The madness in this method

We are just two months into 2013, but already there have been four major events in the rapidly moving crisis of the NHS as it is wracked by unprecedented year-on year cuts and the looming chaos of the Health & Social Care Act in April. All of them have been during a frantic February.

First came the widely expected announcement that Health Secretary Jeremy Hunt had rubber-stamped the plans of the trust special administrator for the sacrificial carve-up of Lewisham Hospital as the key component of rescuing the two collapsed private finance initiative contracts that had bankrupted the neighbouring South London Healthcare Trust.

Administrator Matthew Kershaw had no real answer to any of the many hard-hitting and detailed rebuttals of his plans, not least by over 90 consultants at Lewisham Hospital who wrote in defence of these departments and resorted to simply brushing these concerns aside.

In similar fashion, Hunt chose simply to ignore the clearly expressed views of the consultants and the newly formed Lewisham Clinical Commissioning Group - the very GPs his own government's Health & Social Care Act claimed to be putting in control of commissioning local services in just a few weeks' time.

And of course Hunt's decision to endorse the closure not just of Lewisham's A&E but of all of its complex and emergency surgical and medical services, its busy and successful maternity unit, its trail-blazing Critical Care unit and its state of the art children's services flies in the face of some of the biggest ever local demonstrations of public protest over hospital closures, and the threat of Lewisham Council to challenge the ruling in the courts.

Not only would two-thirds of the Lewisham Hospital site be closed, bulldozed and flogged off to raise a few million towards the staggering £700m scheme to bail out the PFI hospitals in Orpington and Woolwich, but the cuts will hit South London Healthcare Trust as well, with the closure of almost all remaining services and sale of most of the site at Queen Mary's Hospital in Sidcup, and a massive attack on jobs, with over 100 doctors' posts to go, and hundreds more nurses and health professionals.

Hunt's ruling is important because it means that all of the administrator's key proposals - with only a cosmetic change of phraseology to disguise the closure of the full A&E at Lewisham and its replacement by a limited range of nurse-led services in an Urgent Care Centre - have been drawn up and now forced through in record short time since last summer with just the most tokenistic one-month "consultation."

The real danger is that this will now be the blueprint for many more top-down interventions with the use of these same draconian powers to ride roughshod over all local opinions, clinical and otherwise, where it looks difficult to achieve even the flimsiest pretence of a consensus for deep and painful cuts.

Funding has been put aside that could pay for another 60 cases to be treated the same way.

And the fact that the administrator was able to inflict major cuts on an otherwise unaffected and perfectly viable neighbouring trust - as part of his plan to sort out problems in the bankrupt trust next door - should be seen as a clear warning that once these powers are invoked, nobody's local services are safe from unwelcome intervention.

This should raise concerns, for example in Huntingdon where the still-troubled, relatively small Hinchingbrooke Hospital - managed by a private company - is the nearest hospital trust to the tottering Peterborough & Stamford Hospitals Trust that is running an annual deficit of almost a quarter of its £200m turnover since the opening of an unaffordable £310m hospital - funded through a disastrous PFI contract.

Already MPs from the Commons public accounts committee have pressed regional health bosses to consider cannibalising Hinchingbrooke to feed the PFI beast 24 miles away in Peterborough, lumbering Huntingdon residents with lengthy journeys for treatment - whether in Peterborough one way, or Cambridge the other.

But while the special administrator made full use of his extreme powers to intervene and to reorganise - despite local clinical and public opposition - the second major worrying development has been the decision of soon-to-be-abolished primary care trusts in north west London to press ahead with what has been described as the biggest-ever package of health cuts - leaving three boroughs with pockets of extreme deprivation (Ealing, Brent and Hammersmith & Fulham) without emergency hospital services. Four A&E units from the current nine in north-west London, in Ealing, Charing Cross, Hammersmith and Central Middlesex hospitals, face closure.

Over and above these cuts, which also involve the closure of all non-elective services and almost all in-patient treatment in Ealing and Charing Cross hospitals, there are plans in a strategy document that has been adopted without any public consultation for cuts that would close 28 per cent of beds across the eight boroughs.

This would undermine services not only where the A&Es are under threat but also in the hospitals that are supposed to receive the extra caseload after they're gone - Northwick Park, West Middlesex and Chelsea & Westminster, which each face a loss of a third of their beds.

These cuts went through in the teeth of mounting opposition from public petitions and protests and local medics and professionals.

No special powers were invoked, just the now traditional indifference of desperate NHS managers to public opinion where it does not agree with their proposals and the now customary charade of a completely spurious and insincere "consultation" in which no local views or criticisms were ever going to be taken on board.

There was one objective - to force the changes through before the new clinical commissioning groups take control in April, lumbering local GPs with the blame when these massive cuts result in wholesale chaos because the hospital cutbacks are not matched by any equivalent expansion or development of alternative community based health care.

The third major event was the publication of the massive 1,100-page Francis report on the catastrophic failure of health services triggered by cutbacks and a brutally insensitive management regime at Mid Staffordshire Hospitals Foundation Trust. The report itself contains some very important points, but ducks many key issues.

n It avoids pinning any direct responsibility on any of the senior managers whose indifference and negligence allowed such appalling lapses from acceptable standards to go without intervention or investigation.

n It imposes legal obligations on front line staff to report failures in care, but offers them no protection against those who respond with bullying and victimisation.

n It fails to address the flawed "reforms" and the unrealistic financial targets that led management into such desperate actions - but are still forcing similar decisions from NHS managers all over England, and will get worse when the new Act takes effect in April.

n It argues that "It was or should have been the directors' primary responsibility to ensure either that they did deliver an acceptable standard of service or, if this was not possible, to say so loudly and clearly, and take whatever steps were necessary to protect their patients" - but includes no recommendation that might ensure this could happen.

Many of the 290 recommendations the report does make have already been ignored or dismissed by ministers - all the signs are that the Francis report will be at best a landmark, a fleeting interruption in a continued regime of bullying and cutbacks, as politicians force the pace to save £20 billion by next year.

The fourth major development is the underhand legal moves to compel clinical commissioning groups to put almost all NHS services out to competitive tender from April 1, which are being sneaked through Parliament in the hope of avoiding proper scrutiny by MPs.

Under parliamentary procedure, Department of Health-drafted regulations on the implementation of Section 75 of the controversial Health & Social Care Act would normally become law without debate 40 days after being laid before Parliament - the end of March - unless MPs mount a challenge and force a debate.

Behind the arcane wording and legal phrases, the impact of these regulations would be to force clinical commissioning groups to open up virtually all services to competition, either through competitive tendering or using the "any qualified provider" market.

This step, designed to maximise the level of privatisation, flies in the face of explicit assurances given in a letter to all GPs a year ago, as then health secretary Andrew Lansley attempted to defuse widespread fears and professional opposition to his contentious Bill.

The government has quite cynically reneged on its own worthless pledges, through regulations which are set to take effect at the end of March, just before clinical commissioning groups take over responsibility for NHS local commissioning budgets.

The new laws would tie the hands of GPs before they even reach towards any levers of power over local budgets.

This will be tightly policed. Regulator Monitor is given greater powers to step in where it deems these new rules have been broken.

The regulations also prevent any attempt to treat existing NHS organisations as "preferred providers." Instead they put in place an EU-style "right to establish and provide services."

This compels any clinical commissioning groups that do opt to use "any qualified provider" to accept all of the providers that have been approved by the Care Quality Commission and Monitor, and to include them on the list of providers they offer to local patients. It leaves no local discretion for clinical commissioning groups to assess the quality of services.

Labour MPs have mounted a challenge, both in the Commons chamber and forcing a debate on the regulations by the health select committee, and have made some Lib Dems squirm with embarrassment and seek further clarification from their Tory masters.

Thirty-Eight Degrees mounted a petition which drew a staggering 200,000 signatures in a few days.

Professional bodies have weighed in opposing the regulations - but Cameron has stood by the proposals at Prime Minister's questions and there is no sign the Tories will back down if they thinks they can swing gullible Lib Dems onside as they did with the Bill.

The regulations cannot be amended - they have to be rejected or withdrawn if they are not to become law by April 1.

The stakes are higher than ever. The NHS as we know it is being massively changed with little if any in-depth mainstream media discussion, and even less widespread public awareness of the scale of the upheavals. Protests have so far been restricted to defending local services against closure.

From this important beginning we must do everything we can to create a broad, popular movement to resist the incremental destruction of our NHS, resist every cutback, every insidious move towards privatisation and every outrage against local democracy.