Dr Bob Gill has been a practising doctor since 1993. He is a GP and has become - to his surprise - a prolific campaigner fighting to save the NHS. He has a helpful YouTube channel, and has helped to fund and produce 2 full-length documentary films to try and explain how and why the NHS is being privatised, to help local campaigners and members of the public understand the links between the many NHS 'reforms' and NHS privatisation.

His first film project SELL-OFF (edited, directed & produced by film-maker Peter Bach) in 2014 is about a group of doctors trying to save the NHS. It explains how the NHS has been broken up ready to be privatised:

More recently, Dr Bob Gill has described how the project to privatise the NHS in the style of US Accountable Care Systems is now entering it's 'home straight'. His second documentary film The Great NHS Heist brings us up to date. The film is available to rent or buy online via the film website.

The following is an abridged transcript of a talk given by Dr Bob Gill and organised by Keep Our NHS Public - Dorset in February 2019. The talk covers many of the points made in the Great NHS Heist film, and is available to watch on YouTube. You should find much of what is described disturbingly similar to the process unfolding with the  Path to Excellence  in South Tyneside and Sunderland.

What I want to hopefully achieve today is to equip you with enough background knowledge to understand what is going on, and more importantly, to understand where we are going. In my mind, the reason I am giving these talks is to arm everybody I speak to with enough information to challenge the lies that we are surrounded by.

The reason I woke up out of my slumber and decided to take a risk - and it is a risk to speak up - is that we suffered the downgrading of a local hospital (Queen Mary's in Sidcup). We lost our A&E, we lost the maternity. Then there was a threat to another hospital down the road, Lewisham Hospital. I had already seen the effect of the first downgrade. My patients were going into hospital and coming out worse than when I sent them in, some patients were being discharged to home where they died without expecting to die, hospital outpatient appointments were getting harder to access. You could see there was a strain on the service. For any rational person to propose closing yet more hospitals, closing another A&E department, which puts more pressure on [the remaining services] made absolutely no sense. It was at that point that I started to wonder, in whose interest is all this happening?

I'd seen successive reforms over the last 20-30 years, all [failing] to achieve two basic things. One, does it help me do my job? Two, does it help the patient? All of the time, the answer to both of those questions is no it doesn't, so you start to wonder what is going on?

A key element to this is that it has been a very slow process - it has been done by stealth - such that most of us have not realised. We have just thought that it was one incompetent government mistake after the next incompetent government mistake. The reality is that there was a plan laid down back in 1988 by  Oliver Letwin  and his colleague John Redwood called  Britain's Biggest Enterprise . They laid out how you could go from a public health service to a private insurance based system without too many people noticing. They were both working at the time for Rothchild Bank's Privatisation Unit. [Oliver Letwin] was also the author of a book called Privatising The World in the same year. What he laid out was what in fact [subsequent and] consecutive legislation has achieved.

If we go back to Margaret Thatcher's time, she achieved two major things. She started outsourcing NHS services starting with catering, portering and cleaning. They argued this was not really health care and the private sector could do it more efficiently. The epidemic of MRSA infection has shown that to be a big mistake. The other thing she did was to set up an  internal market , where somehow by getting GPs to compete with each other and hospitals to compete with each other, that miraculously this would improve the delivery of health care. It has never done that anywhere else in the world, but [we were told] it would work here for some reason. What it actually did was to rep-purpose the NHS. You went from a very rational and simple system where money came from the Treasury to District Health Authorities and from there to hospitals and GPs - very simple! What they created was the installation of a bloated tier of management, which separates out responsibility for the care of the patient from power. So over the years, responsibility has stayed with the doctors and nurses and health professionals ([particularly] when things go wrong), but all the power is with the managers that you never see - and there is a lot of them.

[All] this is no mistake. Each time a government minister promises to cut bureaucracy, they are in fact doing the compete opposite, because where we are headed requires an enormous bureaucracy. We are paying for an enormous millstone in order to enable profit extraction. You could not make it up, it is an absolute scandal!

Instead of having some respite between 1997 and 2010 [during the period of the New Labour government], unfortunately the Labour Party transformed into a milder form of Margaret Thatcher and John Major. [New Labour] got away with a lot more NHS privatisation [perhaps] because everyone thought 'they are Labour, so they're not going to do anything'. What did [New Labour] achieve, well, they doubled down on the outsourcing, so for the first time in NHS history you had the outsourcing of clinical services (I.e. the provision of care). This is a fundamental pillar of the NHS - publicly funded and publicly provided - not because of some ideology, but because it makes sense to control the provision, because you can control the quality and do away with a lot of intermediaries. There is a logic to it.

So, we had outsourcing of [clinical] services. Lets say knee surgery was outsourced to a private contractor, the private contractor got to pick the easiest cases and the private contractor was paid 11 percent extra compared to the NHS, because 'our friends in the private sector were helping us get the waiting lists down' - that was the story - 'it's just temporary, and it's a partnership'. That's like having a partnership with a tapeworm! That's not the sort of partnership I would advocate, and it was certainly not temporary.

The next major scandal (which forms part of the asset/land grab) was the  Private Finance Initiative . We were somehow persuaded again that the miracle of the market would enable us to finance and build our hospitals on time and on budget, and deliver wonderful spanking new facilities. The reality was that we borrowed £11-billion and we are going to have to pay back £88-billion. For every pound borrowed, we pay it back 8 times - [800 percent interest] that's a good deal for the private sector! That's what they mean [when they talk about efficiency], they mean efficiency of profit extraction. They would love us to believe that this is yet another tragic mistake, and that they are going to learn from the lessons, but no, this is how the City [of London] works. This was planned in advance, there is no country or system in the world where the private sector can borrow cheaper than the government, it does not exist.

You would have thought that some of this ideology would have been questioned after the 2008 [financial] crash. The mask had well-and-truly slipped. The City of London was not the panacea for all of our problems. But did anything change? No. The bankers got a rough deal for a about a year, then we stopped talking about the bankers and it became about tightening our belts and austerity. So a problem created by the banks [private investors looking for new markets], has become a problem for [the general public, who we are told are] living too long, causing their own illness, being feckless, drinking and smoking too much - but it has nothing to do with the banks!

Austerity has provided a brilliant cover for the trashing of the welfare state. It is not just the health service. Look at the police service, probation service, education etc., the whole lot has been gutted and the same process as I have just outlined to you has happened throughout the public sector, with a tier of obedient very well paid management across the top.

So were lessons learned? Well, in 2009 (just to rub salt in the wounds), New Labour created something called a  Trust Special Administrator . This is basically a bailiff which goes into [hospital] Trusts that are financially burdened with PFI [for example], and decides which assets to sell. [It works like this,] PFI is a deliberate debt burden which will gradually get worse over the years. You then come back later on and you say '[this is unsustainable], we will have to restructure'. That restructuring causes the sale of the assets that we all own. I'll give an example: PFI is like you being forced to sell your house, forced to move into a 5-star hotel instead, and then forced to use room-service. Would you do that? PFI is a deliberate financial millstone.

More recently [to finish off the job of the asset/land grab] we have the  Naylor Review . The Naylor Review was written by Deloite, but fronted by a doctor (this is a common way of doing things, you get the accountants to devise the scam, then you put in some medical stooge to front it). What the Naylor Review says to hospital Trusts that have been deliberately de-funded, [in a nutshell] it says that the only way you can buy a new scanner or any new capital (equipment) is if you flog-off your land, and for every pound you raise the treasury will give you another pound. This is a fire-sale. Once they are gone, and once they are built on [by developers] you have had it. Once you loose your city centre hospital on prime real estate, it's gone.

Now we come to the  2012 Health and Social Care Act (HSCA) . That [Act of Parliament] was a seismic step forward. What it actually did, in legal terms, it actually abolished the NHS. It removed the duty of the Secretary of State [for health] (SoS) to provide health care. So the SoS has not legal responsibility to provide you with an A&E. The SoS has a duty to promote stuff, but has no day-to-day control. Day-to-day control of the NHS has passed to a quango called  NHS England , and the man who is [currently] in charge of NHS England is man called  Simon Stevens .

[Following the HSCA], not only was the NHS legally abolished, but also hospitals were now able to generate up to 49 percent of their income from private patients. Why would you introduce legislation like that if you did not anticipate the amount of private work going up - it doesn't make any sense otherwise?

Of course, you all heard about this on the BBC. I remember wall-to-wall coverage for at least six months, or was I having a dream? When parliament introduce legislation you can't quite see how toxic it is, [partly because] they use something called Statutory Instruments, which are legal tricks that are delayed [which means you can't at fist see the mechanism by which such a piece of legislation is going to do it's damage. In the case of the HSCA, it came several months later in the form of the] Section-75 Statutory Instrument. On [the day it was published] the top item on the BBC was the break up of the boy-band JLS, because that is far more important than our health service.

That's why we need to get ourselves informed. You will not hear about any of this via the BBC. I was a big believer in the BBC until this. It is hard to realise what you are not being told, how would you know? In 2013 there was 50 thousand people in Manchester (Manchester's biggest demo) demonstrating for the NHS, it was the Tory Party conference, all the cameras were there, and I thought, this is fantastic, this is a game changer! I rang my wife and said 'don't go to sleep tonight, you have to watch the news with me'. I got back in time and turned on the 10 O'Clock news... nothing, absolutely nothing! I thought 'Oh my God, what else aren't we being told?'. It's like a bereavement, you suddenly realise that the country and the society your living in isn't what you thought it was. It's quite traumatic, and it's far easier to bury your head in the sand and distract yourself, but I thought that I had to start finding out more. I wasn't interested in finance, health economics or policy, but there is no reliable source out there, so you have to find out for yourself. I got involved in the Lewisham campaign, and that was the first time that I was politically active. You learn good and bad things, [including the ways that] campaigns work well and how they don't work well. It's been a learning curve, but there are many people who are traumatised by the experience.

We are all good people in this room, we all love our fellow human beings... The problem is that we confer those values on others, but we are in a very dirty game, where campaigns are sabotaged, and we see it play out in party polities. We have seen the disunity that Brexit has caused across the country, well this can happen amongst campaigns also. [There is something called astro-turfing. Astro-turfing is a deliberate ploy where by people set up as (pretend to be) a campaign group, but are actually doing the opposite. Groups are sometimes infiltrated to try and make sure they don't achieve their goals.] This is a problem that we have come across in various forms, and it is a reason why the [campaign to save the NHS] has not been as successful. The Lewisham Campaign was sabotaged. We had a very high profile campaign, it was in the mainstream media, we had won two legal cases, and there was a [hospital Trust] merger on the horizon. If you know anything about NHS politics, you will know that mergers are a way of shutting down services. You merge two hospitals, then you say, we don't need two A&E departments or two maternity units etc. So, a lot of the campaigners wanted to fight the merger, however parts of the campaign were very close to the hospital board, and it was not in the hospital board's interest. Lewisham wanted to be the dominant party in the merged entity. They had their people within the campaign calling for the campaign to be shut down. [Since then] the campaign is a husk of itself, and at a time when it had a major role to play reaching out to other groups, saying this is not just about Lewisham, this is about the whole country.

The internal market [created in 1990 by the Thatcher government], never delivered any efficiency but did serve to condition the staff to [the use of] contacts and negotiating. After 15 years, we were all used to talking in terms of finance, despite this not being the priority for doctors and nurses. It made us blind to this language, and I catch myself talking this management jargon - we've been brainwashed! [The significance] is that the transition from an internal market to the external market [cemented with the 2012 HSCA] is all the same language, which made it quite easy.

What is [all this] about? It is a about tendering out activity that is profitable, and shutting down [or minimising] activity that is unprofitable: A&Es are high risk and are unprofitable. Intensive care is high risk and unprofitable. Maternity care is high risk and unprofitable. So, these things get closed down. You hive off activity to fewer centres because it is a lot cheaper for the ultimate provider - which will be a private corporation - to do everything on a single site and transfer the cost of travel onto the patient.

They use two very good and reasonable sounding arguments [to try and persuade us of the efficacy of all this]. They talk about heart attacks and stoke. When they want to centralise services they say that survival after stroke and survival after a heart attack is much better if you have a super-specialist service. What they don't tell you is that 95 percent of what your district general hospital does is not stroke or heart attacks. It's routine emergency surgery, it's medical emergencies where your outcome is worsened for every minute you delay getting to the treatment. All these reconfigurations, no matter how much assurance you hear, they know that this is putting people's lives at risk. There is enough research out there that shows the longer you take to travel [to hospital] after an emergency, the worse your outcome, it's common sense and we have the proof, yet they are still [closing and centralising services].

So what will happen to General Practice? NHS staff, like everybody else under austerity, have had their incomes squeezed. It's about a 15 percent real-terms reduction since about 2010. The workload has gone up (austerity causes more illness - surprise surprise!), [remuneration has gone down] and there are fewer staff to do the job. There are ~100 thousand vacancies. Can you imagine working in an emergency setting in a hospital where you don't have adequate staff numbers, you don't have enough beds, your having trouble accessing treatments/investigations, so you can't do a good job. How long is a [doctor/nurse] going to last under those circumstances if your a conscientious person who wants to do a good job?

If you have a mortgage to pay you might put your head down and keep quiet. [Alternatively] you burn out, [and make a mistake]. [Alternatively] you leave medicine or practice it elsewhere. Most people are keeping their head down because they hope things might improve. Most of the pressure is in the acute services. So we have an exodus of staff. This might present a problem to us, but it is not a problem to the policy makers, because it gets rid of organisational memory. It gets rid of people who knew what it was like to work in a public service 20 years ago with higher standards, compared with the system today where there are fewer resources and unachievable targets which encourage people to become fraudulent. People can become corrupted by the system. I've spoken to many health professionals who have falsified targets, they have redefined a trolley into a bed, they have moved people into a cupboard so that they are [technically] no longer in A&E. I've had one person tell me that they had a patient who died in a corridor, and because it looked bad they wheeled him up to intensive care so that it looked like he was in the right place when he died. This is the toxic culture we are [now] in. Good human beings who are trying to do a noble profession are forced to witness this on a daily basis. It destroys you, it chips away at you, or you might become hardened and sadistic.

What does all this mean for people? The chickens are coming home to roost. There is research out there that shows the impact of what has happened over the past eight years. 120 thousand excess deaths due to cuts in health and social care. In 2015 alone, there were 30 thousand excess deaths due to the cuts. You know they keep talking about the ageing population, well don't worry it has stopped ageing, our life expectancy has flattened off, while every other European and [industrialised] country's life expectancy continues to grow.

What is the most shocking statistic? If there is one thing you measure in a health care system [indicative of the quality of a health care system], it is infant mortality. Life expectancy is dependent upon many things, your lifestyle, diet etc. But being born safely and surviving is a good measure of a health system. In England [infant mortality] has dropped in successive years for the first time ever [since the second world war]. So the hard statistics [show] that this is having a devastating impact upon the health of the public, but it is not widely known. External assessors such as the UN rapporteur into poverty have said that there is an epidemic of suffering and poverty.

In response the government go into overdrive, into smearing and discrediting the sources of the information, because they don't want you to understand what is going on. It is all the fault of the EU, or the immigrants, and [ordinary people] for living too long.

Another one of my patents, a lady in her 80s who was a very fit and well lady, was left in casualty for seven hours, with an undiagnosed perforation of her bowel, it was only when she arrested that they made the diagnosis. These are people who can be saved who are dying. There are doctors and nurses witnessing this, day-after-day, and they are seeing what is on TV as a complete misrepresentation of what is going on. They are seeing our politicians letting everybody down.

[You must understand] that the interests of the staff and the patents are completely aligned, our interests are the same, we don't go to work to do a bad job, we want to do a good job with adequate resources and recognition for what we are doing. [Medical staff and patents need to work together], and find some way of fighting back together because there are policy and media tricks to set us against each other. [For example], you are getting charges creeping in, and [discussion] on the radio asking if you are entitled to [services without] prescription charges? So there is the demonstration of the patient, a restriction of service provision, there is a list of certain things that you should not go and see your GP about. There are [certain] procedures that the NHS will no longer offer you. Can you see how the patient and medical profession are being made into enemies?

This is all very deliberate social engineering. There is something called the Behavioural Insights Unit in Ten Downing Street. They are social psychologists who work out how to nudge people from [one position to another]. They hold focus groups to see how opinion is changing, then they put out certain messages in the media [to test how much they will get away with]. It is the stealthy normalisation of a toxic policy.

The other big thing that is happening at the moment is  Accountable Care Organisations  (or  Integrated Care Systems ), they keep changing the name to confuse us. It is a system devised by the insurance industry. The insurance industry in interested in one thing which is maximising profit. How do they do that?

• Cutting costs, staff costs, for example, the Junior Doctor's Contract.
• Denial of care.
• Fraud is endemic in the private health system (about 10 percent). How do they commit fraud? By billing twice, by denying care [to potentially expensive medical cases], but up-coding [E.g. if someone has a simple cold, it might be labelled as pneumonia].

[The above practices] are endemic across the US health system, which is where all these ideas are coming from. [As mentioned previously], the guy in charge [of NHS England] is called  Simon Stevens . In his previous job, he was head of Global Expansion for  UnitedHealth , the biggest American health insurer. Guess where [the NHS] is going!!!

[The following clip from Michael Moore's film 'Sicko' sheds some light on how the Health Maintenance Organisation concept (I.e. Accountable / Integrated Care) was born:]

The key [point from the clip is that] the less care you give, the more money you make. I watched Sicko eleven years ago, thinking to myself thank God we don't have a system like that, not realising that ten years later I'd be thinking oh my God, we're going to have a system like that!. That recording with [Richard Nixon] was stumbled across by accident when a researcher was looking at the Watergate tapes, Nixon had a habit of recording all of his meetings.

So that is the root of Simon Stevens' reforms. If Simon Stevens achieves what he wants for his former employers UnitedHealth, this is what [our health] service will look like. You will have fewer emergency services, most of us will have to travel much longer to access them, when you get there, they will be skid-row emergency services, very understaffed. The staff you will see, may not be qualified enough to deal with you (part of the down-skilling). If however you want to opt to top up your NHS budget - because we will all have a budget allocated to us - either you take your chances and go for skid-row NHS, or you take out 'Vitality Insurance' etc. Have you seen that sausage dog with Jessica Ennis? We are being conditioned, private health insurance is slowly being normalised: Benedan, Bupa, Nuffield, Vitality. They are spending tens-of-millions to advertise to us.

There won't be a big bang. There will be a gradual drift of the middle-class out of the NHS. They have one very cunning plan up their sleeve to prevent the negative headlines about insurance companies, when [as was testified to in the clip from Sicko] they [inevitably fail people who are in need of care].  Personal Health Budgets  will be a temporary bribe to the sickest 10 percent of the public, to keep them away from the insurers, while you have middle-class drift, until a critical mass has drifted over, then the sickest people can be dumped. Personal Health Budgets are presented as giving control to the patient (because patients know more than their consultants, right?).

[With regards to general practice], we are going to go from about 8,000 practices across the country down to about 1,500. When you go to your general practice, first you will have to ring up, then you might have the equivalent of 111, where you talk to a school leaver looking at a computer screen, if you get past that you might get to a [medical expert] on the end of a phone, and if you get past the phone [interview] you might get invited to the clinic itself. If you get past the health care assistant, you might get a nurse practitioner, and if you get past them you might finally see a doctor.

The current recruitment crisis of doctors is no crisis. It is all part of the plan. GPs do not feature in this new NHS. The British Medical Association (BMA) is backing this to the hilt. They produced a backing statement about how GPs are going to work in new  Primary Care Networks . What they don't say is that one of the reasons why the NHS worked, was that we had a very effective primary care system. [The GP] was a highly qualified person as your first port of call. As you down-skill the first person a patient sees, what happens is that their blind spot is much bigger, meaning that there is far less patient safety. The less qualified person may also over-investigate, over-prescribe and over-refer, but that is not a cost to the GP corporate provider, it is a cost transferred to someone else, [the patient].

There are intensives creeping in now that will insentivise me [as a GP] to deny patient care. For example, if I'm referring too many people for knee surgery and I'm close to my target, I might go over my target and lose my bonus. So doctors will be insentivised to act against patient interests. What will that do for trust? This is already happening. Take dementia screening. For a screening test to be an evidence-based screening test, the condition has to be widespread (a common disease), there has to be an effective treatment, and the screening process must not do any harm. Does dementia screening fit any of those criteria? Dementia is common, but does the screening do any harm? Yes, because 40 percent of people are false positives. So why are we doing it? GPs are getting £50 a time for dementia screening. Why? It's about gathering data. Teresa May let slip before the 2017 general election that she is not happy with just selling the hospital assets, she wants your house! If you have a dementia label on your record and no family, then your house will be taken to pay for your care. There is no other reason for dementia screening, but because money is so tight for general practices [they take the financial incentives without looking at them too closely]. Another scam is the over 40 health check. Again it is about collecting data for the insurance companies that are going to set your premium. The people who would benefit most from a health check tend not to go and see their GP. The people who might go are the middle-class people who don't really need it. When money is attached to denying a referral [to see a consultant] then that will be a powerful intensive to normalise not doing the right thing.

This is why it does not really matter [from the government's point of view] if an experienced and public minded doctor leaves the service. What you want is the young doctors who don't know any different, and have been conditioned to follow the protocols, and are subservient to the hospital managers.

As the GP surgeries close and they amalgamate, GPs will be given an attractive offer, which is to have all the administrative burden taken away. They will be given the chance to become a salaried doctor, then someone like Richard Branson -  Virgin Care  - will come and manage the surgery. It won't seem like a bad offer. Many [doctors] I speak to are looking for a way out, if they did not have kids in education they might already be gone. So you can see how we have been softened up to vote for our own execution, and the BMA have rubber stamped it.