NHS meltdown

It's a blazingly sunny spring afternoon in the east London suburb of Walthamstow and the market traders are working hard, fast and loud. As fishmongers gut and clean sea bass and snapper, a Jamaican takeaway stand sells calalloo dumplings to a throbbing reggae soundtrack. In a side street off the market, out of the rare sunshine, about 70 local residents are gathered in a shabby hall to campaign for a better health service ahead of next month's close-fought general election.

The stories told in this East London hall today necessarily concern local services. Stella Creasy, the Labour candidate who has called the meeting, describes how the local hospital, Whipps Cross, is desperately short of funds and has been referred to regulators. Most over-65s in this deprived inner-city area have debilitating conditions such as obesity, respiratory and cardiac complaints, lending extra urgency to campaigners' demands.

A system close to collapse

These east London tales reveal a picture that is emblematic of a system seen by many inside it, and by users themselves, as close to collapse. It is a system to boggle the soberest mind: the NHS is the world's fifth-biggest employer; spends nearly £2 billion (2.8 billion euros) a year on free-to-anyone hip and knee replacements, and its annual laxative bill alone is £60 million.

Most people in this meeting today blame the government's five-year austerity drive, as well as wide-ranging structural reforms that have lead to increased use of private companies, for the current decline and crisis. Many here - and nationwide - say they intend to punish the Tory party, and their Liberal Democratic coalition partners, at the ballot box on May 7 for this.

There is a local and nationwide consensus that any further decline of the NHS is simply unacceptable. "My husband was told he would have to wait three weeks for a doctor's appointment last year," says local Kath Goodwin. "At the time, he was severely clinically depressed and was talking about taking his own life."

Another resident, Graham Hodgkiss, tells the meeting how he fell from a roof in 2013 and can now walk only with the aid of crutches. After two years on a waiting list with his health and mobility further deteriorating, he has just been told he must wait a further six months for an operation.

Reese Williams, a local musician, shares the story of how he found an abscess a year ago, and called his doctor in panic. "I was waiting over an hour and had to redial 22 times just to get through," he says. Later, he was left with open wounds that required daily dressing - but was left without treatment for several days.

The stories continue. Penny Rutherford speaks out: she was diagnosed with cancer in 2014 and has undergone extensive chemotherapy, but says she can't now get a doctors' appointment within three weeks when related conditions flare up. "They say I'm not a priority, and they can only see emergency cases," she says.

NHS rules

The National Health Service is the UK's most-cherished institution. More than the royal family, more than its football team, more than its currency: the NHS, which has offered free health and social care to all UK residents since 1948, is considered central to the British way of life. But with a funding shortfall of around £20 billion a year against a budget of around £115 billion, the service is today in an existential struggle.

In their manifesto, the Conservatives have promised an extra £8 billion a year by 2020. Their Labour rivals allege that these proposals are uncosted. Their own promised £2.5 billion annual fund will, they say, pay for 20,000 more nurses, 8,000 more GPs and 5,000 more home care workers. Labour says this will be paid for by a tax on properties worth more than £2 million, a levy on tobacco companies and by closing tax loopholes for wealthy investors in hedge funds.

In the fog of electoral war it is increasingly impossible to separate spin from fact, with both sides trading blows - and claim and counterclaims - in desperate weekly attempts to claim the moral and electoral high ground. "David Cameron poses a risk to the very fabric and foundation of our NHS," Labour's Ed Miliband told Scottish trade unionists on April 20. "That's why we will fight every day … to stop a Tory plan that threatens our NHS."

More money, more problems?

A Conservative spokesman responded to Miliband's comments, saying: "This marks a new low in Ed Miliband's desperate attempts to weaponize the NHS. His credibility on health is in tatters because he refuses to fund the £8 billion the NHS needs. We have protected and improved the NHS with 9,500 more doctors, 6,900 more nurses, and 1.3 million more life-saving operations every year."

Labour's campaign messaging is becoming brutally direct, with one poster saying in stark white text on a green background, recalling an ECG monitor: "The NHS is on life support. Don't let the Tories pull the plug."

Academics at the London School of Economics' Center for Analysis of Social Exclusion, Polly Vizard and Polina Obolenskaya, struck a more objective note in their 2015 paper on the coalition's record on health policy.

"While the coalition has ‘protected' health relative to other expenditure areas, growth in real health spending has been exceptionally low by the standards of previous governments," they wrote. "Average annual growth rates have lagged behind the rates that are deemed necessary to maintain and extend NHS care in response to increasing need and demand."

More important than spin, and more relevant than statistics, are the real-time measurements in public sentiment on this most emotive of issues. And surveys by the Tories' own chief pollster, Lord Ashcroft show the party is trusted by fewer than three-in-10 voters with the NHS. It is these polls that show the Tories have more work to do on this issue than any other - and it is clear that their failure to win the public's trust on its stewardship of the NHS might be the decisive factor that costs them a parliamentary majority on May 7.