THE headlines are unrelenting. Hospital after hospital resorts to “black alerts” as they run out of beds and space in emergency departments and diverting blue-light ambulances to hospitals miles away.

Beds fill up as older patients stay on after treatment for lack of social care to support them if discharged home.

Delays in A&E are the worst since weekly records began.

Waiting times for operations are increasing along with numbers on waiting lists, now up to three million. It’s as if the 1980s are back again.

Desperate, overworked GPs refer frail older patients for hospital care because the decades-old proposal for expanded community health services to deliver “care closer to home” has remained a hollow promise, lacking staff, facilities, funding and political commitment.

Ambulance services are falling ever further behind performance targets as lines of ambulances form outside hospitals waiting to hand over patients, and journey times are lengthened by the closure of over 60 A&E and maternity units since 2010.

Ambulance staff are increasingly hard to recruit and retain as the stress of the job increases and poor working conditions drive down morale.

Cynical commissioners do nothing to relieve the pressure on emergency services in local hospitals, and then penalise the hospital trusts for admitting extra emergency patients, paying less than a third of the normal rate for every additional patient above 2009 levels, while in a double whammy the same trusts also face soaring bills for hiring agency staff to cover the extra work.

Some clinical commissioning groups (CCGs) are even rubbing their hands at the amount they will receive from fining local trusts for delaying ambulances outside A&E for lack of beds. CCG financial statements celebrate these huge headaches for hospital bosses as the “upside” for CCG financial balance sheets.

With commissioners like these, it’s small wonder that a majority of NHS trusts are facing deficits, while many CCGs are in surplus. But trust finance directors know there is much worse to come.

Each year the “tariff” fixing the price hospitals are paid for each treatment is reduced, while the pressure on services and costs increases.

Each year CCGs try to squeeze down the numbers of patients treated in hospitals and divert them “into the community.”

And since the Health and Social Care Act regulations have required CCGs to break up the NHS into bite-sized chunks and put them out to tender, more and more hospital trusts stand to lose more and more of their elective services — and the revenue to run them — putting other services at risk.

With precious few honourable exceptions, the creation of CCGs as local commissioners of services has been one of the worst aspects of Andrew Lansley’s huge and complex Act carving up the NHS.

The tiny handfuls of GPs who have got involved with CCGs have proved themselves at best irresponsible and at worst self-serving. In Bedfordshire one of the first CCGs to open a competitive tender for musculoskeletal services shamelessly awarded the five-year contract to a consortium led by Circle Health, but also including a company owned by almost half the GP practices in the county — while delivering a further blow to the financially challenged Bedford Hospital Trust.

Elsewhere CCGs are putting vital hospital services at risk. In West Sussex the CCG chose Bupa as the lead provider for another lucrative musculoskeletal contract, ignoring warnings that this could jeopardise A&E services in the two main acute hospital trusts, at Worthing and St Richard’s in Chichester.

Nottingham University Hospital Trust has been forced to close down its top-performing dermatology service after most consultants resigned rather than have their contracts transferred to private provider Circle, which had been awarded the contract as main provider of dermatology by Rushcliffe CCG.

Word has clearly spread on Circle as an employer and the company has struggled to recruit or retain staff.

Up and down the country CCGs, singly or in new alliances, are drawing up madcap plans for cash-driven “reconfiguration” of services.

They ignore the mounting evidence that even if they do invest in expanded community and primary care services they are unlikely to reduce the numbers needing hospital care or save significant amounts of money.

A similar message comes in analysis by the Health Service Journal of the Better Care Fund, for which billions have been top-sliced from NHS budgets, in the hope of securing better co-ordination of care with social care and local authorities.

It is due to begin next year, but a director of the iMPOWER consultancy which is advising councils on implementation of the plans has told the Health Service Journal that the projected savings in the first year, which centre on reducing numbers of emergency admissions, are “wildly optimistic.”

But the irresponsibility does not stop with CCGs. We have also seen a series of disastrous decisions taken by NHS England, screwing up specialist mental health services for children and adolescents and forensic mental health, now planning to dump the commissioning of renal services including dialysis onto ill-prepared CCGs which have no wider overview, and even allow these “GP-led” commissioning groups to commission GP services.

NHS England is also opening up a competitive tender for a £1 billion contract to deliver back-office support to GPs — and excluding the existing commissioning support units from bidding, since they might fall foul of competition watchdogs. In other words, only private-sector bidders need apply.

In the midst of this mounting chaos Simon Stevens, appointed this year as CEO of NHS England, published his Five-Year Forward View, which has been immediately condemned by campaigners as a “blueprint for privatisation” but is seen by even its warmest supporters as unrealistic and over-optimistic.

It calls for an extra £8bn in funding for the NHS in the years 2015-21, to run alongside a staggering extra £22bn in “efficiency savings” which Stevens hopes will bridge the widely predicted £30bn gap between frozen NHS budgets and soaring costs.

Among the optimistic assumptions is Stevens’s idea that health promotion and measures to prevent illness can generate almost instant savings, when it is widely acknowledged such measures take decades to deliver results.

Stevens also echoes the three main political parties in pinning his hopes on “integration” of services.

He envisages new hybrid bodies linking hospital trusts and GPs as “multispecialty community providers” and “primary and acute care systems” — which may offer some theoretical benefits if delivered as public services, but would look very much like some US healthcare systems if they were run by the private sector.

There are significant obstacles in the way of such plans, not least the ability to retain existing staff and attract new recruits to sustain services.

GPs in particular are unlikely to be any more enthusiastic about Stevens’s plans than they were about Lord Darzi’s proposals for “polyclinics” in 2007.

The costs and staffing problems of delivering seven-day working, another main theme of Stevens’s proposals, are also a serious problem.

Some patients may say they want services run this way, but precious few staff want their working week changed to a seven-day model.

At best it seems that Stevens’s plan is a pipedream. At worst it could be reshaping the NHS for a corporate takeover by companies like his old firm UnitedHealth.

Since none of it could proceed without at least £8bn additional funding, the plan doesn’t fit with the guarded promises of any of the main parties.

The most tangible effect will be to divert the attention of many managers to another round of reorganisation, while the daily pressures on services increase to breaking point.

Worse is to come — by the shortest day of 2014, few areas had yet experienced any harsh winter weather.

A serious cold snap, triggering more emergencies and admissions, coupled with more spending restrictions in 2015, more cuts, more closures and more chaotic fragmentation could generalise the crisis conditions and undermine the Tory bid for victory in the May election.

But we still have not seen Labour offer any clear alternative.

We have the weak ambiguous formulations of Clive Efford’s private member’s Bill in the Commons proposing to partly repeal sections of the Health and Social Care Act, but leaving the purchaser/provider split, the huge overhead costs of a competitive market system, the irresponsible, privatising CCGs, the burdens of EU competition law and the threat of the Transatlantic Trade and Investment Partnership deal — David Cameron’s pet EU project — unchanged.
Andy Burnham, as shadow health secretary, has explicitly defended a role for the private sector.

Labour has promised an extra £2.5bn for the NHS in a Time to Care Fund financed through a “mansion tax” and taxes on hedge funds and tobacco profits.

But none of these will offer immediate returns, and each of them could be delayed or knocked off course.

Labour is still tied in to the Tory austerity approach and has made no promise to reverse cuts in council budgets that have undermined social care.

And far from offering action to deal with the unaffordable costs of many PFI schemes, which are pushing more trusts towards bankruptcy, Ed Miliband recently defended PFI as “the right thing to do.”

Another danger is the Labour endorsement of plans promoted by top Tory Francis Maude, with the backing of Lib Dems, to persuade NHS and foundation trusts to opt out of the NHS and public sector, relaunching themselves as “mutuals.”

This would potentially drag tens of thousands of NHS staff out of NHS pay agreements, terms and conditions, and establish more and more providers as freestanding companies. This would take our health service back to the 1930s.

It’s clear that even if we remove the Tories as the immediate enemy of the NHS as a public service, we will still have to fight to force a Labour government to break from the policies of Tony Blair and new Labour that laid the groundwork for the Lansley Bill, policies which are still dominant today.

We need a fight to restore the core values of the NHS and reinstate it as a public service, not a vehicle for profit-seeking private corporations.

So 2015 will be a crucial year in which our NHS could be won or lost. Let’s have no truck with the Tories — or with any government that wants to privatise, marketise and cut back our NHS. Let’s keep it in one piece — and keep our NHS public!

John Lister is director of Health Emergency.

Further resources on the NHS can be found at www.peoplesnhs.org, www.keepournhspublic.com, www.healthemergency.org.uk.