Nell McFadden campaigned to save emergency services at her nearest hospital without ever imagining she would need them herself. Then, on January 7, the Gourock pensioner woke up with pains in her stomach.

"I tried drinking hot water, but as the morning wore on the pains got worse," she recalls. "It got to the stage where I could hardly see for the pains."

That afternoon, she was taken into Inverclyde Royal Hospital in Greenock. There, she was diagnosed with a perforated bowel and peritonitis. By 8pm she was in the operating theatre.

"I have never had anything like that before," she says, still clearly shaken. "All I can say is that I thank the surgeon. If he had not seen that something was very seriously wrong with me, I'm afraid I would not be sitting here talking now."

Two and a half years ago, a question mark hung over the future of emergency and major surgery departments at Inverclyde Royal. The health board, then NHS Argyll and Clyde, wanted to centralise treatment to the Royal Alexandra Hospital in Paisley, amid staffing and financial problems. Thousands of people marched in protest and signed petitions against the plans - among them Mrs McFadden, who has just turned 80.

"I do not know what I would have done if I'd been in Paisley," she says. "Because of the seriousness of my situation, all my relatives and my friends came to visit me. If I'd been in Paisley, I would have been completely isolated - and that's the last thing you need when you've had an operation.

"It's not only the journey they would have had to make: they wouldn't have been able to get the transport there. It just doesn't bear thinking about. I was very lucky I was taken to my local hospital."

Last December, NHS Greater Glasgow and Clyde, which has taken charge of services in the region, announced it was abandoning the scheme to downgrade Inverclyde. The vast majority of acute care will stay in Greenock, under fresh proposals that have been welcomed by campaigners, including Mrs McFadden. "It gives you a really good feeling because they tell you they are going to consult the public and half the time they don't listen to you," she says. "This is one time they consulted the public and listened to us."

Travel from Greenock in almost any direction, however, and you encounter a different story. Plans are progressing to cut the number of accident and emergency departments in west and central Scotland from 14 to eight, and in constituencies such as Glasgow Cathcart, Carrick, Cumnock and Doon Valley, the centralisation of emergency services is likely to prove a key election topic.

During the past 12 months, decisions have been taken to downgrade A&Es in Ayr and Airdrie, despite massive protest. The latter proved particularly controversial as Monklands Hospital serves some of Scotland's most deprived and vulnerable communities and was chosen for closure over Hairmyres A&E, which sits in the constituency of Andy Kerr, the Health Minister.

Meanwhile, unrest continues over the strategy to reduce the number of A&Es in Glasgow from five to two, with the loss of units at Stobhill and the Victoria Infirmary particularly contentious.

Campaigners against hospital centralisation have been accused of clinging to bricks and mortar, or failing to understand the complexity of medical advances. "You can't have neurosurgery on every street corner" runs one of the pro-centralisation arguments.

But Dr Robert Cumming - chairman of the Scottish Health Campaigns Network, which unites groups opposing the centralisation of hospital services - says people do accept the need to travel for such specialist treatment. "The concern is about the day-to-day work of the health service, such as A&E and routine medical and surgical admissions," he explains.

The impact of longer journey times to hospital, not only in emergency situations but for routine appointments and patient visits, is among his biggest worries. The additional stress of searching for parking spaces or waiting at bus stops also takes its toll on patients and families, he argues.

He says he might be more convinced if he could see detailed plans showing how bed numbers were to be increased at alternative hospitals, and how transport networks were to be improved to help patients reach them. However, he says: "The planning that is necessary to produce centralisation that works has not materialised, and we see no sign of it materialising at all."

But just as the case against hospital closures can be belittled through over-simplification, so the real reasons for change can be ignored in the clamour to save the status quo. One pressure is the European Working Time Directive, which is, by law, cutting back the hours doctors work, effectively reducing staff. In order to provide hospital care around the clock, doctors increasingly need to be part of larger teams sharing shifts in a rota.

Some health board managers also argue that re-arranging hospital services in a way that separates emergency care from planned operations helps stop the two from clashing. Nobody wants to phone patients to delay their surgery because a busy period in A&E has filled the beds - and the available statistics suggest that waiting times across Scotland have come down significantly.

Even Dr Peter Terry, chairman of the British Medical Association in Scotland, who has reservations about targets, says resources were used more efficiently in his department to successfully cut the queue for treatment. But other reports suggest patient experience does not always reflect the data trumpeted by ministers. Tina Jordan, who lives near Oban, was told she may have to wait more than a year to see a specialist after her referral letter went missing - but the delay would not appear in official statistics. "They will always hit the targets," she says, "but there are always issues about how they get around the targets."

Nell McFadden says she was thoroughly impressed with the way she was looked after when she was ill. Now recovering slowly, she says the next issue she will tackle is care of the elderly, and how Scotland will manage its ageing population.

"They will need to think very hard to get the right things set up, otherwise there will be a whole lot of older people living in misery," she says, promising: "Before the end of this year I will have the banners and placards out again."

What the parties say

Labour

Committed to ensuring hospital services are as local as possible and as specialised as necessary. No agenda to privatise the NHS but in a limited number of cases has used the independent sector to support patient needs and deliver faster care. Says it has made waiting times a priority and brought them to a historic low, with the NHS treating more patients more quickly than ever before. Committed to further improvements.

SNP

Reverse decision to close A&Es in Ayr and Airdrie. Take a stance of presumption against further centralisation of hospital services and subject any health board proposals to tougher scrutiny. Hold direct elections for at least 50% of seats on regional health boards. Set up a Scottish Public Services Trust as an alternative source of funding to private finance. Supports use of diagnostic treatment centres, but believes they are best run by the NHS. Wants individual waiting time guarantees, set by clinicians for each patient but within national limits. By the end of 2011, wants a maximum wait of 18 weeks from GP referral to treatment.

Conservative

Fight to retain local emergency and maternity services and develop a new minimum standard so people know they have A&E services and maternity provision within easy reach. Devolve power to health professionals and allow patients to choose which hospital will perform their operation.

Libdem

Wants people to access healthcare closer to their homes.

Will expand the work of existing community hospitals and provide 100 new health centres with extra nurses offering a wide range of services (including diagnostics and hospital care) under one roof.

Green

Create rural general hospitals and community hospitals as outlined in the Kerr Report. Doesn't oppose service redesign, but believes NHS must regain the trust of communities and ensure that alternatives are in place before any facility is closed down. Believes PFI should be abandoned and there should be no further encroachment of the private sector into the NHS. Also believes clinicians should prioritise caseload without waiting time targets.

SSP

End all hospital closures except plans backed by local communities. Invest in more doctors, nurses and other health professionals to increase the staff-to-patient ratio. Set a maximum bed occupancy rate of 85% to cope with any surge in demand. Reverse all privatisation within the NHS and cancel PFI projects in favour of public investment. Campaign for a publicly owned Scottish pharmaceutical corporation that would supply a range of cheap generic medicines for the NHS, and work with universities to research new drug treatments.

Solidarity

9:48pm Tuesday 10th April 2007

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