July is not yet over — but it is already jam-packed with symptoms of the escalating crisis and chaos unleashed by the coalition’s unprecedented spending freeze and top-down reorganisation to replace planned health services with a healthcare “market.”

June ended with revelations that the soaring numbers still crowding into A&E departments are driven by the fact that one in four could not get an appointment with their GPs.

July began with new figures on the scale of the cuts still being driven through in social care, even as local commissioning groups hatch more plans to downsize hospitals and deliver more care “closer to home.” 

Three-quarters of councils are using minimal 15-minute visits by poorly paid care staff to keep costs down — guaranteeing  poor-qua--lity care to those unlucky enough to get through increasingly vicious “eligibility criteria” by having needs serious enough to seek support.

In early July we also heard of the biggest-ever attempt to privatise health services, as Staffordshire care commissioning groups (CCGs) — shamefully egged on by Macmillan Cancer Support — got together to invite bids from profit-seeking private companies and “third-sector” organisations for a £700 million 10-year contract to run cancer services, and another £500m contract to deliver end-of-life care. 

All the usual suspects, the big firms which specialise not in patient care but in drawing up bids, seem likely to home in on these massive prizes, while cynical or unbelievably naive CCG bosses claim that this is not privatisation. But their actions make it clear they have written off any notion that the 13 NHS trusts currently delivering cancer care could deliver the “integrated” service that they claim to want.

Meanwhile the Nuffield Trust published figures showing the rapid increase in the share of NHS spending on community and mental health services being scooped up by the private sector since the coalition government took over in 2010. 

Bedfordshire’s fanatical privatising CCG, which has already handed over musculosketal services and now dermatology services to private companies (including a firm owned by half the GP practices in Bedfordshire), has declared itself “off to market.” It has sent out invitations to over 500 potential bidders to come and take a slice of the remaining local services from already struggling local NHS trusts. 

New spins on privatisation have also been prominent throughout July, with NHS England boss Simon Stevens outlining plans to give up to 5 million mainly elderly patients “personal health budgets” to spend on their own support. 

Even if average payments were as little as £1000 per head (a miserable £20 per week) this would milk a massive £5 billion — one sixth — of the NHS budget for care of older people and destabilise every surviving NHS community trust. 

Stevens’s plan came just weeks after an independent report by University of Glasgow and Kings College London researchers found no evidence to support the claims for the effectiveness of personal health budgets, and concluded that those promoting it were driven more by ideology than evidence “which not only fails to support their view but actually contradicts it.”

Towards the end of July came a renewed, concerted offensive for NHS trusts to be taken out of the public sector and turned into “John Lewis-style” mutuals — led predictably by Professor Chris Ham of the King’s Fund, backing up coalition ministers Francis Maude and Norman Lamb, with the obligatory tame one-time Labour frontbencher, ultra-Blairite Hazel Blears. 

They retailed the same old nonsense about “empowerment” and “engagement” of staff — ignoring the fact that not one of the NHS services hijacked into a “social enterprise” by domineering managers had held a ballot to test staff views, and that every time NHS staff have been asked their views on social enterprises, 90 per cent or more have voted to reject them.  

The notion of “empowering” staff by dragging them unwillingly into a new non-profit business that boosts senior managers’ salaries at the expense of destroying the staff’s pensions and terms and conditions is laughable.

Alongside all of the moves to break up and privatise the NHS, the mounting financial crisis has been making itself felt. 

Two-thirds of NHS trusts and many foundations ended the last financial year with deficits, and 19 financially troubled trusts — interestingly including Hinchingbrooke, franchised out to private-sector darling Circle — have been referred by the Audit Commission to Jeremy Hunt. Trusts seeking cash bailouts include University of South Manchester Hospital getting £25m to pay its onerous PFI bills, and West Hertfordshire Hospitals seeking a £45m handout to address its cash crisis. 

Cash-driven savings plans involving hefty cuts have been taking shape, including Leicestershire — where Leicester Hospitals Trust, £41m in the red, is borrowing money to open extra beds while local CCGs plan to cut more than 400 beds — and Lincolnshire, which faces the loss of upwards of 300 beds and the “centralisation” of A&E, maternity and paediatric services.

Bedfordshire and Milton Keynes CCGs are now also eagerly working to promote a cash-driven reconfiguration of hospital services in which either Bedford or Milton Keynes Hospital or both would lose their A&E services, resulting in journeys of upwards of 18 miles to access treatment. 

In recent days we have had Jeremy Hunt contemptuously dismissing any concerns over the impact of financial pressures on staffing levels and quality of care, insisting “money should never be an excuse.” 

Despite Hunt’s insistence just a month ago to local papers that both Charing Cross and Ealing Hospital would retain “full A&E” services, plans have now been published by Imperial Hospitals Trust to follow up the closure in September of Hammersmith Hospital’s A&E with the total carve-up of Charing Cross, reducing the 500-bed teaching hospital to a primary-care unit with just 29 beds on a tiny corner of the site, 55 per cent of which would be sold off to developers.

The list goes on — our NHS is under fire. The question is still where is the main opposition party, as individual councillors and local MPs battle valiantly to defend local services? Ed Miliband seems more preoccupied with arguments over pictures of his losing encounter with a bacon sandwich than taking any battle to the Tories.

Many will recognise at least the seeds of many of the recent developments in NHS privatisation as being pioneered by Labour in the last decade, and which the Tories have now eagerly embraced as their own.

But rather than learning from its failures or trading on their success in boosting spending on the NHS for 10 successive years  — and reaching top spot in the recent Commonwealth Fund survey of 11 comparable countries — Labour seems to have gone on the retreat.

The party has made clear it is not up for a real fight against the Transatlantic Trade and Investment Partnership (TTIP). Its policy forum has signed up for George Osborne’s public-spending limits at least for 2015-16, making a nonsense of its hints of restoring NHS funding to 2010 levels. 

Labour continues its constipated silence on the ongoing disaster of overpriced PFI contracts which are bankrupting trusts even as the Tories rubber stamp more of them. It has not committed to support the campaign by all the health unions for a break from annual pay cuts for 1.3 million NHS staff.

At the moment the agenda is being set by the Tories on their slash-and-burn mission to undermine as much of the NHS as they can before the next election, cynically believing Labour will not have the guts to reverse what they have begun. So far there’s not much to prove that this assessment is wrong.

Strong campaigns continue at local level across the country. There are folk left with faith to fight to defend our NHS. Labour must stand with them if it is to be taken seriously as an opposition — by the Tories, by health workers and by voters. 

John Lister is director of Health Emergency