The National Health Service is not perfect but most of us hold it in high regard and have reason to be grateful for its guarantee of free treatment and care.
Those of us born after 1948 may have come to take its continued existence for granted, but this remarkable institution is now under threat from a government ideologically opposed to state provision.
Andrew Lansley's NHS White Paper has horrified analysts with its apparently hasty and sketchy plans to do away with Primary Care Trusts and Strategic Health Authorities and to replace them with GP commissioning consortiums.
David Nicholson, chief executive of the NHS, estimates that the changes will cost at least £1.5 billion; Dr David Price of Edinburgh University believes “it will remove the government's duty to provide a universal healthcare service” and Dr John Marks, previously chair of the BMA, warns of “confusion, inefficiency and demoralisation”.
Private providers and management companies such as McKinsey and Capita will eye the break up of the NHS with delight while laying plans for maximising their share of the £80 billion budget.
Lansley either does not know or will not say how many GP consortiums there will be. The White Paper suggests a figure of one per 100,000 head of population. That would mean around 600 bodies replacing the 152 Primary Care Trusts and 10 Strategic Health Authorities.
There are no estimates of the numbers of non-clinical staff this will require to negotiate contracts, advise GPs and send out bills, nor are there any figures that will tell us how this is to meet the Secretary of State's promise to cut NHS “bureaucracy” by 45 per cent and make the promised “efficiency savings” of £20 billion.
The coalition has not put forward any explanation as to how the upheaval will avoid the costs which have followed every other reform in the health service.
This dismantling of a national public service accountable to government is being sold to the public as devolution of power to its users, free of central bureaucracy. This appeals to critics who are predisposed to see all that government does as flawed and who believe that 'bureaucracy' is always heavy handed and sclerotic.
The word is so loaded that it has become almost impossible to perceive it as the necessary regulation of our services – which, in common with all regulatory systems, will sometimes go wrong. But because every shortcoming is presented as evidence that the state is inefficient and the market is not, the possibility of reform has been pushed aside by the preferred option of abolition.
Lansley's plans offer us a health service with a minimal workforce commissioning care and treatment from private companies whose ethos is worlds apart from that of the NHS.
Once the public have seen past the chimera of “choice” which will be dangled before them, the bond of trust which still exists between clinician and patient will begin to fracture.
The new contract for GPs is described as having “powerful incentives” to meet commissioning targets, so the question at the back of the mind of the sick, the anxious and the dying will be: “is this the right treatment for me or is it the cheapest and therefore most advantageous for my doctor's consortium?”
Competition law requires tendering for NHS contracts to be advertised internationally and it is unlikely that the multi-national corporations which have fought Barack Obama so fiercely over socialised health care will suddenly have a conversion of heart and enter the new UK health market with a determination to put the well-being of the patient first.
That patient may still get treatment free at the point of delivery, but what interests will be influencing and shaping the delivery?
By far the greater part of the NHS budget is currently spent on the ongoing management of chronic illness. Patients with conditions such as diabetes, heart problems, leg ulcers or depression are at present supported by teams of GPs, nurses and other clinical specialists who keep them out of hospital.
Under the new proposals, hospitals will need to fill their beds and the unspectacular teamwork which benefits the patient will take a back seat. Competition between hospitals will be the order of the day and many areas – probably the poorest - are likely to be disadvantaged if weaker institutions are permitted to close instead of being supported in raising their standards and services. Profitable conditions will be 'cherry-picked' and concentrated in high status hospitals to the detriment of localism and community.
It is a further indication of the apparent haste in formulating these 'reforms' that only two months ago, the coalition, criticising Labour's target culture, promised “no more top-down reorganisations of the NHS”. It is not clear where effective opposition is to come from: Labour has cut the ground from under its own feet in its readiness to embrace private solutions to what it has presented as public service failings.
Politicians who did not oppose PFI initiatives, academies or the privatisation of the Royal Mail will have to be honest and penitent about the past if they are to galvanise support and fight for the future of a comprehensive, just and accountable system of health care.
If corporate power groups are permitted to get their hands on our most important and humane social institution, it will be all but impossible for a future government to restore it. The Big Society will have got quite a lot smaller.
© Jill Segger is a Quaker and Ekklesia's associate editor. She is a freelance writer who contributes to the Church Times, Catholic Herald, Tribune, and The Friend, among other publications. Jill is also a composer. See: http://www.journalistdirectory.com/journalist/TQig/Jill-Segger