LABOUR’S electoral tacticians will be celebrating the latest polls indicating that the party has gained support after putting the NHS at the centre of its campaign.

But it’s far from clear whether the strengthening of support is a sign of confidence in Labour’s still evasive policies, or a hostile reaction to the mounting evidence of chaos in an NHS being torn apart by Tory “reforms” and brutal freeze on spending which is set to run to 2021.

So serious is the situation that NHS Providers, a new organisation representing the majority of large hospital trusts, has taken an unprecedented stand, dug it heels in and declared that enough is enough.  

It has refused to sign off its annual budget, claiming that its members could no longer “achieve the impossible” and that a fifth successive year of cuts in the “tariff” of fees they are paid for each treatment would mean that they could no longer guarantee the safe care of patients.

Already the tariff for A&E services means many trusts are running them at a loss. This is made worse when they are penalised for treating “too many” patients, and get paid just 30 per cent of the tariff for any patients treated above 2009 levels.

Penalties can run into millions for some trusts, which also face the extra costs of hiring temporary staff to fill vacancies and keep A&E running.

The unexpected defiance of the country’s largest acute hospital trusts has been echoed by new resistance among consultants. Last week the entire consultant team running A&E services in Redditch’s Alexandra Hospital resigned en bloc, apparently to take up offers of jobs in Warwickshire.

The Alexandra has been under almost constant threat and pressure since the costly hospital, financed by a private finance initiative (PFI), opened in Worcester. The opening forced the Worcestershire Acute Hospitals Trust, which had already axed services in Kidderminster Hospital, to look for further savings to balance the books.

In Nottinghamshire a team of dermatologists resigned in December after the service was contracted out to Circle, forcing them to transfer to the payroll of the struggling private hospital chain that has just cut short its contract to run Hinchingbrooke Hospital.

The Notts consultants had warned that they would not work for the company, which has become notorious for the bullying regime at Hinchingbrooke, but were ignored.

Now Nottinghamshire’s main hospital trust has no specialist dermatologists, putting access to adult services at risk.

But elsewhere many NHS managers are simply struggling on, making damaging compromises in the quality of care. In Yorkshire, the ambulance service recently responded to staff shortages by agreeing to send out emergency ambulances with no paramedics, but only two Emergency Care Assistants (ECAs) on board. ECAs are not clinically trained and cannot administer any medication.

Yorkshire Ambulance Service has also admitted using over 2,000 taxis to transport “non-urgent” patients to A&E last year, and the trust’s spending on private ambulances, which also employ staff with much less training than NHS crews, has quadrupled in the last year.

The Trust is falling massively short of its target emergency response times.

Just 100 days from the general election, headlines in local papers up and down the country shriek over the crisis conditions in A&E and the plummeting performance of hard-pressed ambulance services struggling to cope.

Some ambulance trusts quote vacancy rates as high as 25 per cent, the highest being East of England, South Central and the North East.

Nationally the average is over 9 per cent, and ambulance trusts are reported to be travelling to Eastern Europe and Australia seeking to recruit trained paramedics who have not yet heard about how bad the conditions are here.

Vacancy rates for ambulance crews have been growing as weary and demoralised paramedics face exhausting 12-hour shifts, often without a break, sitting in ambulances which when not on a call are now in many areas positioned miles from ambulance stations, at strategic points proposed by management consultants for swifter responses.

These can be car parks, flyovers and intersections — cold, deserted, comfortless and isolating for staff.

London Ambulance Service trust (LAS) reports losing an average of 26 paramedics a week, and is struggling to fill 400 vacancies. All over the country ambulance staff do their stressful job, rushing sick patients through congested roads to a reduced number of A&Es after dozens have been closed, only to queue up behind other ambulances outside hospitals with no beds spare or room to keep patients who need to be admitted.

But instead of speaking out and challenging the inadequate funding and intolerable pressures on her staff, the LAS chief executive very publicly scuttled off from the trust at the very point of peak press criticism of its falling performance.

This was no honourable sacrifice to take responsibility for any of the trust’s problems, but a self-interested step into a comfy new job with NHS England.

The situation in A&E is the sharp focus of the dislocation of healthcare under the crushing pressure of five years of frozen spending as population size, costs and pressures increase.  

Five years of cuts of almost 40 per cent in social care have also prompted council leaders and the NHS confederation to jointly sign a letter to the Observer with health professional bodies, warning of the dangers to patients if cuts continue.

Without social care and improved community health services to support older patients discharged from hospital, and primary care services developed to help keep more from needing hospital care, NHS hospitals will remain “gridlocked” with patients they cannot safely discharge, while more urgent cases wait for admission, and ambulances queue in the car parks.

It’s not rocket science, but it’s beyond Jeremy Hunt, who has convinced himself that the NHS can endlessly expand services to cope with rising demand while funding is frozen.

Every story revealing the growing crisis has up to now been met by the routine knee-jerk denial by the Department of Health, or NHS England — the national-level body that now holds the NHS purse strings and has made a right dog’s dinner out of commissioning specialist care.

To cover up the scale of the problem NHS England has jacked up its spending on PR and communications staff to “spin” the bad news by 37 per cent in the last 12 months, to £6.1 million. But even the most extravagant spin can’t hide the fact that, far from focusing on collaboration between NHS bodies to close any gaps in care and raise the quality of services, the Tory Health & Social Care Act has plunged us into a mad maelstrom of enforced competition, fragmenting services.

The local Clinical Commissioning Groups (CCGs) — which even a sympathetic new Nuffield Trust and King’s Fund report now admits are struggling to retain GPs’ interest and involvement — have in the main kowtowed to this new regime, obediently (or, worse, enthusiastically) carving up services to be put out to tender.

This allows the private sector to pick the choicest slices, leaving the NHS with the rest.

Worse is to come. NHS regulator Monitor is piling on the pressure to force CCGs to put even more community health services out to tender in the next 12 months.  

Laing & Buisson, the private sector analysts, predict that on present trends more than half of community health services could be privately run by 2020.

For-profit companies are expected to more than double their current share of this £9.75 billion market, while so-called non-profits pick up other contracts, with as much as 15 per cent of the “market.”

But it’s not clear that Laing & Buisson have got this right. The private sector is not by any means seeing things go their way. One of the major players in this market, Serco, last year pulled out of tendering for clinical contracts after losing money. Care UK has also now pulled out of whole sectors of healthcare.

In West Sussex, Bupa and Surrey-based social enterprise CSH withdrew from a five-year £235m contract to take over elective musculoskeletal services after a PricewaterhouseCoopers report revealed that this was likely to force the closure of A&E services in the two local general hospitals.  

It comes to something when Bupa recognises the need to keep an NHS intact to take on all the emergencies and complex cases that the private sector will not touch, while idiotic GPs on the local CCG were urging them to go ahead anyway, regardless of the damage that would be done to front-line care.

The evidence to show that the private sector has nothing to offer the NHS is mounting, especially when it comes to running large and busy general and teaching hospitals, which are completely different in character and complexity from the tranquil simplicity of private hospitals (average size just 50 beds) where few patients, if any, are seriously ill, and only elective treatment is delivered, with the option of sending any problem cases to an NHS hospital with intensive therapy units and 24-hour medical cover when things go wrong.

But even if no private firms win any contracts, the complex market system that has been set up to allow them to compete for contracts is a dead weight of costs and bureaucracy, dragging down and fragmenting the NHS while the continued freeze on spending puts services under mounting pressure.

What we need is to cut out the wasted costs and bureaucracy of the complex market put in place by Andrew Lansley’s Health & Social Care Act, and reinstate our NHS as a publicly owned, publicly provided service focused on patients, not profits. If Labour would commit itself to that clear line of approach even more voters might feel confident that they offer a genuine alternative.

John Lister is co-author with Dr Jacky Davis and Dr David Wrigley of a new campaigners’ book NHS for Sale (Merlin £10.95), available from www.keepournhspublic.com