Election '97 : Parties take NHS off the critical list

Jeremy Laurance reports on the strange avoidance of a patient in a critical condition

One of the strangest features of this election campaign has been the scant attention given to the NHS. Its condition is critical and the prognosis is poor. Waiting lists are climbing, non-urgent operations are being cancelled and expensive drug treatments denied.

On the doorsteps and at the hustings, voters say the state of the health service is a major worry. Yet politicians of all parties have shrunk from addressing it. They know that the survival of the NHS as a free universal service is under threat. Spending plans for the next two years, signed up to by both main parties, imply zero growth. The politically unpalatable options of rationing treatments or privatising parts of the service to bridge the funding gap are drawing closer.

Haunted by the spectre of Jennifer's Ear, Labour's disastrous 1992 election broadcast, no party has wanted to expose its plans for the NHS to close examination. That's a pity: close examination is urgently required. The health service has just come through its toughest financial year for a decade. Real terms growth in NHS spending, which has averaged 4 per cent a year since 1991, was cut to 1.6 per cent last year (1996-97). Wholesale bed and ward closures were narrowly averted last winter by accountants raiding this year's more generous allocation of 2.9 per cent growth announced in last November's budget.

The future is grimmer. The fiscal rectitude expressed by both main parties has left a gaping hole in their spending plans. Virtual zero growth over the next two years will not be enough to meet the growing demands of an ageing population, medical advances and rising expectations, estimated by the NHS Confederation, the body representing NHS trusts and health authorities, at 3 per cent a year. Only the Liberal Democrats, promising an extra five pence duty on cigarettes, have explained how they will pay for the NHS.

Labour yesterday sought to divert attention from this embarrassment by pledging improvements in cancer treatment. It plans to bridge the spending gap by slashing bureaucracy - ending the internal market, merging NHS trusts and replacing GP fundholding with local commissioning in which GPs band together to buy hospital services for their areas. Some estimates suggest this could save 7,500 jobs.

It is, however, hard to see how the necessary funds can be released in time for the next public spending round in the autumn and inconceivable that they will be sufficient to provide 3 per cent growth, equivalent to pounds 1bn.

Labour has also yet to explain what will replace the internal market. It is unclear what leverage GPs will have over poor performing hospitals once competition for contracts is eliminated.

Stephen Dorrell, the Secretary of State for Health, sought to expose the "contradiction at the heart of Labour's policy" on Tuesday by demanding what would connect the new GP commissioning groups if it wasn't a market.

However, Mr Dorrell was unable to make the Tories' sums add up either. Making only a "base" commitment that the NHS would continue to enjoy real terms growth, as it had done since 1979, Mr Dorrell insisted that the amount of any increase would depend on the state of the economy. Asked how this could be achieved in the absence of tax rises or greater economic growth than forecast, he said: "We shall do it the same way we have done it since 1979, through proper control of public finances and the maintenance of a successful economy."

Health department civil servants talk openly of the inevitability of rationing. Doctors' leaders and NHS managers say a public debate on what should be provided is essential.