David Cameron's first year as Prime Minister has been a year of chaos, confusion and waste for the NHS. He promised at the election to "protect the NHS" and "stop the top-down reorganisations that have got in the way of patient care".
Since then, we've had weak leadership, poor communication, bad policy and rushed legislation as part of the biggest top-down reorganisation in NHS history. Even Professor Steve Field, whose advice as chair of the Prime Minister's Future Forum will be published tomorrow, has said the Government's NHS changes are "unworkable" and could "destroy key services".
All efforts now should be dedicated to reforms that the NHS needs to rise to the three biggest challenges – improving the quality, safety and consistency of care for patients; integrating services better, especially for elderly people and those living with long-term health problems; and increasing efficiency, as public finances are squeezed. But as doctors, nurses, patients groups, NHS experts and even the Tory-led Health Select Committee have all cautioned, the NHS reorganisation makes meeting these challenges harder, not easier.
The Government's declared aims – a stronger role for clinicians in commissioning care, greater involvement of patients, less bureaucracy and more stress on improving results for patients – could all be achieved by the evolution of gains that Labour made, without legislation.
But the legislation is needed to pursue the revolution of turning the NHS into a full-scale market, modelled on the privatised utilities and driven by the force of competition law. This Tory revolution removes proper public accountability, and breaks up the NHS so patients will see greater inequality in services.
In the long term, this means many of the most important decisions about who provides what services may be taken by lawyers in the competition regulator and in the competition courts of London or Luxembourg and it means a postcode lottery in health care for patients.
Running throughout Cameron's plans is the basic Conservative free-market creed, "private sector good, public sector bad". This is why I have argued since last year that these are the wrong reforms, for the wrong motives, at the wrong time.
Public concern about the NHS is the highest for three years, and rising rapidly. Patients are starting to see waiting times rise and treatments cutback. Professionals in the NHS have no confidence in the Government's decisions or direction.
The test for Professor Field's report tomorrow is how far and faithfully it reflects the criticisms of the NHS plans. The test for the Prime Minister is whether he'll honour the promise he made to protect the NHS by making fundamental changes to his NHS plans and scaling back his NHS reorganisation.
David Cameron is a PR man. I fear he'll look for a PR answer, and we'll see a political fix. He may claim he's making "substantial and significant" changes to the health bill, while he leaves his long-term ideological plans for the NHS intact. And he may claim he's making no-other-option NHS reforms, while his very changes make it much harder to tackle the challenges that must be met.
While the past year has been a wasted year for the NHS, I fear there's worse to come.
John Healey is the opposition health spokesman and Labour MP for Wentworth and Dearne