It's a year since the Tory MEP Daniel Hannan called the NHS a "60-year mistake" on American television and prompted a public outcry. Hannan was promptly ostracised by the Tory high command as a dangerous maverick. The Tories officially loved the NHS, we were told.
But it is now becoming clear that Mr Hannan's crime was not in holding a different policy position. For David Cameron, now Prime Minister, and Andy Coulson, his communications director, his sin was to let the mask slip and give the public a flash of true Tory instincts before the election. It wasn't that they didn't have a radical plan in mind for the NHS. They did. But it was a case of the less said about it the better.
Now that plan has been published and it signals the end of the NHS as we have known it. Mr Hannan would surely approve and could easily have written it.
It is without doubt the most dangerous threat to the NHS in its 62-year history: a recipe to turn order into chaos, a fair service into a free-for-all, and to let market forces run riot. For patients, it means longer waits in A&E, months on waiting lists and a postcode lottery writ large.
That's because Labour's national minimum waiting standards – four hours in A&E, 18 weeks for an operation – will be wiped away, as will the publicly accountable primary care trusts (PCTs) which oversee the provision of decent, accessible services for all people in every locality.
Services will vary so widely between the new GP groups that, in time, the N in NHS will be redundant. No wonder Kingsley Manning of the consultancy firm Tribal, which stands to gain from the shake-up, has hailed Health Secretary Andrew Lansley's plan as "the denationalisation of healthcare services in England".
National waiting standards empower the patient with a minimum guarantee. Removing them takes power from the patient and hands it back to the system. As health secretary, I was always warned that, in tough financial times, the temptation for the NHS is to manage pressure by allowing waiting times to get longer. Now Mr Lansley has given every trust in the land permission to do just that and let patients pay the price.
It raises the spectre of the old Tory choice in healthcare – wait or pay. Private providers certainly anticipate more business on the back of longer waits. Jill Watts, chair of NHS Partners Network, which represents private suppliers of NHS care, says: "Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay."
More worrying still, alongside this, is the removal of Labour's cap on the amount of private work that foundation trusts can do. So with no national standards on NHS waiting times and no limit to the amount of private work, can we be sure that trusts will prioritise NHS patients? It may well make financial sense for hospitals to devote more theatre time to private work, let NHS waits grow longer, and thereby stimulate more demand for its private services.
It all points to the development of a market in healthcare. Indeed, we're told in no uncertain terms in the White Paper that there will be no bailouts for any local health organisation. So hospitals will be allowed to go bust and close.
Mr Lansley must explain what his "no bailout" rule means for patients. Is he really saying that the Government will no longer step in to protect essential hospital services?
And this raises the crucial question of where public accountability will lie. At the local level, GP commissioners will apparently have full freedom to spend public funds in public or private sectors. They will be under enormous pressure to make savings, just as PCTs are now. What if controversial decisions are made and some groups are deprioritised because of their complex and costly needs? Who do MPs complain to? Ministers will say to the new NHS Commissioning Board – which turns the NHS into the biggest quango in the world – but the White Paper makes clear that it will not intervene in local decisions.
This is a huge structural upheaval when the coalition agreement promised no more top-down reorganisations of the NHS. GPs are unprepared for it, NHS staff don't want it and patients never asked for it. It is a giant political experiment with no consultation, no piloting and no evidence.
Indeed, experts suggest that only 10 per cent of GPs at best are ready to take on these onerous new responsibilities. A survey from the mental health charity Rethink last week found that two-thirds of GPs are not confident about commissioning mental health services.
Indeed, we might ask, what is the Government trying to fix? Today, the NHS is providing its best-ever service to patients. Last month, the Commonwealth Fund judged the NHS to be the second best healthcare system in the world and top for efficiency.
This is an £80bn gamble with all of the progress made in the past decade. When I think of all the hard graft that went into making that improvement, it makes me want to weep.
Right now, the NHS needs to focus solely on meeting the financial challenge. Scandalously, we learn this week that the coalition may need to set aside £3bn to pay for its dangerous reorganisation – money that should be going on patient care.
So, my message to patients, doctors and staff who hate these plans as much as I do is this – get ready for the mother of all battles. Labour will bring forward a campaign over the summer to show the strength of opposition to these plans before the health Bill arrives in Parliament in the autumn.
We will defend our party's finest creation with everything we've got from a Bill that threatens to unpick its very fabric.
Andy Burnham is Labour's health spokesmanReuse content