The simple statistics for the NHS in London make stark reading and tell you why trying to sort it out and protect it for the future is both incredibly important and extremely challenging.
Every year in the capital:
- There are 60 million GP consultations - that's about 165,000 every single day
- The NHS spends nearly £18bn
- There are currently up to 8,000 GPs in about 1,400 practices
- There are 60,000 nurses across the NHS, local authorities and voluntary sector
- In 2016-17 there were 1,040,128 elective operations reported in London
They are big numbers that require big solutions, along with a big dose of political support. But change of that scale could be hard to deliver.
Ten years ago there was a plan to change the way the NHS worked in London, with greater focus put on primary care rather than hospitals.
Called "A Framework for Action", it was a plan that delivered some big changes in London with particular success in the new major trauma units and the new specialist stroke centres.
It also promised 100 new so called "polyclinics" to offer a range of services from new buildings.
But the strategy was ditched when the coalition government came to power in 2010.
David Cameron's government had its own plan, which promised a boost for local GP services and a move to more care out of hospital.
Today the arguments remain pretty much the same.
There is wide agreement more care needs to be delivered closer to home and more resources need to be funnelled to primary care and GPs.
Experts say a shift is needed to a proper National Health Service that keeps people well and away from a national illness service, that picks up the pieces when they become unwell.
But how do you get there? Change in the NHS is expensive and also politically difficult.
Moving or cutting services at hospitals for example is often deeply unpopular.
Promises made at elections can make you look opportunistic some years later.
Campaigners at Chase Farm Hospital in Enfield, north London, will remember David Cameron promising to keep their A&E open before the 2010 election. It is now closed.
Services across the capital are currently being reviewed under a process known as Sustainability and Transformation Plans, which assess how the NHS will look over the next five years.
There are five of these and all involve moving services around, while some involve the closure or downgrading of A&Es.
All involve plans to save millions in the way services are delivered while also spending millions on new buildings and different services.
All say that doing nothing is not an option. If the NHS continues to spend in the way it is and deliver services in the way it does now, it will face a funding shortfall of more than £4bn in London alone.
If re-arranging hospital services is a challenge, the one facing primary care is just as hard. Shifting the focus to getting patients treated by GPs means finding doctors to deliver that service.
A recent survey by the Londonwide Local Medical Committees, showed 42% of practices had a GP or practice nurse vacancy, while 45% of practices had a GP who was planning to retire in the next three years.
In fact, NHS statistics show the city has the highest number of GPs over the age of 55.
"The situation is worse than I've ever seen it"
Willesden GP Dr Adrian Richardson knows the pressures only too well.
His practice nearly closed last year, as three of its partners left, either retiring or choosing to get out of general practice.
"It's sad the situation in this practice was that people felt that options were better outside the practice than in," he said.
"I stayed because I didn't feel it was right to leave 15,000 patients without a proper practice."
He blames increasing workloads and paperwork for the extra pressures.
"The situation is worse than I've ever seen it.
"If you ask me about 2016 it will go down as the worst year of my clinical life."
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All the parties are committing to recruiting more GPs and nurses but doing it quickly is not possible, given the length of time it takes to train them.
All the parties are promising more money for the NHS and social care. There are promises too of more money for new buildings and pledges to rebuild an ageing estate.
There are promises that may be viewed with some scepticism from those working in the NHS and certainly shared by the Nuffield Trust think tank which specialises in analysing health policy.
It said: "Promises of billions extra for the health service can sound like big sums ... unpicking the pledges from each of the manifestos reveals that the NHS looks set to face a further five years of austerity, whoever forms the next government.
"Whichever party forms the next government will have to face some tough decisions about the future shape of the health service, and how it can continue to meet the needs and expectations of its patients and staff."
Hard choices on the NHS lie ahead for whoever wins the election.
What's on offer from the party manifestos:
- Commit to over £30bn in extra funding over the next parliament through increasing income tax for the highest 5% of earners and by increasing tax on private medical insurance
- Boost capital funding for the NHS, to ensure that patients are cared for in buildings and using equipment that is fit for the 21st Century
- Halt and review the NHS Sustainability and Transformation Plans and ask local people to participate in the redrawing of plans with a focus on patient need rather than available finances
- Ensure the NHS has the buildings and technology it needs to deliver care properly and efficiently
- Increase NHS spending by a minimum of £8bn in real terms over the next five years, delivering an increase in real funding per head of the population for every year of the parliament
- Ensure the NHS and social care system have the nurses, midwives, doctors, carers and other health professionals that it needs
- An immediate 1p rise on the basic, higher and additional rates of income tax to raise £6bn additional revenue to be spent only on NHS and social care services
- Direct additional investment to priority areas in the health and care system including social care, primary care and other out-of-hospital care, mental health and public health
- In the longer term and as a replacement for the 1p income tax rise, commission the development of a dedicated Health and Care Tax on the basis of wide consultation, possibly based on a reform of National Insurance contributions
- Close the NHS spending gap and provide an immediate cash injection to ensure everyone can access a GP, hospitals can run properly, and staff are fairly paid
- Scrap the NHS Sustainability and Transformation Plans
- Roll back the privatisation of the NHS
- Provide NHS England with an additional £9 billion a year by 2021/22
- Launch the toughest ever crackdown on ineligible foreign nationals using the NHS