"medical care ok but"

the new A and E is good and there staff seem organised but staff do not always introduce themselves or brief the patient on whats happening. on wards its pretty mixed and there is a real sense of a lack of leadership or people taking responsibility. everyone does their job but just. toilets not clean and in one 6 hour period last Friday evening did not see any cleaning of toilets despite them being dirty. interface with transport, car at home/ follow on poor. was in various depts./ wards so cannot give one department below