Labour's pitch for distinction in its manifesto is the promotion of a series of legal rights and guarantees for patients, the most important of which relate to a one-week commitment for cancer tests, a two-week referral-to-diagnosis guarantee for cancer patients, the 18-week referral-to-treatment guarantee for most other kinds of hospital-based care and a right to choose a GP offering evening and weekend opening.
The idea behind the first three is to consolidate and extend waiting times targets in a post-target world. Initially, targets helped to create pressure to achieve some key objectives – particularly on speedier access to services – but more recently they have been the subject of criticism in the policy world, mostly for the disruptive rigour with which they were enforced by central government at the expense of staff morale.
But Labour is clearly aware that shorter waiting times have been popular with the public and there is political mileage to be gained by emphasising how both the Conservatives and the Liberal Democrats are campaigning on scrapping targets, with the obvious risk that waiting times could go up. Labour's success will depend on how well it can convince the public that these rights will be backed up, promptly, with any kind of force.
Another big theme is prevention. The detail is thin here beyond the existing commitment to extend screening for 40-74 year olds. There are no new initiatives to tackle alcohol misuse amongst adults and nothing new on obesity. Manifestos are perhaps not the best place for pleasure-limiting commitments, but the assertion that better prevention is the key to efficiency is not supported by tangible commitments.
Better access to GP care outside office hours will be a popular idea. It is not clear whether all GPs will be required to extend their hours to fulfil this or whether patients will have a limited list of extended-hours GP practices to choose from.
The backdrop of constrained resources may explain the non-committal tone of much of the manifesto: how to promise reform without providing significant new resources is a challenge for all the parties. Some of the pledges have clear resource implications: single rooms for parents needing to stay in hospital overnight, home births for mothers, guarantees for home-based palliative care and one-to-one cancer nursing. No timescales have been put on any of these commitments, leaving some wriggle room were Labour to be re-elected.
On social care, the manifesto re-iterates the plans for a National Care Service. The question of how it should be funded will be left to the parliament after next, along with the prospects for a public debate about this important policy question.
The Labour manifesto does include some new pledges – for instance scaling back the NHS IT programme and no more top-down changes to primary care trusts and strategic health authorities.
There are also some interesting omissions: no mention of the four-hour A&E waiting times target and no mention at all of health inequalities.
And there are the usual ambiguities, without which no manifesto would be complete: '3,000 matrons' will have the power to 'manage wards, order deep cleaning and report problems directly to hospital wards' leaves voters to figure out if this means current or new matrons exercising current or new powers.
It is not clear how important the detail of the manifesto on the NHS will be to voters: Labour has always enjoyed an advantage over the Conservatives in public perception of their competency on the NHS, and their hope will be that this message of rights and guarantees will do the trick on polling day.