How can we save the NHS?

This pamphlet is a contribution to the debate over how we organise and campaign to save the NHS. It has been produced by the International Socialist Network and is available to download and distribute.

Banner at the Block the bridge action

What will it take to save the NHS? Almost all avenues have been tried in one way or another. This pamphlet attempts to advance a strategy for uniting the different forces involved in NHS campaigns into a movement which can mobilize the great mass of NHS staff and our patients, the public, in the mass social movement that is needed to halt the programme of cuts and privatisation dismantling the NHS. It does not focus on the attacks, by successive Tory and Labour governments, but rather the response of unions, professional bodies and grassroots activists.

Nothing about the destruction of the NHS is inevitable. The NHS is one of the largest organisations on the planet, and the largest healthcare organisation in the world. It employs 1.2 million people directly, and an estimated 6 million indirectly. Its dismantling is a long term political project which has taken over 30 years.

The process, started under Thatcher and maintained by Labour, has now been brought to its final heightened frenzy by the Tory-Liberal coalition. It has been driven by the needs of the market, had its way greased with lobbyist money, and enabled by politicians and political parties having abandoned principles in favour of corporate careers and the revolving door between ministerial posts and the private sector. They have enabled a massive transfer of wealth from the public to the private sector, at the price of massive suffering for patients, their families and staff.

The attacks on the NHS have been resisted, but nothing has been able to halt them. Partly this is due to the determination of government and their corporate health backers, but has also been assisted by compliance and collusion from those organisations which are tasked with protecting and improving the NHS for its workers and the public.

The NHS under Labour

When Labour was elected they pumped huge amounts of funding into the NHS, rescuing it from the decades of underfunding under the previous Tory government. They also committed to funnelling large chunks of this money to the private sector through allowing the commissioning of services by the NHS, and instruments like the Private Finance Initiative (PFI). The private healthcare market, which was tiny at the turn of the century, was given much needed support and funds in the form of lucrative contracts for NHS work.

The NHS budget was increased, but rather than increasing NHS capacity, independent sector treatment centres (ISTCs) were contracted to reduce NHS waiting lists. Private companies began to cherry pick “easy” operations and function as parasites on the NHS budget, absorbing huge sums for work that was incomplete, poorly done and even dangerous. Nevertheless the funds grew the private sector and set them up for taking over larger contracts in the future. During this time there was a revolving door between the Department of Health (DH) and the private sector as health ministers and DH bureaucrats moved between government positions and private healthcare companies or management consultants.

PFI; bleeding the NHS dry, and the hypocrisy at the heart of austerity. The one thing that will never be cut is the PFI debt. (Private Eye)

During the 13 years of the Labour government, pro-Labour trade union officials sat on every attempt to organise resistance to Labour's privatisations. Where action was organised, it was limited, tokenistic and ineffectual. An example of this is the case of NHS Logistics. This highly profitable department was contracted out to DHL with only two days of strike action organised by UNISON, barely a week before the contract with DHL was due to start. The last minute action, without any attempt to mobilise the public or other sections of the NHS workforce failed. It was emblematic of much of the union leadership’s response to NHS cuts and privatisation. Last minute, disorganised and tokenistic actions, which inevitably ended in defeat and demoralisations.

Those health worker activists at the grassroots levels who organised effective action to stop cuts and privatisation were marginalized and bullied when they attempted to stand up to Labour policy, and where they wouldn't back down or shut up were witchhunted out of their unions and their jobs. Union militants were forced out, and entire branches smashed up in order to allow Labour government policy to be enforced.

Campaigns like “NHS Together” and “Keep the NHS working” were launched by the union leaderships, claiming to unite all the health unions in opposition to growing commercialisation in the NHS. But these were top down, bureaucratically controlled campaigns. Union members had no say in how these campaigns were run, and were just wheeled out for rallies and meetings occasionally. Neither NHS Together nor Keep the NHS working never organised any concrete action to oppose Labour's policies. When the union leaderships couldn't contain anger at cut backs any longer, as in the 2006-2007 period when 20,000 NHS workers lost their jobs, they organised a toothless demonstration in November 2007 of just 7,000 people under the depoliticised slogan “I <3 NHS”. The demonstration served to blow off steam for the workforce but didn't challenge government policy.

Due to its continued agitation about Labour's detrimental policy towards the NHS, Keep Our NHS Public was unofficially made a proscribed organisation by UNISON's leadership, and branches were told they could not organise events with KONP, affiliate to it or donate money to it. In 2009 a motion went to UNISON conference to overturn this unofficial rule and was passed, but UNISON nationally still does not sponsor KONP, although individual branches can and do support them.

The end result was that, even though under Labour there was widespread opposition to NHS privatisation in the general public and among NHS staff, this was never able to cohere into a national movement which could stop or reverse Labour's policies. The process Labour started was to be accelerated under the Tories, til we faced the prospect of the destruction of the entire NHS as we knew it. Unfortunately despite Labour being out of power, the same inaction, corruption and political compromise plagued the unions under the Tory-Liberal government.

References:

1. Kings Fund Briefing, “Independent Sector Treatment Centres” October 2009
2. A Pollock, G Kirkwood, “Independent sector treatment centres: the first independent evaluation, a Scottish case study” Journal of the Royal Society of Medicine 2009
3. Thompsons Solicitors, 2012, The hidden cost of independent sector treatment centres
4. W Wallace, “Independent sector treatment centres: how the NHS is left to pick up the pieces” British Medical Journal March 2006
5. UNISON Bargaining Support Centre, “Private sector in NHS health care” August 2005 via Keep Our NHS Public
6. Socialist Worker “NHS Logistic Strike Ballot” 12 August 2006
7. BBC “NHS Staff out in national strike” 22 September 2006
8. BBC “Union finalises second NHS strike” 18 September 2006
9. MedicalHarm “Karen Reissman and Manchester Mental Health” July 2011
10. Socialist Worker “Union betrays UCLH hospitals strikers” 3 April 1999
11. Socialist Worker “Leading defenders of NHS under attack” 5 Feb 2000
12. Socialist Worker “Yunus Baksh: The fighter who refused to go down” 6 November 2012
13. Wikipedia “NHS Together”
14. The Times “20,000 job cuts forecast as more NHS hospitals join critical list” 24 March 2006
15. BBC “NHS staff protest against reforms” 3 November 2007

The NHS under the Tories

The methods utilised under Labour to ensure acquiescence to government policy were used again under the Tories. Despite the worst attack on NHS funding, the 20% budget cut nicknamed the “Nicholson Challenge”, and legislation designed to dismantle the entire NHS, not a single national demonstration has been organised in the NHS defence.

Although Andrew Lansley presented his White Paper “Equity and Excellence: Liberating the NHS” in June 2010. Little opposition was organised to it initially.

In September 2010 UNISON produced a pamphlet, “More than just a brand” which accurately laid out the effect the white paper would have on the NHS. UNISON then mounted a legal challenge to the White Paper in October 2010. When that failed UNISON did little further. UNISON produced a leaflet after the Health and Social Care (HASC) Bill passed titled "How UNISON changed the Health and Social Care Bill", which serves as the unions account of its campaign against the bill. It is largely a series of media campaigns, and lobbying of party conferences, with “victories” from these campaigns such as “there will be a longer transition for hospitals becoming foundation trusts; separate accounts are announced for private and NHS income.” 

None of the core of the Bill was affected by UNISON's actions. Throughout the 18 months of the bill’s passage, no attempts were made to mobilize members or organise protests on the streets or at NHS hospitals against the bill. This is despite the fact that one third of the NHS workforce, 437,000 people, are UNISON members and are directly affected by the reforms.

The leaderships of the RCN and BMA both adopted a policy of critical engagement with the government rather than opposing the Health and Social Care Bill.

The BMA did this for a mixture of conservatism and naked material interest; their members in the private sector and in some GP practices stood to benefit immensely from being given responsibility for allocating NHS funding. Doctors and other health workers repeatedly lobbied the BMA to change their stance. Eventually BMA members managed at their annual conference in June 2011 to change BMA policy to call for withdrawal of the Bill, but the BMA leadership under Hamish Meldrum continued to engage with the government against the democratically agreed policy of the BMA membership. The BMA Council finally adopted a policy of full opposition to the Bill in November 2011 when the full reality of the effects of the bill were revealed to GPs, but the BMA leadership refused to implement this and no campaign was organised.

The RCN engaged with the bill from a sectional standpoint; believing that they could influence the bill and obtain a better deal for nurses and more say in how the NHS was run by participating in the process. Although the RCN passed a motion of no confidence in Andrew Lansley at their national Congress in April 2011, this measure was done at the expense of more political motions which would have committed the RCN to outright opposition to the HASC Bill. Through they engaged with the bill, nurses ended up with next to nothing. The RCN eventually came out against the bill in January 2012, but it was too little too late.

Unite supported several demonstrations organised by grassroots campaigns against the HASC bill, and has shown a willingness to back struggles like the Save Lewisham Hospital Campaign. However it has used its status as a "minority" union in the NHS (despite being the largest union in the UK) as an excuse for not trying to spearhead the defence of the NHS when all other unions capitulated. Its strategy at present is to support community campaigns to defend services, but UNITE has shied away from using its organised membership to oppose government policy through protests and strike action. 

The scale of potential opposition to the Health and Social Care Bill. That this opposition was never manifested in the streets allowed the bill to pass through parliament largely unopposed. (NHS Support Federation)

The Trade Union Congress finally organised a rally against the HASC Bill on March 7^th 2012. The rally was indoors in Westminster Central Hall, with a maximum capacity of 2000, a carefully managed array of speakers, and no plan of action for the weeks and months after the rally. The leaders of all the main health unions who had barely lifted a finger in the previous 24 months to stop the HASC Bill, all paraded on stage to issue loud denunciations of the government and expressed their commitment to defending the NHS. Their real contempt for grassroots activists was shown when the doors of Westminster Central Hall were closed in the face of 500 students who had marched down to the rally from their universities. The last thing the union leaders wanted was anyone attending who might have demanded they actually act to stop the destruction of the NHS.

The bill was eventually passed into law on 1^st April. UNISON held a minutes silence outside of parliament to protest the passing of the bill.

References:

1. UNISON “More than just a brand” September 2010, via Socialist Health Association
2. BBC “Union challenges NHS 'shake up' 24 August 2010
3. Dave Prentis “The case for the NHS” 13 October 2013, The Guardian
4. Ehealth Insider “UNISON legal challenge rejected” 19 October 2010
5. UNISON “How UNISON changed the Health and Social Care Bill” April 2012
6. The Independent “Nurses pass vote of no confidence in Lansley” 13 April 2012
7. RCN “Royal College of Nursing Health and Social Care Bill briefing to the House of Lords (Report Stage)” RCN Briefing February 2012
8. RCN “Why the RCN is opposing the Health and Social Care Bill” RCN Briefing January 2012
9. Right to Work “Day X for the NHS – 1,000 march through the City of London” 10 March 2011
10. Indymedia “Kill Lansleys Bill - NHS protest Tues 17 May, Gower Street, London, 5.30pm”
11. TUC “All together for the NHS”
12. TUC Youtube“Rally To Save Our NHS”
13. Youtube “TUC Save Our NHS rally - BMA feeder march - 7th March 2012”

Organising from below

As union after union has reneged on its responsibility to protect the NHS, activists have taken it upon themselves to do so.

In 2011 myself and other health activists formed the Healthworker Network to coordinate opposition among NHS workers to the Bill and the effects of the 20% budget cuts. We organised demonstrations and protests in London to rally NHS staff and students against the bill and try and pressure the unions into action.

NHS workers formed the National Health Action Party to organise and give expression to their desire to defend the NHS on the electoral field.

The Block the Bill action mobilised 2,000 people to block Westminster Bridge

UK Uncut called days of action against the cuts to the NHS. They called for and organised the Block the Bridge action where 2,000 people came from around the country to symbolically block Westminster Bridge and stop the passage of the bill.

Whistleblowers let down by the health unions unwilling to stand up to management and expose the cover ups and victimizations which plague the NHS formed Patients First to support each other and campaign for whistleblowers' rights and the protection of patients in the NHS.

Gloucester Keep Our NHS Public combined public campaigning with a legal challenge which went all the way to the High Court, to successfully stop the transfer of community services and 8 community hospitals to a social enterprise. The decision at the High Court forced the Primary Care Trust to create a new NHS Trust for the services, and campaigners created a guide for how others could replicate their victory.

Nurses formed the 4:1 Campaign to pressure the government to introduce mandatory minimum staffing levels for the NHS to safeguard patients and staff.

Keep Our NHS Public has tirelessly campaigned to defend the NHS, organising protests and leading many smaller local campaigns to defend hospitals and services. They organised a march of 8,000 people through central London in May 2013.

The Save Lewisham Hospital campaign was founded and lead by the community and local health workers, with almost no support from the local UNISON hospital branch. They mobilised 25,000 people to march in defence of their hospital. The leadership of the UNISON branch denounced activists leafleting the hospital and publicly criticised the campaign to all hospital staff.

Mothers opposed to the destruction of the NHS have launched the 999 call for the NHS campaign which is organising a march from Jarrow to London in protest at the attacks on the NHS. The march is being organised in the spirit of the 1936 “Jarrow Crusade”, a march by unemployed workers from Jarrow to London in protest at the conditions they were made to endure during the Great Depression.

Mental health service users in Cambridge occupied the Lifeworks clinic for four months and eventually stopped its closure at the hands of the local NHS management.

While no union has organised coordinated resistance to the cuts, individual branches have taken action themselves. They have often been supported but left isolated. Admin workers in UNISON at Mid-Yorkshire NHS trust waged a hard battle against down banding, but UNISON refused to generalise the fight or bring out other branches in support, despite down banding happening right across the NHS.

UNITE members strike for patient safety in Yorkshire Ambulance Service

The Unite Yorkshire Ambulance Service has a long running dispute against cuts, shift changes and de-recognition. The strike action has been strong, but the UNISON ambulance branch at YAS refused to come out in support, and told its members to keep working, undermining the dispute. The UNITE branch went out again in July.

Many NHS pathology labs are coming under increasing pressure from cuts and privatisation. Labs at my hospital have been privatised, and have had to be bailed out by the trust due to inefficiency and mismanagement. Recently Northampton Hospital has locked out a group of pathology workers who refused to sign no-strike contracts. This follows other long running disputes at other path labs in Chorley, Leeds, Wigan, Salford and Reading. Despite these attacks taking place almost everywhere, UNITE is not trying to coordinate a national campaign to protect pathology services in the NHS.

GMB branches have lead many strong local campaigns in defence of cleaning staff, and lead a strong campaign against racist bullying at Swindon Hospital by private contractor Carillion.

GMB members strike and protest against racist bullying in Swindon

Doncaster Care workers are currently fighting against huge cuts to their pay, and have had several weeks of continuous strike action, levels of action almost unheard of in the care sector.

Despite the wholesale destruction of the NHS, there has still been no national demonstration in its defence. The TUC eventually called for a demonstration in September 2013 in Manchester. This was termed a national demo, but it wasn't in London and was only targeting the Tory Party conference, not Parliament and the Department of Health. No action by healthworkers was planned to try and put pressure on the government after this show of opposition to government policy.

References

1. Right to Work “Day X for the NHS – 1,000 march through the City of London” 10 March 2011
2. Indymedia “Kill Lansleys Bill - NHS protest Tues 17 May, Gower Street, London, 5.30pm”
3. National Health Action Party www.nhap.org
4. “Anticuts groups descend on banks in NHS protest” The Guardian 28 May 2011
5. UK Uncut “Press release: UK Uncut to shut down Westminster Bridge in protest over NHS bill” 21 September 2011
6. The Guardian “Protestors against NHS reforms occupy Westminster Bridge” 9 October 2011
7. UK Uncut “Block the Bridge, Block the Bill” 21 September 2011
8. Patients First www.patientsfirst.org.uk
9. False Economy Blog “How Gloucestershire Campaigners stopped NHS privatisation” 12 November 2012
10. False Economy Blog “A glimmer of hope: we can stop the privatisation of the NHS” 1 May 2012
11. False Economy Blog “Keep our NHS Public Gloucestershire campaign guides” 1 May 2012
12. 4:1 Campaign for Mandatory Minimum Staffing Levels http://4to1.org.uk
13. Keep Our NHS Public www.keepournhspublic.com
14. Occupy London “Defend London's NHS Demonstration 18 May”
15. Save Lewisham Hospital Campaign www.savelewishamhospital.com
16. 999 Call for the NHS www.999callforthenhs.org.uk
17. 999 Call for the NHS “The peoples march for the NHS”
18. OpenDemocracy/OurNHS “Patients occupy threatened mental health clinic, some signs of victory?” 23 April 2014
19. Cambridge News “Mental health drop-in centre Lifeworks saved from closure after four-month sit-in by Cambridge patients” 28 june 2014
20. Press Association “Ambulance staff strike in care row” 2 April 2013
21. NHS Fightback “Yorkshire: Unions sabotage strike by ambulance staff” 9 April 2013
22. ITV “Yorkshire ambulance staff to walk out in Grand Depart week” 4 July 2014
23. The Guardian “NHS lab failings follow SERCO-led takeover” 30 September 2012
24. Northampton Chronicle & Echo “Northampton pathologists forced to strike as hospital refuses them entry to the building” 26 June 2014
25. Lancashire Telegraph “Chorley Hospital staff in threat to strike” 20 April 2013
26. Yorkshire Evening Post “Leeds Pathology Workers Strike Threat” 1 July 2013
27. Wigan Today “Strike is avoided” 1 March 2013
28. World Socialist Website “UK: Unite union imposes Salford NHS Trust’s attacks on workers” 3 June 2013
29. Union News “Managers make pathologists' blood boil over patient safety” 27 March 2014

NHS Employers on the offensive

NHS Employers, seeing the inaction and unpreparedness of the unions, have not sat idly by. In May 2012 16 NHS trusts formed the South-West Pay Cartel. They openly argued for breaking away from national pay bargaining organised through the Agenda for Change pay scale, and imposing regional pay agreements on NHS workers in the South-West.

While regional pay deals have been raised repeatedly by governments and health ministers as “the answer” to the supposed inability of the government to afford the NHS, this was the first time that trusts had lead the way in trying to implement a regional pay deal.

They met stiff resistance from local unions, with 27,000 people signed a petition against the pay cartel, and everyone from local trade NHS union branches to the South-West TUC coming out against the proposals. Rallies and protests were held outside hospitals across the South-West, and a march organised by NHS union branches drew over 1400 NHS workers to Bristol. Local protests and lobbying knocked Trusts out of the Pay Cartel one by one, reducing it from 20, to 13 till eventually it dissolved in April 2013.

UNISON members in the South-West protest the Pay Cartel

Its purpose had been fulfilled by then though. With the South-West Pay Cartel in existence, NHS Employers leant heavily on NHS unions throughout 2012 to accept changes to Agenda for Change at the national level, with the threat that if they didn't, other trusts inspired by the South-West Pay Cartel would be let off the leash. Staff were already facing severe attacks, with North Tees and Hartlepool NHS Foundation Trust threatening to sack all 5,500 staff and remploy them on new contracts if they did not agree to changes.

Rather than call their bluff and organise to fight as the union branches in the South-West had done, the RCN and UNISON accepted this concession bargaining and signed up to revisions to Agenda for Change in January and February 2013.

Both RCN and UNISON claim they agreed to give these concessions in exchange for maintaining national pay bargaining. But these concessions involved an agreement to implement performance related pay, a divisive measures which hands more power to management to discipline the workforce, and they include the loss of out of hours sick pay, and loss of pay increases for newly qualified nurses. And the agreement does nothing to prevent employers trying the same tactic again.

UNISON states its reason for agreeing to the concessions, that it was “in response to a number of NHS trusts attempting to ‘break away’ from the national agenda for change agreement.”

UNISON continues “Members in these trusts had to organise, campaign and take industrial action to try and stop the employers reducing terms and conditions and moving to local contracts.”

Given that this is exactly what a union is supposed to do when its members are attacked, and its members were already doing this in the South-West, it should have been possible for UNISON to role out this action across the NHS in response to the employers threats. Campaigning could have improved morale, defended tems and conditions and been a chance to organise and politicise the workforce.

UNISON's reason for not doing so was a “consultation” they held with branches over their willingness to take action to defend Agenda for Change. This “consultation” never went beyond branch committee level in most branches, and its result were never released to the branch committees or the wider membership. We were never able to judge whether members were willing to fight, and were not even balloted over whether we would be wiling to fight. The democratic method would have been to ballot members over their willingness to take action. Being democratic has never been high on UNISON's leaderships priorities.

Even if members weren't up for a fight, and they had already shown their willing to fight in the South-West, its the role of the union leadership to lead, not just sit meekly by and accept their members pay and conditions being trashed, forcing them into poverty. allowing the undermining of NHS' ability to recruit and retain staff and forcing the burden of austerity onto NHS staff and patients.

References

1. Nursing Times “South West Trusts set up regional 'pay cartel'” 25 May 2012
2. The Guardian “NHS Employers warn George Osborne against imposing local pay rates” 22 March 2012
3. Skwawkbox Blog “THE 28 MEASURES THE SOUTH-WEST PAY CARTEL IS CONSIDERING AGAINST STAFF” 12 September 2012
4. BBC News Cornwall “Unions angry at health consortium's ideas for South West” 23 August 2012
5. HM Government E-petition “No to postcode pay” http://epetitions.direct.gov.uk/petitions/36063
6. Express & Echo “Protest against NHS Pay Cartel deepens” 6 December 2012
7. BBC News Dorset “NHS hospitals trust leaves South West pay consortium” 13 November 2012
8. Blackmorevale Magazine “Health unions jubilant as Dorset County Hospital trust quits pay ‘cartel’” 16 March 2013
9. UNISON South-West “South West Pay cartel Now Down to Thirteen Trusts” 5 April 2013
10. British Medical Association “Regional Pay Consortium disbands” 18 April 2013
11. The Mirror “5,500 could face axe at just ONE NHS Trust if they don't sign new pay deal” 5 October 2012
12. Royal College of Nursing “RCN COUNCIL DECIDES ON AFC PROPOSALS, FOLLOWING CONSULTATION” 23 January 2013
13. Nursing Times “Unison accepts Agenda for Change proposals” 6 February 2013
14. Health Service Journal “Unison accepts Agenda for Change proposals” 6 February
15. UNISON “Defending Agenda for Change”
16. Nursing Times “Trusts desire fresh Squeeze on Agenda for Change” 3 June 2013

The NHS will only be saved by massive social protest

Labour's Shadow Health Minister Andy Burnham has promised to repeal the Health and Social Care Act, but promises are cheap, and we've heard plenty before. Labour still have to win the election, and how they can repeal the bill, stop privatisation and still meet Tory spending plans is not clear. Repealing the bill will mean cancelling contracts for the services privatized. Unless Labour commits to cancelling them without compensation (which I would support, but the private health corporations would not) this will be a costly exercise which will eat up the NHS budget. Much like the promises to renationalise the railways pre-1997, I expect these words to not amount to much.

Instead we need to look to Spain where massive protests by healthworkers and the public, and strikes by hospital workers halted plans to privatize the health system.

Strikes and protests by NHS staff and communities can terrify politicians, and scare off private companies looking to make a quick buck on the NHS. The last thing these private companies want is a workforce that will stand up to their greed and attempts to gouge profit from the NHS by intensifying work, slashing staff and rationing care.

The forces are there, what the situation needs is a group of radical healthworkers and community activists with the connections and social weight to initiate a campaign and draw the great mass of supportive but inactive NHS workers and patients into it.

The grassroots organisations exist which could lay the basis for a national staff and community lead campaign to defend the NHS. Keep Our NHS Public has dozens of local groups, there are several local Save A&E campaigns, the most well-known being the Save Lewisham Hospital Campaign. Alongside this is the growing Save Our Surgeries campaign of East London GPs, and the National Health Action Party which has thousands of healthworkers as members. There is also Medsin, the radical student medical society, with hundreds of members in universities around the country. As well there are many union branches who have resisted NHS cuts, like Mid Yorks Hospital fighting downbanding, Yorkshire Ambulance Service, GMB Carillion standing up to racist bullying and Brighton GMB opposing cuts by Kershaw, the Trust Special Administrator who tried to close Lewisham Hospital.

Organising a national coalition of these forces to defend the NHS could begin to assemble the critical mass of activists and organisations which is needed to mobilise enough people to defend the NHS, and start to develop the organisation in the NHS workforce that must exist for the sorts of strikes and direct action needed to cripple the government’s plans.

Save Lewisham Hospital: Mass community opposition to hospital closures

Several opportunities have already been missed to construct such a campaign. As the HASC Bill went through parliament in 2011, the grassroots activists who spearheaded the campaign against the Bill could have organised themselves into a national campaign aimed at coordinating action and providing a lead for all the tens of thousands of people opposed to the Bill, but who were left disorganised by the health unions do-nothing or openly collaborationist approach. This was not done, and following the calling off of the national public sector strike against pensions, in January 2012, the movement was demobilised, demoralised and petered out.

As the A&E crisis grew through 2012-2013, the government proceeded to target A&Es up and down the country for closure and the Save Lewisham Hospital Campaign received national press coverage, a national Save A&E campaign could have been launched to unite all the local campaigns into a national movement to halt the governments closure programme. This could have overcome the unevenness between the campaigns, given a national perspective and coverage to the issue, and forced the health unions to act on the issue, rather than leaving the campaigns isolated as supposed “local” issues, when they were the result of national government policy. Unfortunately this did not happen. The Labour Party played a pernicious role in this respect, opposing attempts in local campaigns, primarily Lewisham, to link up with other campaigns and raise the issue to a national level. This would have forced the Labour Party nationally to openly oppose government policy, which they were unwilling to do, so local Labour Party activists did what they could to keep campaigns localised.

Millwall players warm up in Save Lewisham Hospital campaign t-shirts. Opposition to NHS cuts is widespread and popular, but remains a "local" issue.

Labour activists have made clear their opposition to anyone trying to oppose them on NHS policy, or trying to build an organisation independent of their control. This article by a Labour activist argues that the NHS Action Party should be “strangled at birth” as they may take votes away from “the only truly NHS party – the Labour Party”.

It’s not the fault of NHAP or other campaigners that Labour may lose votes or support to other parties. It’s the fault of Labour's policies during their time in office, and the fact that many of us having memories longer than a few months. Labour needs to come out wholeheartedly against the government's plans for the NHS, and help, rather than hinder, attempts to construct organised opposition to it. Until they do, voters and activists have every right to look elsewhere and support other groups who have maintained a principled opposition to all attacks on the NHS.

A conference called Reclaiming the NHS was eventually organised in June 2012 to oppose the government’s attacks. This was called by the NHS Support Federation, a trade union supported organisation which carries out research on reforms to the NHS and opposes cuts and privatisations. The possibility of uniting the different campaigns was discussed prior to the conference, but the conference itself was not organised to do so. There were mostly top table heavy sessions with academics, journalists and union leaders giving their thoughts on the NHS reforms, with no forums for discussing and democratically deciding how to unite all the different campaigns into a working coalition. Workshops were held on different areas of campaigning, but these just reported to the main conference, and no decisions or votes were taken on any matters. The conference was a talking shop, which produced little in the way of action.

Given the future we face if the reforms continue unopposed, it’s an absolute necessity that grassroots activists in the health service and communities affected try and unite their various campaigns into a national movement to save the NHS. The unions have abdicated their responsibility to do this, Labour are largely opposed to doing so, so it’s up to us to do it ourselves.

Why aren't we choosing one Saturday a month and designating it an NHS action day and targeting the banks and corporations involved in NHS privatisation?

If no one feels they have the authority to call actions (what authority did UK Uncut have? It just did it!) , let's create an authority that does by combining all the different campaigns into a national save the NHS campaign, under the democratic control of NHS workers, patients and communities. 

Such a campaign could overcome the conservatism and bureaucratic inertia of the unions, and force the NHS onto the political agenda in an active way, forcing politicians and parties to take our demands seriously, and cease treating the NHS as a chance for political point scoring while behind the scenes they do deals to hand it over to their private sector donors.

We have spent 4 years fighting the reforms as a fragmented mess of local campaigns and individuals. Its time we united our forces into the mass social movement that the NHS needs and deserves. Anything less will not do, and we will continue to lose important battles, and the state of the NHS will deteriorate to the point we can no longer mobilise people in its defence. Once this happens then it will be the end, but it’s not happening yet, so if we act now, we can still save the NHS.

If we organise a conference to launch a Save the NHS campaign in the autumn, we can begin to coordinate action in the run up to the election. We could set a NHS day of action each month to keep up the pressure on the government, and galvanise more widespread action and coverage.

We could launch a monthly bulletin for NHS staff, informing them what is happening and how they can fight cuts and privatisation in the workplace. Ignorance of the effects of the reforms and a fatalistic belief that nothing can be done lies heavily on the NHS workforce. A source of knowledge and grassroots networks of staff committed to fighting and organising direct action in the workplace could begin to turn this around.

We could call a national Save the NHS demo for the Spring and ensure the election is all about the NHS, so the Tories definitely lose.

And we can set the groundwork among NHS workers, community campaigners and NHS activists to ensure what whoever wins the 2015 election, we have a strong united movement capable of defending the NHS against further attacks.

The NHS: Still the best health system despite 4 years of austerity and government attacks (Commonwealth Fund)

References

1. Portside “Spanish doctors and nurses protest privatisation” 17 February 2013
2. Russia Today “Spain: Waves of health workers descend on Madrid protesting privatisation” 17 February 2013
3. Revolting Europe “Spanish unions call fresh wave of strikes over healthcare privatisation” 25 April 2013
4. El Pais “Madrid abruptly cancels plans to outsource management at public hospitals” 27 Jan 2014
5. Bloomberg “Madrid Hospital Privatization Frozen Amid Legal Challenge” 12 September 2013
6. BBC “Mid Yorkshire NHS Trust staff union vote for new strike” 29 May 2013
7. BBC “Further strike action in Yorkshire Ambulance Service dispute” 17 May 2014
8. Labournet “Swindon hospital strike against Carillion” 28 February 2012
9. Union News “Blacklisting scandal widens with link to “racist bullying” hospital dispute” 12 March 2012
10. Nurse Boothroyd Blog “Brighton Defend the NHS Demo” 7 April 2013
11. The Telegraph “NHS opens door on widespread A&E closures” 18 Jan 2013
12. BBC “London A&E closure plan published” 21 June 2012
13. The Telegraph “Mass closure of NHS walk-in centres fueling A&E crisis” 10 November 2013
14. Labourlist “The National Health Action Party must be strangled at birth” 18 October 2012
15. Red Pepper “Reclaiming our NHS” 22 June 2012
16. NHS Support Rederation “How to reclaim our NHS”

Epilogue: What kind of NHS do we want?

What sort of NHS we want is a crucial question, because what we want the NHS to become determines what we are prepared to do to defend it, and how we go about that.

Most supporters of the NHS are in favour of a publicly owned, universally accessible and free at the point of use NHS, funded by general taxation. This is what the NHS was at its inception, and the socialist principles it embodied have imprinted themselves on our consciousness. The vast majority of people in Britain strongly oppose the idea that people can or should be made to pay for healthcare, and instead view it as a right.

Millions understand the NHS as a massive progressive gain, which should never be allowed to be rolled back. However the NHS was not without faults. Created in a capitalist society, it was subject to the problems of hierarchy and exploitation which are central to that system.

While providing excellent treatment to many, its unaccountable bureaucracy was party to a great many cover-ups and scandals, and many NHS workers sacrificed their livelihoods and careers to blow the whistle on dangerous practices, corruption or incompetent practitioners. Patients suffered devastating medical errors, and lacked control and autonomy within the system, and despite recent government rhetoric, still have little say in how the NHS functions.

While massively more efficient than any market mechanism, the NHS bureaucracy still committed errors, and its plans and allocation of resources was distorted by governments political priorities, the influence of the medical hierarchy, and for many years, too little input from patients and service users.

The NHS still operates in a parasitic way on many countries health systems. Chronic underfunding of nursing schools, and a constant shortage of doctors forced the NHS to recruit staff overseas, effectively stealing highly trained professionals from the poor nations who had done the costly work of training them. This has robbed those nations of staff they desperately need, while allowing successive British governments to reduce training budgets and close nursing schools in Britain.

Bearing these issues in mind, is it enough to want to go back to the way the NHS was, with all these faults? Shouldn't we be projecting a vision of an NHS fit for the 21^st century, taking the best bits of the NHS from the 20^th century; its socialist universalism, healthcare as a right, free to access with the cost borne by the whole of society, and combine that with best of the 21^st century rejection of hierarchy and authoritarianism, respect for the individual and their autonomy, and a grassroots, democratic approach to organising and providing healthcare.

A democratically controlled NHS, with budgets under the control of NHS staff and patients, with elections for all managerial positions, and with representation at all levels for patients and local communities, would create a truly accountable and open health system.

An egalitarian NHS with a greatly reduced hierarchy, which acknowledges the collective nature of all healthcare work, and values the work of all NHS workers, from cleaners and porters up to clinical nurse specialist and neurosurgeons, and gives them all an equal say in how it is run.

Nationalising the pharmaceutical and medical science companies and incorporating them into the NHS in order to eliminate costly interactions with the private sector which drain the NHS budget. With pharmaceutical and technological development incorporated into it, the NHS could become the centre of advancement for medical science, able to develop and share its discoveries and knowledge internationally without recourse to the profit motive and its distorting and exclusionary effects.

Re-nationalising the care home system, and properly integrating health and social care so the NHS once again provides care from cradle to grave, providing well resourced and staffed nursing homes for older people with properly trained NHS staff, where older people can receive the support they need to lead dignified and stimulating lives, free from the poverty and social isolation that at present affects millions of them.

Making the struggle for the NHS part of a struggle for a new social system which seeks to eliminate the causes of illness, not just the symptoms; working to eradicate poverty, inequality, exploitation, hierarchy and guarantee everyone housing, education, fulfilling work and plenty of leisure time.

This is a vision of an NHS worth fighting for, and one which we can create, if we organise to make it so.