A brand new hospital in the New Forest, to be paid for by the NHS, is handed over to the management of a private company before it even opens: in Oxfordshire a long-standing NHS orthopaedic hospital, which has just spent millions on rebuilding work, faces the threat of closure or merger as private sector treatment centres hijack the simplest routine cases.
Two Essex NHS trusts scrap plans for new hospitals because they face massive losses under the new system of payment by results: west Hertfordshire residents fight the "centralisation" of A&E services on the condemned crumbling site of Watford General, now plans for a £550m super-hospital have been binned. In Bolton 132 medical and nursing staff face the axe as a strategic health suthority opts to divert work to a private treatment centre.
Like the sorcerer's apprentice, Tony Blair's "modernising" reforms of the NHS now threaten to lurch out of control: they have conjured up a booming new, costly, private sector in health care provision, while the core public sector hospitals and health services are sent reeling from one cash squeeze and reorganisation to the next.
A new pamphlet outlining the dynamics and the implications of what it terms the "patchwork privatisation" of the NHS has just been published after months of research by the Keep Our NHS Public campaign.
It shows that while Thatcher's privatisation of state-owned utilities were high profile campaigns with mass sales of shares, the piecemeal process of hiving off key NHS services to private providers has been an obscure process, largely conducted behind a cloak of "confidentiality" with minimal public involvement or debate.
Especially tight security has shrouded the contracts for Independent Sector Treatment Centres (ISTCs) with all future decision-making now in the hands of Strategic Health Authorities with no local accountability to patients or public.
The Healthcare Commission this week underlined the lack of data on the clinical quality of ISTC services: but the general public is equally in the dark on the real cost of these controversial new units. Ministers admit that the ISTCs get paid an average 11.2% more than the NHS for each operation they do: but no details are published on the profits pocketed by ISTC companies at the expense of the NHS.
Similarly, the details of the £8bn worth of new hospitals to be built through the controversial Private Finance Initiative (PFI) remain under wraps, with deals signed behind closed doors and not a single unexpurgated full business case having been published.
Government figures now show the long-term cost of borrowing the £8bn capital in this way will be a staggering £53bn - £37bn in "rent" for use of the new buildings over 30-35 years, almost five times the initial cost. Had trusts been allowed to borrow as a conventional repayment mortgage at 6% they would pay back twice the cost of the initial investment - over just 25 years. The extra cost above this (equivalent to paying a massive 18% interest) is the premium that the NHS is set to pay for this one-sided, extravagant "partnership" with the private sector - without taking any account of further windfall profits from refinancing their loans on the money markets once the construction phase is complete.
It seems the secrecy surrounding these deals is because there is plenty that ministers are understandably eager to hide. But while every million extracted from the NHS in profit is a million less in resources for patient care, the real cost of private sector involvement is far higher than its profits and bureaucracy.
The NHS is being transformed from a comprehensive, equitable provider of healthcare into a tax-funded insurance fund, commissioning services from a range of providers in a new healthcare "market" which continues to destabilise many local NHS services - to make space for the new private providers.
Even though NHS spending has doubled since 1997, government policies have still triggered a constant sense of crisis and uncertainty among health staff, record deficits, job-losses and closures - and lost the confidence of the electorate, especially those who believed Blair's claim New Labour was the party to "save the NHS".
The "purchaser/provider split" which Labour in opposition correctly castigated as "costly and wasteful" has been widened - with tension between the purchasers (now primly termed "commissioners") - the Primary Care Trusts (PCTs) - and the providers (NHS Trusts and foundation trusts) exacerbated everywhere as each side seeks to resolve its financial problems at the expense of the other.
All of the constraints have fallen on the public sector: all the growth is in the private sector. That's why NHS trusts like Ipswich, which once sweated to reduce waiting lists and waiting times, are now being forced to drive them back up again, or face fines and penalties from indebted primary care trusts.
It's all gone horribly wrong, leaving a dozen ministers - and dozens more local communities - supporting local campaigns against "reforms" endorsed by Tony Blair. In 2005 New Labour were reinventing failure in health policy: now with their own Starship Enterprise they are exploring new dimensions in failure, with patchwork privatisation at the centre of policies that have managed to be both more expensive and more unpopular than ever before.
· Dr John Lister is Information Director of the NHS pressure group London Health Emergency. john.lister@virgin.net
