FIVE years ago in the run-up to the 2010 election, many people concerned about the NHS were giving up on Labour — 10 years of experiments with market-style reforms, privatisation and the costly nonsense of the private finance initiative had been followed by the threat of £20 billion cuts as a result of the crash triggered by the bankers.

But anyone who had reacted against Labour’s policies by trusting David Cameron’s mendacious Tories was heading for an even bigger shock.

Cameron’s populist promises to halt closures of A&E and maternity units, increase NHS spending each year and avoid any top-down reorganisation were all cynical, blatant lies.

As the election approached, the halt to closures became a “moratorium” — it was to be the shortest-ever, lasting just a few weeks over the summer, before all the A&Es threatened with closure began to close.

The increase in spending proved to be a microscopic fraction above inflation, lagging way behind rising demand and need for healthcare, opening the meanest-ever five years of NHS funding increases, and driving a massive 16 per cent real-terms wage cut for most NHS staff.

The pay cuts and the residual momentum of Labour’s 10 years of above-inflation increases from 2000 delayed the full impact of the freeze on NHS budgets until the last 12 months.

But now A&E performance is the worst in 10 years, cancer waits are growing, staff shortages and excessive use of agency staff are driving up costs, trusts and foundation trusts are mired in debts with many reliant on Department of Health bailouts, PFI bills are bankrupting a growing number of trusts, waiting lists are creeping back up and there are warnings of at least another £30 billion gap in NHS budgets by 2021.

Five years of brutal cuts in local government spending have left social care services in a state of near-collapse.

There are shortages of GPs, district nurses and therapists in primary care, while mental health spending has been falling for the first time in over a decade, community teams have been axed and mental health bed shortages have resulted in long-distance dumping of patients in costly, low-quality private beds.

As for the promise of no more top-down reorganisation, within weeks of taking office Tory health secretary Andrew Lansley had unveiled a white paper outlining a root-and-branch reorganisation of the NHS followed six months later by the monster Health & Social Care Bill, a reform designed to separate the NHS from parliamentary control and carve it into bite-sized chunks for the private sector to pick and choose the most profitable bits.

The Tory “reform” has created a new market-based NHS in which commissioners, clinical commissioning groups, allegedly led by GPs, but in practice led by the nose by management consultants and the greed of a handful of GP privatisers, are compelled to put a growing range of services out to bids from “any qualified provider.”

Although the latest figures show only 6.1 per cent of NHS spending on clinical care going to private providers, this represents over 13 per cent of the services the private sector wishes to take over (elective services, primary care, mental health and community health services).

And the pace of privatisation is accelerating, with contracts pending for control of cancer services in Staffordshire, and ever-increasing “pathways of care” as irresponsible clinical commissioning groups open tenders that threaten to undermine existing local services, some even looking to privatise the process of privatisation by appointing “lead providers.”

So five bitter years of experience shows us exactly what the Tories want to carry on doing if they win a majority or are able to lead a government after May 7. The plans are already clear to see.

In every part of the country clinical commissioning groups have been responding to the looming cash gap by drawing up more plans to dump the lion’s share of billions in “savings” onto their local NHS trusts and foundation trusts, axing beds, services, centralising A&E, reducing numbers of outpatients and operations, squeezing mental health services and hoping somehow growing numbers of frail older people can care for themselves without NHS support.

Tory minister Francis Maude has been driving a new attempt to force struggling NHS trusts to step outside the NHS and become “mutuals,” a denationalisation in which staff would no longer be NHS employees or receive NHS terms and conditions, pensions or professional development.

NHS England boss Simon Stevens, recruited from US private health giant UnitedHealth, is a huge fan of personal health budgets, in which patients receive a cash limited annual sum and are left to purchase their own care — topping up the budget themselves as required.

Most of the services they need to buy have already been cut back and privatised, with social care reduced to poor-quality fleeting 15-minute visits from desperate staff on zero-hours contracts and the minimum wage.

Just weeks before the election Chancellor George Osborne made the surprise announcement that £6bn of the NHS and social care budget would be handed to a new Greater Manchester Combined Authority — a completely undemocratic stitch-up embraced by council and clinical commissioning group bureaucrats without any consultation with the public they are supposed to serve.

This could pave the way to the balkanisation of the whole of England’s NHS, permanently ending any responsibility or duty of central government.

Labour has certainly not excelled itself in opposition, responding weakly and slowly to the Health and Social Care Act, accepting the austerity cuts, and even now understating the desperate plight of social care and the mounting financial debts of the NHS.

The party still has not learned the lessons of its disastrous implementation of the Tory private finance initiative, and still argues the need to make use of private providers, despite all of the private-sector failures of recent years.

But Labour has promised an extra £2.5bn per year, committed to repeal the Health and Social Care Act, “call time on the market experiment,” and build a “national health and care service.”

This falls far short of what many of us would like, way short of reinstating the NHS — as the Greens and National Health Action Party have called for — or the demands of the Communist Party, Left Unity and Tusc. But unlike these parties, Labour could form a government.

We know there will be battles to come — but many will feel the chances of winning some of those battles would be greater with Labour in office than against a ruthless Tory second term. Whatever you decide, vote for the NHS and against the Tories — but get ready to fight, whoever wins.

• John Lister is director of Health Emergency.