Many Scots assume an SNP-led team would have to modify policies in the face of harsh realities

'If the NHS was going to be a serious issue in this campaign the Scottish National Party would have staged a press conference on it by now,' a waspish Labour official told me in Glasgow after Tony Blair had swept in and out of town.

Next morning, as the election campaign entered its final week, NHS Scotland was plastered all over several front pages as well as radio and TV. Why?

Partly because Monklands Hospital senior accident and emergency consultant Dr Martin Watt had made outspoken criticisms of the postponed downgrading of his department to a minor injuries unit. Other protesters have included local Labour MP John Reid.

But it also emerged that Labour's Scottish health minister Andy Kerr had botched his own campaign promise to pay 67,000 nurses and midwives their full 2.5 per cent in April - in contrast to Gordon Brown's two-stage rise in England. Nurses would have to wait.

Not tragic, but worth a headline.

Those sorts of incidents seem typical of Labour's accident-prone campaign to avoid defeat in its Scottish heartland.

But my Labour source was right in one sense. The NHS has been a local issue in Scotland's third devolution elections - with three potentially crucial Labour seats put at risk by challenges from 'NHS first' candidates. They want to save local services threatened by the Scottish Executive's strategy of closing district hospitals in favour of super-hospitals.

But overall it has not generated the passion it has sometimes managed to do these past few weeks in England with its rows over doctors' training, leaked medical records and postcode lotteries.

In Scotland's campaign the Nationalists' 'It's time' - for a change of government - seemed to be catching a public mood. So more attention has focused on SNP leader Alex Salmond's political strategy (moderate and reassuring, that independence referendum postponed to 2010) than on specific policies or what Labour calls his£12bn tax-and-spend black hole.

In any case many Scots assume an SNP-led team would have to modify policies in the face of harsh realities - free prescription charges, for example, or a patients' rights bill guaranteeing appropriate waiting times - and all this in possible coalition with the Lib Dems. Whoever takes over will take weeks, months even, to settle down.

What seems to have happened under Labour since 1999 (also in coalition with the Lib Dems under the proportional representation voting system used here) is the familiar UK story, but more so. First Minister Jack McConnell has not created deliberate 'clear red water' differences with Whitehall, as Rhodri Morgan did in Wales.

So extra billions were poured into the NHS where per capita health spending is£2,019, compared with£1,839 in England. But Scotland's historic legacy on heart, cancer and alcohol means health productivity and performance has remained poor.

Audit Scotland admits scant evidence that all the money has been well spent and highlighted high levels of absenteeism, especially among nurses.

To some, including Dr Watt, that suggests overwork and stress. 'People are dying in our hospitals because doctors and nurses are stretched beyond the limit,' he said, criticising top-heavy management and its demands that medics make a 'business case' for extra resources.

There is a poignant local footnote to all this. Much publicity has been given to the disappearance on 18 April of Dr David Hughes, a Royal Navy surgeon lieutenant on secondment to St John's Hospital, Livingston.

The 37-year-old, who was due to return to Basra next year, had complained of the stress of working up to 85 hours a week.

All the party manifestos include ideas for doing better, including community services closer to home and new campaigns to improve Scottish lifestyles. The SNP and its Scottish Socialist allies hope to curb private finance initiative hospitals; the Tories want more choice and cash to follow patients.

It will all require money, but also leadership drive. At stake in the years ahead is not the quality of NHS management, but political management on what could turn out to be the road to independence.

Michael White is an assistant editor (politics) of The Guardian.