The Con-Dem Coalition is trying to pretend that the NHS is safe as no cuts were featured in the autumn spending review, but this is far from the case.

The NHS has been forced to make efficiency savings year on year for decades, and while overall spending was raised under the Labour government to match European levels, this was a short term boost that failed to address a number of inefficiency issues, such as handing large amounts of cash to private sector companies who had been forced on the NHS to build new hospitals at overinflated costs (up to 16 times the value of the build) under a scheme called the Private Finance Initiative (PFI - invented by the Tories no less).

This saddled the NHS with a bill, estimated to be at least an extra £60 billion in excess of what it would have cost for the Government to borrow to pay for these buildings. This cost will take decades to settle and this will be at the expense of other services - it is also guaranteed profit for the PFI companies, who will still own the buildings even when we have paid all the debt owed to them off! The PFI consortiums subsequently boosted their profits even further by re-financing their debt totake advantage of the lowest interest rates ever - while still insisting the NHS pays the full cost of the original contract.

In addition money was wasted when Primary Care Trusts (PCTs) were forced to buy services from untested private contractors at the expense of NHS services, as happened with Oxfordshire's Eye Hospital (BBC report)

Now the NHS has to make £15 billion "efficiency savings" over the next 4 years. These are cuts by another name. This was demonstrated last September when a document about NHS workforce planning from Oxfordshire PCT was scrutinised by Oxfordshire UNISON Health branch stewards. The document announced plans to cut £100 million off Oxfordshire's NHS workforce over the coming 4 years. £45 million of this would be accounted for with the loss of 1,900 jobs. However this still leaves a further reduction of £55 million to meet the PCT target. If this is calculated on a pro-rata basis it could amount to around 4,500 jobs, or one third of Oxfordshire's total NHS workforce.

When challenged by UNISON the PCT denied any increase in job losses above the 1,900 declared but would not say how the remaining £55 million would be cut from the workforce bill.

The picture that has developed since has been patchy. We do know services are being "redesigned" with 3 ward closures at the JRII which was strangely omitted as a possible factor in the subsequent winter bed crisis and cancellation of operations.

Oxfordshire and Buckinghamshire Mental Healthcare (OBMH) Trust's "re-design" of it's Adult Community Services included a proposal to axe nearly 1/4 of the staff, as managers tried to implement 4 years cuts in one year. OBMH UNISON Health branch members managed to win a delayed implementation, which opens the door to a more robust defence of services further down the road. In all Trust's mangers are looking to re-organise services to reduce costs - often "losing" posts and downgrading remaining posts to lower pay points on the way.

The scale of these cuts is staggering and in no way can they be carried out without seriously undermining services and morale of the staff who have worked harder to deliver previous decade's efficiency, and who now face carrying even greater workloads with fewer staff, and with a two year pay freeze and a cut in pensions on top.

Worryingly symptoms of impending crisis are appearing in the Oxford Radcliffe Hospitals Trust (JRII, Horton, Churchill hospitals) with the Care Quality Commission reporting last September that it was "not compliant with the essential standards of quality and safety relate to trust-wide issues around adequate staffing levels, staff training and systems for monitoring and checking quality of care."

The main issue is poor staffing levels and a subsequent reliance on casual staff. Departments are so pressured staff cannot be released to do even basic mandatory training . Oxford has a unique problem in that NHS staff are expected to pay London prices without the compensation of London weighting (an extra £2000/year). The pay freeze is only likely to make more staff look at working in more affordable areas.

The pursuit of a cheaper service at any cost will have disastrous results for the majority who use the NHS. The prime example of how badly it can go wrong was the scandal of Staffordshire hospitals, where a preoccupation with the pursuit of money pushed clinical concerns into the ground. Care suffered and people died as a result.

We can expect more of this as the NHS is forced more and more to compete with untested healthcare providers to win contracts unless we challenge the Tory imposition of the market on the NHS. We have to win the argument that the NHS is run for patients not profits.