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DOCTORS last night accused David Cameron of plotting to smash up the NHS as he sets out plans to rush through privatisation of the historic public service.

Critics fear the move will lead to closed hospitals, lengthy waiting lists, rationed medicines and a steep decline in the quality of care for patients.

And staff warn health reforms he will put before Parliament on Wednesday will spell the end of the NHS as we know it in a kick in the teeth for the dedicated staff who have worked ­tirelessly over the decades to provide free care for millions.

In a key speech today, the PM will say he wants more “competition” and “greater independence” for hospitals and schools. And in a worrying sign for thousands of workers, Mr Cameron is to claim he wants “one of the great legacies of this Government to be the complete modernisation of our public services”.

But experts fear the move is a cynical ploy to flog off large parts of the NHS to private medical firms who will put profit before health.

Mr Cameron was also accused of breaking his pre-election promise that there would be no more NHS “top-down” reorganisation.

Dr Clare Gerada of the Royal College of GPs said the shake up being pushed through by Health Secretary Andrew Lansley could “remove the letter N from the letters NHS”. Mr Lansley is planning to hand control of 80% of the NHS budget to groups of GPs or consortia who will be ­responsible for buying ­treatments, operations and drugs for their patients.

Strategic Health Authorities and Primary Care Trusts will be axed. In his speech today Mr Cameron will boast that 140 GP consortia are already poised to start work.

But a report by the NHS Confederation which ­represents doctors, ­administrators and medical groups, said the reforms were ­“extraordinarily risky”.

Shadow Health Secretary John Healey said: “This report is a big red warning light ahead of the ­Government’s legislation. The more health experts see of the plans, the harder they find it to say something in support.

“The NHS is David Cameron’s biggest broken promise to date. He made the personal pledge to protect the NHS and his Coalition Agreement could not have been clearer in saying, ‘We will stop the top-down internal reorganisations of the NHS that have got in the way of patient care.

“The policy aims of more patient involvement and clinical control of commissioning are sound but can be achieved by the evolution of Labour’s reforms, not Mr Lansley’s revolution of NHS organisation.

“The report is a comprehensive demolition job on the Conservative-led Government’s handling of the NHS. Ministers are putting unprecedented pressure on the NHS by forcing through this high-cost, high-risk internal reorganisation and breaking their promise to protect NHS funding.

“Everyone saw big improvements in the NHS with Labour, but many great gains for patients are being put at risk by this reckless reorganisation.

“The report confirms that those who run our NHS see the Government’s reorganisation plans as a cocktail of instability and uncertainty, laced with broken promises.”

Lib Dem Andrew George also attacked Mr Cameron’s planned changes. He said: “The structures the Government is putting in place put at risk the public sector ethos of the NHS.”

He claimed Mr Lansley was allowing private firms to “cream off” the best bits of the health service.

The Confederation warned that the Government’s plan to allow “any willing provider” to carry out NHS work would lead to the further privatisation of the service. It warns that the NHS will have to shrink to make space for private firms and says the “closure of existing services will be ­necessary”.

Mr Cameron will defend the changes, saying they will be carefully “worked through”.

He is to add: “That’s exactly what we have done through our years of preparation in opposition, and we will continue to do so every day in Government.

“But remember this. Every year we delay, every year without improving our schools is another year of children let down, another year our health outcomes lag behind the rest of Europe, another year that trust and confidence in law and order erodes.

“These reforms aren’t about theory or ideology, they are about people’s lives.”

But the NHS Confederation’s acting chief executive Nigel Edwards warned Mr Cameron to stop and think before ­railroading the changes through without consulting NHS staff.

He said: “Having a vision is all well and good, but you’ve got to understand how to get there. You have got to ­understand that these changes will be taking place during what will be one of the toughest years the NHS has ever faced.

“Real transformation will only happen if staff and patients are on board.

“Getting them engaged will require a compelling story about what the reforms will mean for the way our NHS care is delivered, how it will change and how it can be improved.”

Hospitals

Health Secretary Andrew Lansley wants to abolish Labour's cap on how many private wards a hospital can run - currently about 2% of income in most trusts. Warnings have been issued that hospitals will eventually be completely privatised. Hinchingbrooke Hospital in Huntingdon, Cambs, may become the first to be run by a private firm, despite an outcry from patients.

GPS

Consortiums led by family doctors will manage £70billion of NHS cash to pay for services such as hospital care. The market will be worth about £500million. In London, plans to privatise out-of-hours GP services have already caused widespread concern among GPs, who say quality will be reduced for 950,000 patients who currently rely on a non-profit making company.

Waiting lists

Nhs patients are being urged to get private health insurance as cuts send waiting lists soaring. Mr Lansley has axed two of Labour's key waiting time targets: 18 weeks from referral to treatment and the right to see a doctor within 48 hours. Shadow health secretary John Healey said private healthcare providers "know Tory governments are good for business".

Social

Services at risk include those run by the British Red Cross, which helps people settle back into home life after long stays in hospital.The over-65s, especially those recovering from falls, rely heavily on the scheme, in which volunteers drive patients home and check up on their pets. Such services save each NHS commissioner an average of £1million every year.

Payment

Charges for prescriptions are creeping up. The National Consumer Council has called for a review, pointing out that 80% of adults in England have to pay £6.30 per item.Hospitals in Scotland, meanwhile, have been criticised for setting up premium-rate phone lines. NHS parking charges have been dubbed a "tax on the sick" after rising by up to 150% since last summer.

Jobs

Up to 27,000 nursing roles will be cut for the efficiency drive - equivalent to shutting six major hospitals, according to the Royal College of Nursing. Plans to axe all 10 strategic health authorities and 152 primary care trusts will hit at least 60,000 managers. More jobs will be lost if NHS Professionals, a jobs agency with 50,000 shift workers, is sold off.