Lansley's pincer attack tightens

So despite all our efforts Andrew Lansley's Thatcherite Health and Social Care Bill was carried through its second reading vote in the House of Lords by the votes of the Lib Dems and a few others, with Labour and the Tories exactly cancelling each other out.

The Lib Dems are helpless hostages in the control of the Tories, polling on a level with or just below the Green Party.

They will be wiped out at the next election, losing ministerial cars and fat parliamentary salaries.

They know it too. Maybe that's why their opposition to Lansley's Bill - led by a gallant few - has largely petered out. Even Shirley Williams didn't vote in the Lords.

But the Lib Dem shame must not divert from the fact that it is a Tory Bill, promoting Tory values. It's a determined effort to drive through the privatisation that Thatcher chose not to do.

The Bill is not out of the woods yet - there are still weeks of committee stage discussion in the Lords and the early signs are that there is likely to be more stomach for this piecemeal guerilla resistance to specific clauses than there was to turn the whole Bill over.

Every week it drags on does more damage to David Cameron and the Tories, for whom the NHS - and the Bill - are once again a toxic issue.

Some very interesting figures tell the story. A poll of 1,900 GPs by the Royal College of GPs (RCGP) found a staggering 78 per cent against the Bill, with just one GP in six (16 per cent) saying they wanted to be involved with the new commissioning groups.

On one level this is no surprise because a majority of GPs have been opposed to Lansley's white paper and the Bill from the start, even though a wafer-thin majority of BMA GPs initially accepted the principle of GP-led commissioning.

But on another level this solid and growing opposition among the very people who are supposed to be empowered by the Bill, and to whom Lansley plans - in theory - to devolve a massive £80 billion in commissioning budgets, is remarkable. It bucks the trend of MPs, peers and others who have begun to justify their acquiescence on the grounds that much of the Bill is already a fait accompli.

That's why Lansley, key NHS managers, and the handful of fanatically pro-market GPs who are heading up the consortiums have been forging ahead, implementing more and more of the Bill in advance of it completing the parliamentary process.

Senior primary care trust managers have been departing in droves, leaving vacant posts and confusion in their wake, while commissioning groups have begun signing up firms of management consultants, giving us a clearer idea of who will really run services if Lansley eventually gets his Bill through.

The RCGP poll shows that GPs have not been cowed by this.

Another interesting survey has also punctured the illusion that Lansley has won over any broad GP support. It shows that while the local commissioning groups talk big and act tough, the vast majority of their leaders are unelected - only 7 per cent of commissioning group board members have been subject to competitive election.

Most GPs are ignoring them and just getting on, caring as best they can for patients.

It's not just GPs who are unmoved by Lansley's rhetoric - 84 per cent of psychiatrists, in a poll of 1,890 members by the Royal College of Psychiatrists, were also against the Bill, convinced it would do nothing to reduce bureaucracy or improve services for their vulnerable patients.

And the Academy of Medical Royal Colleges, representing 20 royal colleges has registered "united opposition" of its members to aspects of the health Bill - notably the proposals to promote competition.

Even the normally docile Patients Association has spoken out on its members' fears of the consequences of Lansley's Bill.

So it's more or less unanimous on all sides - thousands have marched and tens of thousands have petitioned.

But Lansley and Cameron have blocked their ears and closed their eyes, and there was not enough life left in many of the Lords to undo the damage done by MPs.

But as evidence mounts to show how Lansley's Bill would open up a weakened and fragmented NHS to private-sector vultures, the other side of his pincer attack can be seen in the scale of the cutbacks taking shape up and down the country.

Whipps Cross University Hospital has asked staff if they would be willing to give up paid leave and work unscheduled time for free.

Primary Care Trusts in South Essex are seeking cuts of £300 million, with Basildon & Thurrock Hospitals Trust looking down the barrel of £34m cutbacks, with the loss of 100 beds and hundreds of jobs, and Southend is looking to axe 56 beds and hundreds of jobs.

In Yorkshire the state of the art £66m emergency service at Pontefract Royal Infirmary, expensively rebuilt as part of the £380m PFI scheme for a new hospital, seems set for closure as the cash-strapped trust searches for £60m of savings while paying its big and growing PFI bill.

In Staffordshire cuts are not only hitting the University Hospital of North Staffordshire - where another expensive PFI is set to trigger a loss of 300 beds and a new cull of jobs - but its notorious neighbour the Mid Staffordshire Hospitals Trust.

Even while the public inquiry continues into the virtual collapse of care in its A&E which killed dozens of patients a few years ago, Mid Staffs is again contemplating desperate cuts to balance its books.

It's a grim reminder of the catastrophic situation which led to staffing being cut below minimum levels - to save £10m a year.

So bad is the situation for many trusts that, following dire warning from the National Audit Office on the state of hospital finances, Lansley is expected to announce loans and subsidies to prop up anything up to 40 of the weakest, some of which may otherwise go bust.

Meanwhile, below the radar of media attention, cutbacks continue unabated in mental health.

And the Care Quality Commission survey that recently exposed widespread and gross failures in elderly care also reminds us that neglect and under-funding are the order of the day here too, as trust bosses focus all their energies on targets for financial cuts and elective - waiting list - care.

And frail older people discharged from hospital face the grisly reality of constant social service cuts, while many in cheapskate private care homes face problems easily as bad as those on NHS wards - but forking out from their own savings to pay for the privilege.

All this reminds us we have a brutal, old-style Tory government, dragging us back to the nastiness of the 1980s.

The union leaders who have ignored these issues and focused narrowly on the public-sector pensions fight have missed an important opportunity to build a broad and active alliance to link up with the fight against cuts, against privatisation, against the Bill and in defence of the NHS and its workforce.

It's vital that NHS staff rally behind the unions, turn out and vote Yes in the ballot, and make the November 30 day of action a massive blow in defence of public-sector pensions - but this would all be much stronger as a united fight to stop Lansley and Cameron smashing our NHS to fuel the profits of their city pals.

We have to have this fight. Let's join together and make sure we win.

John Lister is director of Health Emergency.