Little to choose between big two

The state of the NHS looks set to remain a key issue on the stump as the various parties try to convince us the service is safer in their hands. The claims may sway some voters, but there is a sense of cynicism among many NHS staff fed up with working for a service governed by people with one eye fixed on the ballot box. So how do the manifestos for health stack up?

The Lib-Dems' proposals have caught my attention. Their promises to introduce free eye and dental checks and to end the unfair way in which prescription charges are levied are timely, affordable and should provide real benefit.

Why should someone with asthma or heart disease have to pay for their prescriptions, while those with diabetes and thyroid problems get them free? Their stance on free long-term personal care is just as laudable. Do we really want to live in a society where the frail and weak have to sell their homes to pay for help with feeding, washing and dressing?

One of the Tories' major selling points is the promise to contribute to private medical care. About a quarter of a million non-insured people will pay to have an operation done privately this year, and under a Tory government they would get a contribution towards the bill, based on half the amount it would have cost the NHS. An ill-thought-out idea that is likely to prove a logistical nightmare.

Labour and the Lib-Dems take a more pragmatic approach to private medicine. Both promise to make better use of slack capacity in the private sector to speed up the diagnosis and treatment of NHS patients. Labour are the only party to make a hard-and-fast pledge to reduce waiting times; promising, that by the end of 2008, no one will have to wait longer than 18 weeks for an operation. Based on their track record so far, that looks achievable.

Patient choice is another key issue for Labour and the Tories. Vote for them and you will be offered more choice when deciding which hospital and specialist you would like to be referred to, though it is unclear how well this will operate in practice.

At one extreme it may make little practical difference (most patients will continue to defer to their GP's selection), while at the other it could cause chaos (what will happen if every worried parent in the South-East wants their child seen at Great Ormond Street?).

All parties are united around the need to do something about the parlous state of NHS dentistry. But should not Labour have done something earlier? NHS dentistry has plumbed new depths under their administration.

MRSA and dirty hospitals are both huge problems, but the link is nowhere near as strong as the politicians will have you believe. Most cases of MRSA are spread through poor personal hygiene rather than caught from dirty wards - indeed a third of "hospital acquired" cases are brought in by patients themselves.

That said, bloodstained floors and curtains, and filthy loos, are unacceptable. But do proper standards of cleanliness really need to feature in a political manifesto? They should be taken as read and rockets ignited under those responsible if they are not. Matron has better things to do.

Mental health is singled out for more resources by the three parties, as is health prevention through public health measures and better education. Both Labour and the Tories agree that more needs to be done about abuse by "NHS tourists".

Of course it is not just the promises that matter - the ability to deliver them is key, and this is where the Lib-Dems fall. It is no good having the best manifesto if you are unlikely ever to form a government.

So it comes down to the big two, Labour and the Conservatives - both of whom have surprisingly similar health manifestos and have sworn to match each other when it comes to funding. Herein lies the key issue - it is how they plan to raise those funds that is most likely to determine which of them gets the chance to run the NHS. Plus ca change.