spoke of "simplistic national targets based on middle-class expectations". But whose expectations would he prefer them to be based on?

I am keen on "value-added" measurements which allow us to see how well selective schools really are performing, given their intake. But specialist schools are generally thosewhose initial improvement predates their new status and their additional government funding. And - we cannot repeat this enough to ourselves - we need somehow to explain why some schools in poorer areas do improve, while others don't.

If they are not careful, the anti-tables brigade will end up denying that there are such things as good practice and bad practice; as good heads and bad heads; as good teachers and bad teachers. So Doug McAvoy, leader of the National Union of Teachers, was quoted yesterday as saying: "Schools that have to work to overcome, for example, socio-economic deprivation, disillusion with education fed by low expectations among parents, high levels of homelessness, do not get the credit that they deserve."

But isn't the truth that some of them deserve credit and some of them do not?

Like Elizabeth Phillips, head of the fast-improving St Marylebone Church of England School in London's Westminster, I would prefer parents to use Ofsted reports coupled with the evidence of their own eyes when judging schools. She at least is clear that the single biggest factor in improving a school lies in heads' recruiting and keeping the best teachers. This builds up what she calls a "critical mass of positiveness". And the rest follows.

Well, we can all wait around for the good heads and good teachers to come to us, or we can do what is necessary to make more good heads and good teachers. I do not quarrel with the need for more money so that teaching can compete in pulling-power with other professions. But I don't think we are going to get better schools simply by telling everyone that they are doing a jolly marvellous job. Some are, some ain't. Just like some doctors, some nurses, some hospitals, some casualty departments. Robustly telling the good from the bad can, after all, be a matter of life and death.

David.Aaronovitch@btinternet.com">David.Aaronovitch@btinternet.com