Election `97: The truth about health: An ailing service ignored by the politicians

The next government faces a formidable challenge in revitalising the NHS, which has become fragmented and dispirited as its funding crisis worsens

The six people who tell their stories on this page show the National Health Service in a grim light. Each has a different perspective but all testify to the growing pressures on the service.

Their experience stands as an indictment of the parties who have, so far in this election, almost completely ignored the NHS's plight. Together they present the next government with a formidable challenge.

On cancer, the elderly, emergency care, expensive drugs and waiting lists, the service is failing to meet the need, as their evidence shows. These are the key pressure points for the NHS and it is on these that the new government will be judged.

By 2015, one in two of the population will develop cancer at some point in their lives. The disease is becoming increasingly common, only partly accounted for by the ageing of the population. Professor Karol Sikora, clinical oncologist at Hammersmith Hospital and medical director of the Imperial Cancer Research Fund estimates that 15,000 people die of cancer unnecessarily each year because they do not get the best treatment.

Three years ago, Sir Kenneth Calman, the government's chief medical officer, published plans for re-shaping cancer services to provide 30 major centres with up to 300 cancer units in general hospitals. The idea was to concentrate expertise and raise standards.

Professor Sikora said: "The aim was to provide the same quality of care wherever you live - a sort of oncological McDonald's. The problem now is implementation in an increasingly fragmented, competitive and dispirited NHS. At the end of the day any improvement is going to cost money."

He estimates an extra pounds 100m is needed to refurbish buildings with a further pounds 100m a year to run them. "The politicians want it, the professionals want it and we have done an awful lot of talking about it. Now we need the resources to get some action."

The NHS is withdrawing from care of the elderly as it has withdrawn from dental and optical care. The 45,000 beds available for long-term care in 1990/91 have fallen to about 27,000, a 40 per cent cut in five years. An estimated 9,000 acute hospital beds are blocked at any one time by elderly patients who cannot be discharged because the shortage of community care means there is nowhere for them to go. Last month, the all-party Health Select Committee called for a return to free nursing care for the elderly which the Government said would cost pounds 180m.

Christine Hancock, general secretary of the Royal College of Nursing which proposed the move, said the public could not understand why it should cost hundreds of pounds a week in a home but be free in

an NHS hospital. "Access to nursing care is a fundamental right," she said.

The unexplained rise in emergency hospital admissions - averaging 13 per cent a year over four years - shows no sign of diminishing.

Casualty departments are overstretched and the pressure on beds has meant delays for non-urgent surgery, causing waiting lists to rise. In addition, hospitals are carrying over deficits from the last financial year, which was the toughest financially for a decade.

NHS managers despair as they see the hard won battle to reduce waiting lists being lost once more. Philip Hunt, director of the NHS confederation, representing NHS trusts and health authorities, said: "The task of remaining within Patient's Charter targets for routine elective work is likely to prove very difficult. The overwhelming sense I have of the future is one of pressure."

The introduction of expensive drugs is adding to the problems. The first treatment for Alzheimer's disease to be licensed in this country, launched last month, costs pounds 1,200 a year and is estimated to be suitable for 200,000 of the 500,000 Alzheimer sufferers.

More modestly priced treatments may impose an even bigger burden when measured against their benefits.

The new cholesterol lowering drugs have been estimated to cost pounds 360,000 to save one year of life for a middle-aged woman.

The three main parties have limited proposals on these issues - with the possible exception of the Liberal Democrats who are pledged to provide an extra pounds 350m for the health service funded from an increase in employer's national insurance contributions.

One issue, however, sets the Tories and Labour apart - GP fundholding.

For the Conservatives, it is a means of ratcheting up standards, the grit in the oyster of the NHS reforms. For Labour it has introduced a two-tier service which is unjust and inequitable.

Labour's plan to replace fundholding with GP commissioning, under which groups of GPs would control the total hospital budget for their areas, risks removing incentives to efficiency brought by competition.

But Labour also promises to allow existing fundholders to continue operating, by agreement with their local commissioning group, so long as they observe the group's overall aims.

The real test of that policy will be how it can be made to work in the Welsh towns and villages of Montgomeryshire, where the service offered by Dr Tony Evans and his partners, the sole remaining non-fundholders, compares so poorly with that offered by their fundholding neighbours.