The end of 2013 has come in the same way as the year began, with the Tory-led coalition driving through massive cuts in England's NHS and public services, coupled with unprecedented levels of privatisation.

In January we were still waiting to see if Jeremy Hunt would rubber-stamp the brutal plans of the trust special administrator to close 60 per cent of Lewisham Hospital and bulldoze much of the site to help bail out the failing South London Healthcare Trust next door.

In December, having tried to do so, and having lost twice in court to legal challenges to his right to make these cuts, Hunt is pressing for changes to the law to give arbitrary powers to cut, downsize and reorganise any hospital in the vicinity of a failing trust.

In January we were waiting to see the results of the implementation of the Health & Social Care Act.

By December we could see a chaotic picture in which many arrogant, remote clinical commissioning groups - in many cases "led" by just a handful of self-interested local GPs - were pressing ahead with competitive tendering.

Some are even drawing up huge and complex tendering processes for "integrated pathways of care" that threaten to create new, private monopolies at the expense of existing public services, with no consideration of the impact on local NHS providers and no attempt at public consultation.

One clinical commissioning group in Bedfordshire is planning to sign a contract for musculoskeletal services with a privately led consortium that includes a company set up and owned by local GPs.

Windfall profits for some Bedfordshire GPs could therefore come at the cost of axing services in Bedford Hospital, obliging patients to trek an extra 17 miles for services to Luton & Dunstable.

Asked about the obvious conflict of interest, the clinical commissioning group's only answer was to argue that the decision was taken by "consensus" - so no votes had been required - and to insist even now that the final contract has not yet been signed.

Cambridgeshire clinical commissioning group - advised and effectively led by relics of the old privatising strategic projects unit of the now abolished East of England Strategic Health Authority - is planning the biggest-ever privatisation, another "integrated pathway" for all services relating to elderly care, worth up to £800 million over five years.

The plan drew bids from 10 consortiums, but the massive and complex document setting out the terms of the contract made clear there would be no extra money on the table and that 15 per cent of the total value would be conditional on meeting various "outcomes."

To make matters worse, the winners would have to share any "excess profits" with the clinical commissioning group.

Faced with this, two of the 10 consortiums have already pulled out, including the one led by Capita that included Cambridgeshire Community Services, the trust which has been delivering the majority of these services.

Cambridgeshire Community Services has now thrown in its lot with the bid from the predatory Optum, the company previously known as United Health, the US-owned former employer of incoming NHS England chief executive Simon Stevens.

So it's clear that whoever wins will effectively be a new provider.

However it's also clear that since there's no more money on the table for what are already poorly resourced services, no profit can be made from the contract unless savings are made either through reducing numbers of more qualified staff, down-banding them to cut the wage bill or increasing workloads - almost inevitably at the expense of quality of care.

All of which might be expected to mean that the clinical commissioning group would consult local people on these proposals and the implications for future services - but again no consultation is proposed.

The clinical commissioning group does not want to know local people's views.

Nor does the group want to address concerns over what would happen to the various services - most notably community health services for children - that would be left adrift if this big lump of Cambridgeshire Community Services is broken off and handed over to a privately led consortium.

There appears to be little consideration of the fact that by handing this whole "pathway of care" over to one consortium, any notion of "choice" for patients in Cambridgeshire and Peterborough would be killed off for at least five years.

The new providers would be a real monopoly, subject to no public accountability.

What happens if they fail - as more and more private providers are doing? What option is there to bring the service back into NHS control?

But while these bureaucratic horrors multiply in the post-Lansley NHS, there are even bigger potential horrors being lined up by a bizarre alliance of David Cameron, Barack Obama and the EU.

The Transatlantic Trade and Investment Partnership, being hatched up behind closed doors by unelected EU bureaucrats, with Cameron's explicit support, masquerades as a means to generate jobs in the EU, but in practice threatens to open up British healthcare to the greedy claws of US health corporations seeking easy profits.

The plan is being driven through with minimal public awareness or debate.

There is little sign that Cameron's Eurosceptic backbenchers are aware of the extra powers and control being signed away under the direction of the Brussels bureaucrats they claim to despise.

Even Ukip is strangely silent. The Europhobic Daily Mail and Sun apparently have no view as the proposals take shape.

But the big unions have now recognised the danger to public services - Unite, Unison and other unions have made clear their opposition to any attempt to open up health to the greedy clutches of US multinational corporations, and this has shifted the TUC away from its previous naive acceptance of the ostensible plan for jobs and investment.

Labour leaders too have started to ask critical questions, although there is no clear policy as yet.

Meanwhile there is mounting evidence of the social cost of the EU's horrendously unaccountable, undemocratic bureaucracy lining up increasingly blatantly behind brutal neoliberal policies.

The most obvious example is the establishment under German leadership of the "troika" of EU commissioners, the IMF and the European Central Bank to impose savage austerity on Ireland, Greece, Portugal and Cyprus under the guise of a "bailout" package.

In both Greece and Portugal this has involved especially vicious cutbacks in health spending and public-sector health jobs.

In Greece a 30 per cent cut in spending has run alongside a 50 per cent increase in "outsourcing" of contracts.

In both countries new and increased charges have been imposed for drugs and treatment, while grim statistics chart the fall in life expectancy, the rise in sickness, suicide and even, in Greece, the return of malaria.

These policies are being driven by the arrogant Finnish commissioner Olli Rehn, a failed right-wing politician in his own country, who with German patronage has been elevated to high office in the completely unaccountable EU machinery. Rehn has easily survived the abject failure of his proclaimed economic objectives in Greece and Portugal, which have prolonged and deepened the recession, and hit none of their apparent targets.

But it's more sensible to regard the EU intervention, like Osborne's austerity plan, not so much as an effort to restore the economy but more of a deliberate attempt to take advantage of the situation to drive through far-reaching neoliberal policies, privatisation, reductions in state spending and destabilisation of pay, pensions and welfare benefits.

This is not blundering bureaucracy but capitalism red in tooth and claw, prising back open markets that have been dominated by state spending and public provision for half a century or more in much of Europe.

This is the rich and super-rich reasserting their power and privilege at the expense of everyone else.

To inflict a delay or a setback to the transatlantic treaty would be an important step in halting this effort to turn back the wheel of history.

The treaty aims to create a new, irreversible fait accompli, in which competition laws and the "rights" of corporations are dominant and the needs and interests of the majority are subordinated to market forces.

The control over public services and public budgets, like our NHS itself, is under threat.

Twenty-fourteen is the crunch year for fighting back. Once it's gone, it could be gone forever.

Don't let them get away with it. Let's renew the fight to keep our NHS and similar health services around the world - and keep them in public hands.

John Lister is director of Health Emergency