Prime Minister David Cameron's promise to "protect" the National Health Service will be meaningless if his government remains determined to force through the most significant and controversial rewriting of the NHS' mission in its 60 year history, say health workers.
Unite, now the country's largest trade union, says that widespread distrust of the government's plans to dismantle the NHS have forced the Prime Minister into the astonishing position of making yet another declaration of commitment to the NHS - in the face of doubts brought about by his own policies, and by lack of confidence in Health Secretary Andrew Lansley.
Unite says Mr Cameron's emollient words on 7 June 2011 will be met with "justified voter anger" if, as feared, the pause on the Health and Social Care bill results in little or no change to the competition-first proposals which have attracted an astonishing degree of criticism from health professionals.
The union adds that promises to keep waiting lists "low" insult the thousands of people now facing an 18-week or more wait since the government scrapped waiting time commitments as one of its first acts in office.
Despite government pledges, the reality on the ground is very different, says Guardian newspaper health editor Sarah Boseley, in a special report.
An array of financial pressures is forcing primary care trusts (PCTs) and hospitals across England to get used to having less money to spend just at a time when their costs are rising, she reports.
Health Service bosses are also gloomy. Increasingly their NHS organisations are having to ration access to healthcare just when demand for it is growing. More and more of them are shrinking their workforces – by as many as 1,600 staff over the next four years, in the case of the Heart of England NHS Trust, which runs hospitals in Birmingham and Solihull.
Rachael Maskell, Unite national officer for the health sector, commented: "It looks like the Prime Minister and his deputy, Nick Clegg, have been spinning us a line. Despite the phenomenal criticism of their health bill, their listening exercise was a sham. They are determined that the wasteful competition ethic will be imposed upon the NHS."
Talk of greater competition has prompted concern that private companies will cream off the most lucrative parts and weaken the service.
Mr Cameron said on Tuesday 7 June that there would be no "cherry picking" of services by private companies, but that competition could benefit patients.
But critics say that the proof will be in the detail and contracts, and that in practice there are all kinds of ways of subverting restrictions.
"If you go abroad, to Sweden, to Germany, to Spain, you will see lots of different healthcare organisations providing care paid for by the state," he said. "Our NHS has always benefited from a mixed economy of providers."
Unite's Rachael Maskell continued: "Promises from David Cameron in his speech will not shield patients from a government hell-bent on shackling the NHS to the legislation that will destroy it.
She added: "The debacle of Southern Cross shows all too clearly what happens when competition, cost-cutting and regulatory failure seize hold of an essential service. Tens of thousands of vulnerable people suffer.
"Our legislators will never be forgiven if they now deliver NHS services into a similar fate. Neither will the public trust the Prime Minister when one of his promises - low waiting lists - was undermined within moments of his government taking office. When it scrapped waiting targets at the stroke of a pen, it left tens of thousands of patients in uncertainty and distress. Vague promises now, while remaining committed to a bill that will surely mean the return of a postcode lottery of care, are simply an insult.
"All those with the power in parliament must now see past hollow words to the reality of the bill that will soon be before them. Health professionals understand that the only way to continue to improve our NHS is through consensus and with the values of quality care put firmly first. Promises are not the same as consensus.
"The only promise on the NHS worth making now, Prime Minister, is the one to drop this bill and start all over again," concluded Ms Maskell.
"David Cameron has spent a year mismanaging the NHS and the consequence is chaos, confusion and damaged patient care," opposition leader Ed Miliband told a news conference at the Royal Festival Hall.
Guardian NHS cuts special report: http://www.guardian.co.uk/society/2011/jun/08/nhs-health-service-cuts-re...