George Osborne looks likely to rebuff the increasingly desperate calls for more NHS cash when he gets up to deliver the Spending Review next Wednesday. There’s not even a guarantee that the promised £8bn (let alone the £30bn actually needed) will be forthcoming any time soon. The new chief NHS regulator said this week that the government's NHS 'efficiency plans' were "unachieveable, and frankly, bloody stupid".

Wouldn’t it be handy for Osborne if had in his back pocket a new NHS plan – one that the public had supposedly been consulted on – that suggests the NHS can sustain and indeed expand high quality care on his meagre cash offering? That it's fine to deliver it on the back of fewer, cheaper, more overworked doctors, with the gaps filled with unevidenced digital health tech and other Osborne Northern Powerhouse hobby horses?

Of course, this is a fantasy – and anyone who actually knows about the NHS would say so, given half a chance.

So how do you deliver a freshly ‘consulted-on’ plan, without raising these inconvenient truths?

Step forward, Jeremy Hunt.

On 29 October, Jeremy Hunt’s department published a ‘consultation’ on what the government will tell the NHS to do for the next five years (the NHS ‘mandate’), and whether it can do it with the money George Osborne is likely to fork out.

And then… he didn’t breathe a word about it in parliament.

His department didn’t press release it. It doesn’t appear on their list of consultations online.

He didn’t say a word about the consultation in a major speech the day after it was released, even though this speech was all about an “inescapable, irreversible shift to patient power”.

Hardly anyone knew anything about it until last week – and it closes this coming Monday (23rd).

OurNHS got wind of it – and discovered that the proposed mandate objectives are full of worrying hints that the government may permit the NHS to retrench to a cut-back service, providing free care only to those who need it ‘most’, with mechanisms for back-door healthcare charges (like personal budgets) being given the green-light.

OurNHS also saw an email from HealthWatch England in which they revealed that "Due to the Government’s spending review, the consultation period for the Mandate is shorter than originally planned."

A storm brewed. The Department of Health started receiving complaints, even from normally supportive groups like National Voices.

And that’s when it starts to get really strange.

The Guardian picked up OurNHS’s story this week, and asked NHS England what it thought about the mandate. NHS England told the Guardian “The mandate is a matter for the Department of Health and the public (via the consultation on it) – we wouldn’t have anything to say on it.”

But OurNHS has seen emails from the Department of Health’s NHS England Sponsorship and Mandate Team, advising complainants this week that:

“The statutory requirement is for the Secretary of State to consult with NHS England and HealthWatch England before specifying objectives and requirements in the mandate. We wanted to go further and publish our proposals for setting the mandate so that stakeholders and the public can feed in their views.”

In other words, NHS England is saying the mandate is nothing to do with them, that it's between the Department of Health and the public.

Whilst the Department of Health is saying that the mandate is basically a matter between their Department and NHS England, and nothing to do with the public, though they’re going the extra mile and allowing us to have a say anyway (sort of!).

So which is it, Jeremy Hunt?

The confusion shows the sham at the heart of the NHS since 2012. The idea that the NHS is now a standalone body (or rather, a tangle of competing, squabbling standalone bodies), given its money and mandate and left to get on with it, suits the small-state Tories very well.

Whilst Hunt pulls the strings behind the scenes, when problems arise, he steps back. Suddenly it’s ‘the NHS’s own plan’. It’s ‘local decisions’.

It’s a classic exercise of power without responsibility from the media man Hunt.

Especially if no-one notices what the government says (and doesn’t say) in the one bit of formal legal responsibility the government has left, its mandate to the NHS.

The public has until Monday to submit responses to the mandate consultation, you can do so here.

Though in a further piece of farce, OurNHS is getting reports that some responses are currently bouncing back saying ‘mailbox full’. Please let us know if that happens (caroline.molloy[at]openDemocracy.net]! (Update: we hear from readers that if respondents delete the logo and/or save their responses as a PDF, it shrinks the file enough to fit in the Department of Health's mailbox...nice for them to add an extra obscure hurdle!).

As well as OurNHS’s own response, the National Health Action Party has compiled a useful response that people could also find helpful.

Hunt told us last month that his aim is to see the NHS “moving… to a democratic culture where for the first time in centuries of medical history the patient really is the boss”.

But meanwhile he pretends to consult public and patients whilst reciting the mantra “we must stick to the plan”. He pretends to offer negotiation to doctors whilst refusing to meet them at arbitration service ACAS.

This isn’t democracy. This is dictat. Which is the only way the NHS can be dismantled.

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