Last year I described the Government's Health White Paper as "an avoidable train crash". Since then, with the Health Bill published and GP commissioning consortia rolling out, I admit I was wrong. It will be far worse.
The resulting carnage of a dismembered and disintegrated health service will provide rich pickings for private companies and the unscrupulous among private GP contractors. The fractured NHS will be monumentally difficult to hold together.
Ministers have been desperately cobbling together selective statistics which they hope will demonstrate that the NHS is not as good as it could or should be. It's true and it could be a lot better. But that doesn't justify the complete trashing of all of the institutional architecture of the NHS.
Indeed, it has the risk of being disastrously wrong; because:
* It attempts the biggest re-organisation while simultaneously seeking the greatest cost savings in the 62 years of the NHS, indeed at a level never tried by any other health system anywhere in the world;
* It opens the door to profit-seeking private companies to run the easier and more profitable bits of the NHS, thus undermining the viability of many of our core public health services and hospitals;
* It risks the disintegration of the NHS at a time when everyone believes it should be more (rather than less) seamless and better integrated with social care services;
* It hands extensive powers, and most of the NHS budget, to a narrow group of private contractors – GPs, some of whom are horrified at being turned into NHS managers.
The Health Secretary's decision to press ahead with GP consortia is prejudicing decisions which have yet to be made by Parliament. It is one of the oldest tricks in Government: to do so much ground preparation work that it leaves MPs no choice other than to let it go ahead. Creating GP consortia whilst allowing the primary care trusts to be dismantled before our eyes is creating an environment in which parliamentary debate is effectively bypassed.
The pressure on GP consortia and the freedoms afforded to "any willing" private company will contribute to the break-up of services which ought to be acting together as an integrated whole.Is that really what we want for our NHS?
Andrew George is the Liberal Democrat MP for St Ives