Miranda's voice crackles with frustration. She is a GP in a poor area of north London, and her patients have no choice but to live - and die - through Labour's 'new NHS'. She has one elderly man who has been waiting 18 months for a prostate operation. He keeps getting painful infections but his operation has now been postponed four times.
Another patient is a builder who tore the ligaments in his knee. He is in constant agony and can hardly walk. He's been waiting months for a routine operation, and has now lost his job. A third man had blisters covering his entire chest and back but Miranda couldn't get a dermatologist to see him. He ended up in the local casualty department.
'People come to us in desperation and we spend hours trying to get them appointments. They become angry and frustrated - it's rationing by waiting list. Apart from children and cancer, I can't think of one area where people don't have to wait a long time. There's no operation that can be done in a few weeks or months. Labour has made no difference.'
Four years after he told voters they had only 24 hours to save the NHS, Tony Blair last week felt the brunt of mounting public anger. As he was canvassing for votes at the supposedly model Queen Elizabeth Hospital in Birmingham, the distraught girlfriend of a cancer patient harangued him, insisting: 'All you do is walk around and make yourself known but you don't do anything to help anybody.' Her partner, who has a form of lymphatic cancer, has had to endure disturbed nights in the accident and emergency ward after a bone marrow transplant because there are no ward beds for him to sleep in.
Those who can afford it are simply giving up on the NHS. The number of sick people digging deep into their own pockets to pay for operations privately has doubled under Labour from 100,000 to 200,000 a year.
Some are giving up on Britain. When Ken Roche, a 71-year-old Navy veteran, faced a wait of more than a year for a heart bypass operation on the NHS, he flew to India and paid £6,300 to have it done there - a third of the private cost in the UK. Roche's case hit the headlines but it is not unique: 'surgical tourism' is growing at a spectacular rate.
So, after four years of 'saving the NHS', Labour has done more than any Conservative government to prompt a boom in private operations to dodge waiting lists, to kick-start a market in people going abroad to save their lives - and to cripple doctors with frustration.
Dr Richard Taylor has no doubt that the NHS is worse now than when Labour was elected. The retired rheumatologist is making a desperate bid to save the threatened Kidderminster Hospital by standing as an Independent MP under the banner of 'Health Concern'. The Government's much ridiculed Private Finance Initiative - getting private money in to pay for building new facilities - has meant the merging of three local hospitals, with the loss of the accident and emergency department and all acute in-patient services. Some 100,000 people now have to travel 18 miles to hospital.
'Nationally, the health service is in crisis,' said Taylor. 'The NHS has got worse over the last few years. The Private Finance Initiative is robbing the NHS of money and stopping it delivering services. Privatisation of cleaning and catering services was a disaster - that's why hospitals are so dirty. Morale is low.'
The Liberal Democrats, keen to see health made the central election issue, have stood aside and are lending their support to Taylor. The party's campaign director Lord Razzall said last week: 'We are a party that believes fully in a commitment to the NHS and that's the platform on which he is standing.'
The never-ending crisis in the NHS hit the top of the political agenda early last year when Britain was left with only a couple of intensive care beds to spare. Patients were shuttled hundreds of miles between hospitals, and all too often died en route. Labour accepted that the problems arose because it had frozen spending on the NHS for two years, and promised to let the money flow more freely. We spend far less than other European countries on health, but spending is now rising at 6 per cent a year, the fastest sustained growth ever seen.
This belated flow of cash is just starting to cast some light on the NHS gloom. Labour has, most notably, succeeded by one definition (look only at England, and consider only in-patients) in meeting its manifesto commitment to cut waiting lists by 100,000 people. A massive recruitment drive in the world's poorest nations has allowed the NHS to slightly increase the number of nurses. The number of doctors, too, has just started to edge up, but from a spectacularly low base: Britain has around half the number of doctors per 1,000 people as most other Western countries.
'The NHS is better now than when Labour was elected,' says Dr Jennifer Dixon, director of healthcare policy at the King's Fund, an independent think tank. 'It has more money, and marginally more staff. Mixed sex wards have gone, and there are new hospitals.'
In its manifesto last week, Labour repeated its old pledge to have 20,000 more nurses and 10,000 more doctors. It promised patients booked appointments by 2005, with waiting times reduced to a few months. The trouble is that, as yet, patients are not seeing significant improvements. 'The money is there, but it is not feeding through,' said Dixon. 'The things patients really notice - cleanliness and staff morale - haven't changed much.'
Dixon recently went to see her own GP for the first time in five years. Where before the GP was serene with a big empty desk, she was now frazzled, with paperwork everywhere. 'It was quite a shock,' said Dixon. GPs are now often down to six minutes per consultation, and have many more forms to fill out. The frustration is so great that earlier this year GPs threatened to resign from the NHS en masse, and simply go private.
But the nation's health is not just a question of the NHS. Labour had broad ambitions to get us to eat better and exercise more and improve our mental health. So what has happened to our national wellbeing under Labour?
The Government may be able to claim more success over its public health policies - preventing people getting sick in the first place. Its meningitis C vaccination programme, the first of its kind in the world, has been extremely successful at curbing the disease, saving dozens if not hundreds of lives.
Labour's main focus has been to reduce 'health inequalities', by making sure the poor enjoy as good health - and live as long - as the rich. Some methods have been direct, such as helping poor people tackle smoking by giving them free nicotine patches.
Anna Coote, director of public health policy at the King's Fund, said: 'This inequality perspective is terribly important, otherwise it is only the better-off who benefit. The key thing the Government has done is focus on social policy - elimination of child poverty, income tax credits, new deal for communities, the new deal for the unemployed. All these things are likely to contribute to better health more than tweaking the NHS.'
Other factors contribute to the national wellbeing. The lowest jobless figures for a generation have helped. 'Quality of housing, sense of control over one's life and destiny, empowerment - they all matter,' said Coote.
American academic Robert Puttnam claimed in his book Bowling Alone that belonging to an association - club, neighbour group and so on - can add 10 years to your life. In Britain most associations are stagnant, with membership of groups like the National Trust neither rising nor falling. Many communities have been devastated by the loss of shops, banks and schools. 'Associating with other people is good for your health, but traditional forms of association have run into the sand. A lot of communities are teetering on one leg,' said Alex McGillivray of the New Economics Foundation. 'The Government definitely has a role in an intelligent, sensitive way, but no one in government is interested in these things.'
Dr Richard Byng of the Rushey Green group practice in east London prescribes 'time' to some of his patients who suffering from depression or other mental health problems. Rather than give them drugs he arranges visits to help elderly people, or to use their skills to help the community. 'For some people it's made a big difference - they are happier now, more empowered,' said Byng.
These issues, vital for national wellbeing, are not discussed in Labour's manifesto. Instead it concentrates on ways to improve the NHS, where progress is slow. 'They want a step change, but there just hasn't been one yet,' said Dixon. In desperation, Labour is increasingly looking at solutions that it previously had an almost religious aversion to. The Government has been trying to cut waiting lists by paying for patients to go to the private sector - a record 25,000 NHS patients were operated on in private hospitals in the first three months of this year, and that number is set to grow sharply. 'The independent sector has had significant growth in recent years. We're confident this is just the beginning,' said Tim Evans of the Independent Healthcare Association, which represents private medical groups.
Even if Labour does manage to improve the service by the time of the next election, it could be too late. Labour inherited a crippled NHS from the Conservatives - and the Tories could inherit a revived NHS from Labour. 'However much Labour improves the health service, it is likely the Tories will reap the benefit,' warned Coote. At the last election Labour saw health as its trump card. Four years later, health has become its Achilles' heel.
Four years of Labour
• The quality of life in Britain has improved under Labour. In 1997, according to the United Nation's Human Development Index, Britain was the fifteenth best country to live in. By 2000 it had crept up to tenth, overtaking France.
• 87 per cent of Britons either belong to a local association or do voluntary work at least once a year.
• Women are having fewer babies: the number of babies born fell from 158,100 in the first three months of 1997 to 148,600 in the first three months of last year.
• The number of inpatients waiting for an operation has fallen by 125,000, but the number of outpatients waiting for an appointment with a consultant has risen by 152,000.
• The rate of male suicide in 1999 was 15 per 100,000 for men - a slight increase since 1994 - and 4.8 per 100,000 for women, a slight decrease.
• 4.3 per 1,000 people are admitted to NHS hospitals for mental illness specialist care. The over-75s are most likely to be admitted. Those aged in their fifties are less likely to be admitted than those in their twenties.
• Three-quarters of the population consider themselves to be in good health.
• Obesity is rising - 63 per cent of men and 54 per cent of women are obese or overweight, a 5 per cent increase since 1994.
