The NHS 10-year plan has cleared a path for total privatisation of our health service

World class healthcare is a tough ask after a decade of almost £40bn of efficiency savings, mass service closures and bed-to-population ratios lower than Eastern Europe

The latest strategy for Britain’s National Health Service has made some bold projections and headline-grabbing commitments. The endgame though is a corporate NHS.

The 1990s internal market introduced competition into the NHS. The NHS Plan 2000 ramped up outsourcing and public-private partnerships, and gave us the disastrous legacy of private finance initiatives, or PFI.

The Health and Social Care Act 2012 doubled private sector outsourcing to 8 per cent of the budget. It also enabled foundation trust hospitals to make up to half their income from private patients. There is a thread running through: a narrative of marketisation and privatisation.

To read this week’s pre-launch coverage of the NHS Long Term Plan, one would be forgiven for thinking it had laudable intentions ­– until the politically expedient rhetoric is peeled away and the narrative revealed anew.

In the press release, the phrase “out of hospital” care was mentioned only in passing. However, the actual document devotes its entire first chapter to the 21st century transformation of the NHS into US-style integrated care systems.

Building on the 2014 Five Year Forward View, the Long Term Plan is being touted as a way to reverse the damaging competition of the Health and Social Care Act (HSCA). The creation of integrated care combined with devolution will supposedly join up primary, community and hospital services with social care. Integrated care is therefore partly about provision of “care in the community” in order to reduce costs.

However, plans to create networks of GP surgeries and chains of super hospitals – accompanied by closures of individual GP surgeries (7,500 surgeries are slated to be reduced to 1,500 networks) and planned closures at over 60 hospital trusts – pave the way for economies of scale and therefore corporate takeovers.

If you don't believe me then just have a look at the chains of nursing and residential homes run by private equity and hedge funds. The Dalton Review specifically stated that either private companies or NHS trusts could run these super hospital chains.

Integrated care systems (already being rolled out) could ultimately become integrated care organisations with a single provider responsible for regional health and social care. There is presently nothing to stop these multi-billion-pound, 10-year contracts from being won by a private health or insurance company. In other words, far from reversing privatisation, integrated care would consolidate privatisation.

The 3.5 per cent average increase per year in funding for frontline services is welcome. However, it is still below the historical average for the NHS.

It is also worth noting that the funding issue is useful to the government for the way it frames the debate, and distracts from a discussion around privatisation. As I have previously written, the extra funding – announced as a 70th NHS birthday present – comes with strings attached related to the introduction of those US-style integrated care models.

The late Tim Evans – one of the arch-proponents of marketisation – once envisaged – that the NHS would be just “a kitemark attached to the institutions and activities of a system of purely private providers”. But it is true that the major pressures on healthcare costs come not from our ageing population, but from expensive drugs, new technologies and the catastrophic market experiment inside the NHS seeing which has tens of billions siphoned towards marketisation and privatisation.

NHS England Chief Executive Simon Stevens spent the best part of a decade as a senior executive at UnitedHealth – the largest private health and insurance corporation in the US. Previously as health advisor to Alan Milburn and then Tony Blair, Stevens was one of the architects of market expansion.

There is a term for it: corporate capture. The phrase was used to describe the effect of the revolving door between the financial industry and regulators before the 2008 financial crisis. Now there is corporate capture of health policy by big banks, private healthcare and insurance corporations, the big three management consultancies and the big four accountancy firms.

Meanwhile, digital health and big data could be the new gold rush. Silicon Valley and big tech want to crack open the NHS oyster and then expand globally. Unsurprisingly, the Long Term Plan devotes a section to digital healthcare. It also envisages the expansion of personal health budgets thus potentially enabling top-up co-payments for private health insurance.

The government spin centres on the prevention of heart disease, stroke and cancer. It also focuses on mental health, diabetes, smoking, alcohol and elderly care. Yet public health budgets have been slashed.

World class care is a tough ask after a decade of almost £40bn of efficiency savings, mass service closures and bed-to-population ratios lower than Eastern Europe. There are 100,000 vacancies across the NHS. The axing of the student nursing bursary and the redesign of the junior doctors' contract have served to only exacerbate these issues.

We are told that the Long Term Plan could save up to 500,000 lives over the coming decade. Yet shockingly 120,000 excess deaths have been linked to austerity since 2010. One study found that 30,000 excess deaths in 2015 alone were linked to cuts in health and social care.

This reminds us that health outcomes are correlated with socio-economic. Health secretary Matt Hancock tweeted yesterday about personal responsibility for health. This is health illiterate. In fact, health outcomes are directly correlated with socio-economic status.

Healthcare is not purely a clinical endeavour. If we want to genuinely improve the health of the nation then we not only require publicly funded, provided and owned universal healthcare. We also need to tackle climate change in order to dramatically curb air pollution, we should impose strong regulation on the food, alcohol, tobacco and pharmaceutical industries, and we must address inequality and the root causes of the mental health crisis.

Youssef El-Gingihy is a GP in London and author of the new, updated edition of How to Dismantle the NHS in 10 Easy Steps