Today the NHS is dying. Cameron & Clegg will never be forgiven.

So let's mark this date in our calendars and tell our grandchildren. The NHS - that wonderful institution created after a war in which every family came to experience first-hand what it was to suffer and to lose loved ones -  is officially dying. Today, the Health and Social care bill became law.

• It allows private providers to cherry pick what services it provides leaving NHS to pick up the problem patients which don't present an easy profit (the Lib Dems have claimed they have amended the bill to prevent this happening but their amendment only demands that providers are transparent when they do cherry pick).
• It forces hospitals to compete against each other for funding meaning that they are at threat of unplanned closure if they don't get enough patients. It also promotes competition rather than integration of care which is what is needed to help better manage the prevention of long-term conditions such as diabetes and liver disease, two illnesses that are rising exponentially and are a massive drain on NHS resources.
• It allows up to 49% of work at NHS hospitals to be given over to private patients effectively doubling the waiting list for those people who can't afford private health insurance.
• The risk register, that the Government refused to release despite repeated demands to do so from the Information Commission, was leaked yesterday. It is thought to be an early draft but it clearly warns that the Bill could make the NHS unaffordable: "[A risk that ] design work proceeds without the confirmation of cost envelopes for each organisation which means that the future system design is signed off, and the Bill proceeds, without assurance that the whole system is affordable. One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system". The document continues:: "[A risk that] Future efficiencies cannot be managed and driven through the system effectively, because there is no organisation to plan and manage holistic efficiency programmes. So there is a risk that costs of the future system cannot be controlled."

So what are my predictions?  

• In the short-term there will be a vacumn of authority as the old system devolves power to GPs who are learning on the job. I predict there will be a flurry of contracts awarded to private companies to take control of local commissioning and health services as GPs struggle with the enormity of the challenge imposed upon them

• In the medium-term integration between departments and hospitals will begin to splinter as hospitals concentrate on pulling punters into their doors in order to 'win' funding from GPs. (For example from my own experience Chelsea & Westminster hospital send their doctors to Brompton hospital to enable joint consultation for CF patients who also have liver disease. I can imagine such arrangements ending due to funding complications.)  

Waiting lists will rise as services try to stick to budgets by rationing care

More and more obese people and smokers will find themselves denied services as GPs find any excuse to limit care in order to meet spiralling costs. 

National scandals will arise in which private health companies are accussed of patient neglect and care as they cut services in order to make a profit. This has already happened under Bupa.  

• In the longer-term, we'll all get used to paying for some NHS services. I can easily imagine paying for evening and weekend doctors appointments as it'll be billed that you are buying the convenience of the time, not the service. 

It'll become routine to take private healthcare if you can afford it.

• In the very long-term the NHS will become a safety net only for those who have no private healthcare, and people will expect only the most basic care for it. 

As such the life expectancy gap between the rich and poor will continue to widen.

So as I say, mark this date in your diary. The health and social care bill is the worst thing this Government has done while in power, and Cameron and Clegg will be hated for it by future generations far more than Thatcher ever was for her deindustrialisation drive and war on the miners.

NHS reforms pose worrying questions for Britain’s democratic process

At the end of April, amid growing condemnation of NHS reforms, the Government asked for a 'pause' in the Health and Social bill to allow it to perform a second consultation. As the third reading of the Health and Social bill starts today it would be fair to assume that a pause in the legislation has translated nto a pause in ground-level implementation. But that hasn’t been the case.

In early July, Lansley announced at the NHS Confederation conference in Manchester, that the 'pause' in the Bill was "over. It's now time to act” - which may explain the speed of reform over the summer.

After last year’s initial consultation process, when doctors said they would struggle to meet the 2013 deadline for all GP surgeries to be part of a local consortium to manage NHS budgets, Lansley declared in December 2010 he would “press ahead immediately with pathfinders of emerging GP consortia”. Ostensibly they would blaze a trail for the proposed reforms and help the Government discover any potential future pitfalls in the plan. However, since the Bill is yet to pass, these consortiums are operating “under existing legislation”. At best this seems undemocratic as, according to Lansley himself, 97% of the population is now covered by these consortia without any legislative change to account for this rapid transition.

This leaves the NHS reforms in a muddle as, in a speech at University College London Hospital in June, David Cameron scrapped the 2013 deadline for GPs to take on full commissioning responsibility. With PCTs already offloading staff (Freedom of information requests from 54 PCTs show that at least 2010 jobs have been shed through a combination of redundancies, unfilled posts and mutually agreed resignation) and some consortia further advanced then others, what will fill this authority vacuum?

A recent investigation by trade magazine Pulse found that only 84 PCT-led GP surgeries now exist in England and PCTs are re-tendering existing PCTMS contracts (for which they are directly responsible) under the belief that any such contracts still in existence by April 2013 will not be legal as PCTs will not exist. Of the four types of alternative contracts the PCTs could choose, 41 of these 84 practices have had, or are in the process of having, their contracts retendered under Alternative Provider Medical Services (APMS), which has been specifically designed to broaden the range of providers that GPs can commission from. In short it allows private companies to bid for GP contracts. Unison has said of APMS contracts: "Worryingly, APMS contracts allow for increased privatisation of primary care services and a profit-driven approach to health care provision".

Just as worryingly, some PCTs want to put out to tender entire care pathways, opening up its patient care provision to private companies. According to Pulse: "NHS East of England plans to auction off £300m of services to GPs, private companies or a combination of the two, in pathways including respiratory and musculoskeletal medicine." A further eight PCTs are expected to follow suit.

Yet the health bill’s most contentious aspect has been the desire to open up the NHS to “any willing provider”. Following strong criticism, the wording in the Bill is likely to be changed to “any qualified provider” meaning that all providers would have to meet a set of standards – yet as these are yet to be agreed upon, it seems the offloading of entire care pathways is moving faster than the legislation that allows it to.

Finally, the Department of Health has announced that Hinchingbrooke NHS hospital in Cambridgeshire has been given the go ahead to be run by a private company, called Circle Health, as long as the Treasury approves it’s “viability” . This contract has been given an initial green light despite the fact that the company in its recent flotation document warned that a profit might "become unachievable". Having watched the disastrous collapse of care homes operator Southern Cross, putting many patients at risk of becoming homeless, it seems extraordinary that the Government is considering allowing a company to take over a hospital when it has openly announced it may struggle to make and maintain a profit. This will call into question the long-term survival of Hinchingbrooke or the need for a Government bail-out should Circle Health fail to keep its investors happy.

When they return to debate the Health and Social Bill this week, I think many MPs will be shocked at the pace and extent of ground-level reforms. It seems almost inevitable now that GPs will take on some form of commissioning as PCTs have all but dismantled themselves, even though the Bill allowing this to happen has yet to be signed off. Meanwhile private companies are already sniffing out profits by taking on GP contracts, care pathways and even whole NHS hospitals. It poses worrying questions for Britain’s democratic process when the sitting Government pushes ahead with reforms while intense debate in the Commons has by no means reached its conclusion.