Labour created the NHS 50 years ago. It is under threat from the Conservatives. We want to save and modernise the NHS.

But if the Conservatives are elected again there may well not be an NHS in five years' time - neither national nor comprehensive. Labour commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone - not on your ability to pay, or on who your GP happens to be or on where you live.

In 1990 the Conservatives imposed on the NHS a complex internal market of hospitals competing to win contracts from health authorities and fundholding GPs. The result is an NHS strangled by costly red tape, with every individual transaction the subject of a separate invoice. After seven years, bureaucracy swallows an extra £1.5 billion per year; there are 20,000 more managers and 50,000 fewer nurses on the wards; and more than one million people are on waiting lists. The government has consistently failed to meet even its own health targets.

There can be no return to top-down management, but Labour will end the Conservatives' internal market in healthcare. The planning and provision of care are necessary and distinct functions, and will remain so. But under the Tories, the administrative costs of purchasing care have undermined provision and the market system has distorted clinical priorities. Labour will cut costs by removing the bureaucratic processes of the internal market.

The savings achieved will go on direct care for patients. As a start, the first £100 million saved will treat an extra 100,000 patients. We will end waiting for cancer surgery, thereby helping thousands of women waiting for breast cancer treatment.

Primary care will play a lead role

In recent years, GPs have gained power on behalf of their patients in a changed relationship with consultants, and we support this. But the development of GP fundholding has also brought disadvantages. Decision-making has been fragmented. Administrative costs have grown. And a two-tier service has resulted.

Labour will retain the lead role for primary care but remove the disadvantages that have come from the present system. GPs and nurses will take the lead in combining together locally to plan local health services more efficiently for all the patients in their area. This will enable all GPs in an area to bring their combined strength to bear upon individual hospitals to secure higher standards of patient provision. In making this change, we will build on the existing collaborative schemes which already serve 14 million people.

The current system of year-on-year contracts is costly and unstable. We will introduce three- to five-year agreements between the local primary care teams and hospitals. Hospitals will then be better able to plan work at full capacity and co-operate to enhance patient services.

Higher quality services for patients

Hospitals will retain their autonomy over day-to-day administrative functions, but, as part of the NHS, they will be required to meet high-quality standards in the provision of care. Management will be held to account for performance levels. Boards will become more representative of the local communities they serve.

A new patients' charter will concentrate on the quality and success of treatment. The Tones' so-called 'Efficiency Index' counts the number of patient 'episodes', not the quality or success of treatment. With Labour, the measure will be quality of outcome, itself an incentive for effectiveness. As part of our concern to ensure quality, we will work towards the elimination of mixed-sex wards.

Health authorities will become the guardians of high standards. They will monitor services, spread best practice and ensure rising standards of care.

The Tory attempt to use private money to build hospitals has failed to deliver. Labour will overcome the problems that have plagued the Private Finance Initiative, end the delays, sort out the confusion and develop new forms of public/private partnership that work better and protect the interests of the NHS. Labour is opposed to the privatisation of clinical services which is being actively promoted by the Conservatives.

Labour will promote new developments in telemedicine - bringing expert advice from regional centres of excellence to neighbourhood level using new technology.

Good health

A new minister for public health will attack the root causes of ill health, and so improve lives and save the NHS money. Labour will set new goals for improving the overall health of the nation which recognise the impact that poverty, poor housing, unemployment and a polluted environment have on health.

Smoking is the greatest single cause of preventable illness and premature death in the UK. We will therefore ban tobacco advertising.

Labour will establish an independent food standards agency. The £3.5 billion BSE crisis and the E. coli outbreak which resulted in serious loss of life, have made unanswerable the case for the independent agency we have proposed.

NHS spending

The Conservatives have wasted spending on the NHS. We will do better. We will raise spending on the NHS in real terms every year and put the money towards patient care. And a greater proportion of every pound spent will go on patient care not bureaucracy.

An NHS for the future

The NHS requires continuity as well as change, or the system cannot cope. There must be pilots to ensure that change works. And there must be flexibility, not rigid prescription, if innovation is to flourish.

Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working cooperatively for patients, not a commercial business driven by competition.