I WILL deal with general practice next week, this being the bedrock of the NHS. I have not said how OUR NHS has been dismantled.

I wrote last week of ‘keeping the show on the road’. The vast majority of that million serving in it want to do just that, and have great goodwill towards it. But it had become a political football decades ago.

Since qualification in 1964 until partial retirement in 1992 I had witnessed about eight convulsions of ‘management’. The intended effect on the workforce is well summarised as ‘destabilise > demoralise > dismantle’.

An example. Early in the Thatcher regime a study was instituted by the Department of Health called the Resource Management Initiative. Eight hospitals were chosen to pilot this. I think Torbay was one.

Computer systems were installed and account kept for instance of even trivial items. The intention was economy but counting cotton wool balls was not. This plan was rolled out throughout the service BEFORE its usefulness was analysed!

When it was properly scrutinised the benefits were found to be insignificant. But burdens had been added, especially upon the nurses. In about 1988 a plan came out of the Rand Corporation via a Professor Enthoven, an ‘economist’. This was for an ‘Internal Market’. This had competition at its base – Sainsburys v Tesco style, and economy was meant to flow from it. Instead, hospitals and specialists had always co-operated for every benefit.

I briefed myself on the detail and saw it as the first stroke in felling the NHS. At a big meeting at Torbay with the Regional General Manager promoting this in front of about 70 consultants, I dared to say that it would at least double the cost of administration which was then about five per cent of the total NHS budget. The ex-nurse Ms Hawkins dismissed this. When I persisted with a second question I was instructed by the consultant chairman to ‘sit down’.

This hare-brained plan coming out of the US, where millions have no proper medical care and billions are spent in the medical insurance bureaucracy, was pushed through.

The cost of administration doubled at least in most hospitals, and in some it went even higher. Titles and desks proliferated. At Torbay there was a Patients’ Services Administrator but I had to write to tell him to remove the broken down floor polisher and crisp packets from beneath the stairway down to the dark basement and the Fracture Clinic.

There are dozens of examples of wilful but hidden destruction. The Princess Elizabeth Orthopaedic Hospital, Exeter is one. As I have written previously, I started training there in 1970, and was appointed a consultant in 1975. Along with five Exeter surgeons, two from North Devon, and two of us from Torbay we dealt with elective, ie planned, orthopaedic surgery except for Plymouth and its catchment.

We trained surgeons from around the world. The hospital had an excellent esprit de corps, and good facilities, especially its valuable 120 beds. Orthopaedic surgery has great potency in relieving chronic pain and disability. Our leading surgeon, Robin Ling, lobbied with us to expand the hospital; demand for our skills was growing and with it unnecessary waiting lists.

The hospital was re-engineered in 1986 – all the plumbing, a new Ward 3, and a boiler house with a 40ft chimney etc! Instead of two theatres, we had four so there were four operating lists every day. Then the steady barrage started up. The surgeons fought hard to keep this vital hospital with its beds shielded from the increasing flow into the general hospitals of acute medical conditions.

I helped lead the fight, and this included OUR NHS. I became suddenly very ill in 1992 with undiagnosed thyroid hormone deficiency, with these battles and a very heavy clinical workload being likely added factors.

In 1996 the hospital was bulldozed and an up-market housing estate inserted. I went on operating in the substitute P E Orthopaedic Centre helping with the waiting lists – mostly knee replacements. But with two wards only, and now over 30 specialist surgeons, beds are always scarce and cancellations very frequent.

The potential for a fully competent orthopaedic surgical service had been throttled. And we had predicted all that has happened. The same goes for the Community Hospitals. The April 1, 2012 Health and Social Care Bill presented by Lansley saw the end of a statutory duty of universal care.

You will not be surprised to be told that there was a completely new ‘management system’. This was constructed by an international bean counting firm – I think PWC.

It included ‘Clinical Commissioning Groups’. These were made up of GPs with one specialist member. In Devon it applied itself with vigour to the closure of the vital beds in these local hospitals – 70 per cent of the whole. And those remaining like Totnes often have patients who are less able to be transferred to less intensive facilities like care homes, dementia being one reason.

Given the present and shameful crisis in prompt diagnosis and care, the re-opening of our Community Hospitals should happen within weeks.

‘Money’ some will say. HMG spent £400 billion on ‘covid’ - three times the annual NHS budget, and without any good scientific basis.

An example of the profligacy – 3,000 beds put together at the Excel Centre with the ‘modelling’ of Ferguson a prompt. About 40-plus were used because the London hospitals had sufficient ICU capacity.

I end with an example of the quiet but vicious brainwashing that is emblematic in the Britain of today. You will hear via the State Broadcaster, the BBC, and read in the Western Morning News, that the ‘delayed discharges’ are due to the absence of ‘social care beds’.

Citizens paying for relatives in care will know that social care is carefully billed separately from any medical care – say for dressing of a varicose ulcer.

The absolute need for ‘medical care’ of the patient who could be discharged from the DGH is not said. And I note the wall-to-wall silence when the present grotesque failures of OUR NHS are discussed. Community Hospitals are two words that are never heard.