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Congratulations, politicians. You have done it!

And so the great political game plan for the NHS comes to fruition. Started in the early ‘90s the central theme has been to shift responsibility for the NHS from its only true budget holder - the government - to the periphery, to the people trying to provide services for patients. Various reasons for this are given, some with a grain of sense and truth to confuse and beguile, but the central thrust has always been to shift responsibility for an underfunded service away from politicians.

In a way, you can understand the government. They have been faced with an intractable political problem. The NHS enjoys unparalleled popularity amongst the population. Nothing else comes close. And although by international standards it is both successful and also economical in terms of providing comprehensive, no questions asked care for an entire population, it still needs funding. And that funding represents a considerable chunk of public spending. Underfunded it underperforms, and inevitably the people responsible get the blame. That used to be the government of the day, and they didn't like it.

Put all that together and the issue is stark. To be seen to get rid of the NHS would be political suicide, with a legacy lasting a generation. To provide adequate resources for a successful service would mean unacceptable financial strain elsewhere. But to shift the perceived responsibility for providing a good service away from the government could be the answer; others would take the blame and governments could gnash their teeth at the failings of the managers, nurses and doctors providing the poor service. "Don't blame us; we have passed responsibility for these decisions to those closest to the patient. Complain to your Primary Care Commissioning Group"" And if the service fails completely? Well, clearly that would also be the responsibility of others and certainly not the government.

Is this a conspiracy theory? You bet it is.

And now ministers can reap the benefits of this cynical, all party plan. (Oh yes - it may have been started by Tories but Labour saw the sense of it too) Now the Prime Minister and Secretary of State for Health can apologize for the service and express regret for its failings. Not their own failure to fund it adequately, of course, but the failings of the service. If only the hospitals and GPs could use the available money wisely, all would be well. How cynical and devious can they be? Crocodile tears.

Cunning long term politics; deeply saddening; disastrous for the NHS, and we have let them get away with it for three decades. The NHS is far from perfect but it is a fantastic, sophisticated, surprisingly economical and deeply loved public service that deserves adequate funding. If politicians say they are providing adequate funding they are all too obviously utterly wrong and merely making fools of themselves. For sure it is not all about funding, but that is a large part of the problem; the main part.

We may all too soon appreciate the real value of the NHS as it slides beneath the waves. That’s not too much of a problem in the short term if you are well off, in good health and a young or middle aged adult. But many people do not possess those qualities of good fortune, a small minority have all three, and even for those who do - any or all of them can and will change.