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Back to the Future - How to Dismantle the NHS

30/07/2015 15:55 BST | Updated 29/07/2016 10:59 BST

What do the next five years hold for the NHS? The pre-election jamboree is quickly evaporating. The promise of billions more in funding now feels like a distant sound-bite. The Daily Telegraph recently set the tone with a front page headline in which Jeremy Hunt declared that the NHS now has enough money and will have to make do. However, all the talk on funding in the election debates completely missed the point.

The Health & Social Care Act 2013 has legally abolished the NHS. Except nobody has told you this. I am a GP in Tower Hamlets. This is the reason I have written a book - How to Dismantle the NHS in 10 Easy Steps http://www.zero-books.net/books/how-dismantle-nhs-10-easy-steps - in order to inform the British public. On the surface, nothing appears to have fundamentally changed. You can still see your GP or go to hospital and receive care free at the point of delivery. Underneath, however, everything is being insidiously transformed.

The Health & Social Care Act 2012 weighs in at over 400 pages and came into effect two years ago. At the time, I wrote a Guardian article warning of its perils - http://www.theguardian.com/commentisfree/2013/mar/30/health-act-means-death-of-nhs . We will continue to see the consequences play out combined with other damaging policies. During the election, we heard a lot about broken promises on the NHS; namely the Conservative manifesto promise of no more top-down reorganisations from Whitehall prior to the massive overhaul of the Health & Social Care Act. The great irony is that the Act will guarantee exactly this - no more top down reorganisations. It is effectively self-perpetuating.

The Health Act severs the government's responsibility for the NHS. This has been devolved to a series of bodies including NHS England and Clinical Commissioning Groups (CCGs) at arm's length from Whitehall. A key part of denationalisation is abolishing day to day government responsibility for the NHS. As Andy Burnham pointed out when I spoke to him at a British Medical Association pre-election event, there is nothing to stop the CCGs breaking away completely from the NHS. The CCGs are enabled by Commissioning Support Units (CSU). CSUs will be spun off from next year and are set to be privatised.

The Manchester experiment is the next phase and will be extended nationwide. Devolving health and social care spending to regional control is actually the dismantling of a NATIONAL health service under the guise of localism. This devolution of the axe masks cuts in funding. The merging of health and social care also raises all kinds of questions. Presumably health care is likely to become more like social care rather than the other way round - in other words means-tested. This would be in keeping with what David Cameron's health advisor Nick Seddon has outlined. He suggests that CCGs should be merged with private insurance companies and those who can afford to should contribute to their health care. Personal health budgets are being rolled out this year and will be extended to 5 million patients by 2018. In view of these budgets being finite, they are likely to lead to top-up payments ie co-payments and therefore private health insurance.

CCGs are now legally obliged to provide limited services, such as emergency care and ambulances - much reduced compared to the remit of Primary Care Trusts. Beyond this, the CCGs can provide services as they deem to be appropriate. The imposed funding constraints on CCGs will leave them between a rock and a hard place. Rationing has always been a feature of the NHS but this will guarantee a significant increase. We are already seeing this panning out with hearing aids and cataracts being rationed. Devon CCG recently announced that all routine surgery would be restricted for obese patients and smokers. And routine shoulder surgery would be restricted for all patients. Simon Stevens has been forced to personally intervene to try and stop this. CCGs, modelled on accountable or managed care organisations, should be viewed as insurance pools.

NHS contracts are now forced open by compulsory competitive tendering through such mechanisms as Any Qualified Provider. Private providers will increasingly run lucrative services. This cherry-picking leads to unbundling - NHS trusts invest the surplus from routine services into complex healthcare. However, cherry-picking leaves them with a smaller pot of money to provide comprehensive services. Last year alone, out of £9.63billion NHS deals signed, £3.54bn (nearly 40% of them) went to private firms.

Integrated care, which entails the plans to transfer specialist hospital care into the community, will mean a massive programme of hospital closures. We have already embarked on this with North-West London in the eye of the storm. And this storm will be coming to a hospital near you soon. This will be aided by the fact that scandalous Private Finance Initiative (PFI) debts will run hospitals into the ground. Meanwhile, general practice is imploding. 656 surgeries have been merged, taken over or closed completely since 2010 largely due to chronic under-funding and under-investment. Mergers will lead to federated organisations - a corporate model. This will be the precursor to privatisation of general practice with buy-outs and take-overs of these federated organisations.

So, the 21st Century English health service will have CCGs (supported by spun-off CSUs) commissioning care increasingly from private providers with the NHS budget translating into a funding stream. In effect, the NHS will move from being a state deliverer to a state insurer along the lines of Medicare in the US. Meanwhile, more patients will have personal health budgets, supplemented by co-payments and insurance in the future, thus making them self-paying consumers in a market-based healthcare system. The government ran slipshod over the objections of the medical profession, NHS staff, the Royal Colleges and unions in order to ram through the Health Act. It's now over to the public to save our NHS. It's up to you.

Youssef El-Gingihy is the author of 'How to Dismantle the NHS in 10 Easy Steps' published 31st July by Zero books - http://www.zero-books.net/books/how-dismantle-nhs-10-easy-steps

Twitter handle @ElGingihy

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