A £10 charge to visit a GP would be just the start of a slippery slope for the NHS

We either let our NHS be trashed by the privatisers and cutters, or we defend a properly funded, publicly run, universal system that is free at the point of use

A GP with a patient. ‘This ideological assault is being accompanied by an actual attempt to dismantle and privatise the NHS.’ Photograph: David Sillitoe for the Guardian

A slow hand clap for Andy McGovern, a London hospital nurse who has proposed that the Royal College of Nursing supports a £10 charge to visit a GP. On its own terms, the proposal is an unacceptable assault on the very foundations of the NHS: that it is free at the point of use. But the suggestion is so menacing because of where it originates from. The many enemies of the NHS – who have to be diplomatic, knowing that the NHS “is the closest the English have to a religion”, as Nigel Lawson once put it – will rejoice. “Aha!” they will think. “Now even the nurses are debating NHS charges, we have been given the political cover we need!”

That the NHS has just been declared the world’s best healthcare system by the Washington-based Commonwealth Fund should be a matter of national pride. But the institution is in mortal danger. The free market crusaders who first took power in the late 1970s have long regarded NHS as an aberration. It is an irritating example of a service run on the basis of social need, rather than private profit – and, even worse, it is loved for it. As long as the NHS exists, it serves as a defiant reminder that there is an alternative to the neoliberal project.

No wonder it is under constant assault. Nick Seddon is the former deputy director of rightwing thinktank Reform; before that, he was head of communications at Circle Partnerships, which boasts of being “Europe’s largest healthcare partnership”. Reform is an outfit funded by private healthcare firms such as Bupa Healthcare, the General Healthcare Group and BMI Healthcare. Seddon has backed charging to see a GP, NHS budget cuts and the sacking of frontline staff. Last year, he became David Cameron’s health adviser.

Then there’s Lord Warner, a Labour peer who in March published a report with Reform calling for a £10-a-month NHS membership fee. What he didn’t mention was that he works for private companies that depend on the NHS.

Even in this newspaper, Simon Jenkins and Ian Birrell have been floating ideas to dismantle and privatise the NHS. And then there’s Ukip, that famed anti-establishment party whose economic policies are mostly about cutting taxes for members of the establishment and handing them public assets. Paul Nuttall, Ukip’s deputy leader, has declared “that the very existence of the NHS stifles competition”, claiming that “as long as the NHS is the ‘sacred cow’ of British politics, the longer the British people will suffer with a second rate health service”. Read the Commonwealth Fund report and weep into your Milton Friedman textbook, Mr Nuttall.

This ideological assault is being accompanied by an actual attempt to dismantle and privatise the NHS. I’m not going to insult people’s intelligence by pretending that the last Labour government was some socialist utopia: it too promoted a private sector agenda, including private finance initiatives which saddled hospitals with long-term debt. But that’s nothing compared to this government’s Health and Social Care Act. Again, knowing the popularity of the NHS, the government didn’t have the guts to put what it was going to do to the British public, and promised no further “top-down reorganisations”. Panic stations should have been manned before the general election, when it was revealed that the private office of Andrew Lansley, who would become Tory health secretary, had been bankrolled by the former chairman of Care UK to the tune of £21,000. And lo, under Section 75 of this government’s legislation, the NHS is driven to put its services out to competitive tender. In Surrey, community health services were handed to Virgin Care in 2012; last year, NHS outsourcing worth £1.1bn was announced in Cambridgeshire and Peterborough. And so on.

On top of all of that, the government is implementing the most protracted squeeze on NHS spending since its foundation; throw in the government’s savage cuts to local authority spending – which is putting pressure on the NHS as services like social care are hit – and take into account our ageing population, and a serious crisis indeed is on its way.

And so it’s up to us. We can let our NHS be trashed by the privatisers and cutters, the private health companies and their assortment of outriders and useful idiots. We can surrender the principle of a service free at the point of use. We can move towards the grotesquely inefficient and unjust US system we have long ridiculed. Or we can defend a properly funded, publicly run, universal system that is free at the point of use. It’s make our mind up time.