First, we must realise that although we may have lost the legislative battle, we have not lost the argument. When Labour’s Andy Burnham turned over the keys to the Department of Health before the 2010 election, the mandarins told him that if he came back there was only one issue to worry about – the money. What he could not do was devise another fantastically ambitious NHS reorganisation. The NHS had to be about quality and efficiency.
When Andrew Lansley’s bill was published, Burnham knew that proposals for the biggest upheaval in NHS structures since 1948 were not what the country could digest. The health select committee agreed. Running a £20 billion efficiency programme alongside a massive change in philosophy (a new era of private sector colonisation of health services) was simply reckless. Not one expert inside or outside government believes this is a sensible strategy.
We are about to see a phase of unprecedented chaos in our health services. Those of us who opposed the bill should not gloat as this confusion takes hold. People will die thanks to the government’s decision to focus on competition rather than quality in healthcare. The coming disaster puts even greater responsibility on us to overturn this destructive legislation and remove this undemocratic government.
Second, therefore, we must begin collecting rigorous and reliable information on what is happening to our health services. When the Conservatives introduced fundholding to the NHS in the 1990s, it took years before we learned that the promises ministers had made were false. There was no consistent improvement in services. There were no gains in efficiency. Patients did not benefit from giving greater autonomy to GPs over how they spent their budgets. But the news of this policy failure came too late to influence the political debate.
We can’t allow that delay to happen again. We need to ensure that health professionals who study the NHS – and there are many of them – turn their attention to the bill’s impact on the lives of those who will suffer the fragmentation and disintegration of services. We need to build the evidence base now to show how the government’s policy is hurting people.
Finally, we must convert our arguments and the evidence we accrue into effective opposition. Labour was slow to respond to the Cameron-Lansley assault on the NHS. Those of us outside politics need to work harder to provide the necessary tools to the only opposition we have left. That way I hope we can make the NHS the central issue in the next election. The health of this nation depends on it.”
Richard Horton is editor of The Lancet.
Dr Jacky Davis: “It is inconceivable that we will all sit back and watch our NHS wantonly destroyed. We must make it clear to coalition politicians that we will not forgive their anti-democratic behaviour. There are more than a million people working in the NHS; our votes and those of our friends and families will be used to punish the politicians responsible for this, both locally and nationally. We must also hold Labour to its promise to reverse the legislation when it is back in power.
The fight must go on in other ways too. Many groups have woken up to the dangers of the health bill and joined with campaigning organisations against it. Public health doctors, medical students and patients have all organised to protest and these groups can work together in future. There must be some sort of public statement, possibly a high-profile conference, to decide the way ahead and it must be made clear to politicians that the fight is not over.
We must monitor the changes to the NHS once the legislation comes into effect. By its very nature it will be increasingly difficult to know what is going on, as the service fragments and financial dealings and patient outcomes are lost behind a convenient curtain of ‘commercial confidentiality’. It is essential that we keep track of the bill’s effects if we are to show we were correct in our predictions of its dangers. The coalition will certainly not be telling us about the problems that arise, their predilection to massage the truth being only too apparent in their introduction of the bill in the first place.
Finally, we need an urgent inquest into the abysmal failure of medical ‘leadership’. Early and united opposition would have seen off the bill long ago. Instead our leaders, in trade unions and professional bodies, saw ‘opportunities’ and decided they could work with it on our behalf. When they were finally persuaded to see the dangers, their policy changed to seeking ‘significant amendments’, despite the fact that the government showed no sign of conceding any.
Few organisations conducted a proper campaign, even after being mandated to do so. The leaders of the professions were only moved to opposition after internal struggles and grass-roots organisation. They have not represented their members. They must be held to account for their failure and the whole structure of representation needs critical examination.
In sum, we will need a combination of actions such as continuing media coverage, evidence about the detrimental effects of the bill, protests, occupations and perhaps a refusal to co-operate with the legislation – for example, a boycott of the private sector. This battle may be over but the war is just beginning.”
Jacky Davis is a consultant radiologist and British Medical Association council member. She is writing in a personal capacity
Jonathon Tomlinson: “The first priority must be to protect patients, in particular those who are least able to articulate their needs or access care. The health bill is intended to convert healthcare and patients into commodities. GP will be pitted against GP and hospital against hospital, vying for patients. Patients will be expected to compare GPs and hospitals in league tables and shop around, competing with each other for increasingly limited resources. Hospitals will be allowed to succeed or fail according to the values of the market, irrespective of patient need.
Since it is far more efficient and profitable to care for people who are motivated and able to care for themselves, it is those patients who are lacking motivation and ability who will be the first to suffer. Services for people with mental illnesses, dementia, drug addiction and language barriers are being cut first because those who depend on them are least able to complain. We will need to take urgent action to protect them. ‘Occupy Healthcare’ as a movement will exist to show that healthcare for vulnerable people cannot be run according to the same business ethics as industrial healthcare. Day hospitals will need to be occupied. There is now a daily picket at the gates of Chase Farm Hospital to keep it open, with a view to occupation to prevent the closure of A&E and maternity.
The NHS has entered the political consciousness of the public more than at any time since it began. One urgent need is for all of us to get involved with the new democratic structures, however toothless they may seem. These range from patient participation in GP surgeries and GP commissioning groups, and membership of Health Watch and health and wellbeing boards to standing as non-executive directors at foundation trust hospitals and so on.
Finally, we have to reject industrial healthcare. It is unsustainable, unhealthy and immoral. It’s time to bring humanity and sustainability back to the NHS.”
Jonathon Tomlinson is a GP in Hackney.
Yasmin Gunaratnam reflects on John Berger’s gut solidarity with the stranger
Charlie Clarke and Heather Mendick discuss how to work through the tensions within Momentum
As man-made global warming gets closer to the tipping point, Andrew Simms finds reasons to be positive about averting catastrophic climate change
In this extract from his new book The Candidate, Alex Nunns tells the inside story of how Jeremy Corbyn scraped onto the Labour leadership ballot in 2015
Graham Jones proposes a framework for a diverse movement to flourish
Bryony Moore profiles Stitched Up, a non-profit group reimagining the future of fashion
Musician Eliane Correa reflects on the fading revolution
Trump's victory is another sign of the failure of the centre-left's narrative on climate change. A new message is needed, and new politicians to deliver it, writes Alex Randall
Siobhán McGuirk says the question we are too afraid to ask is simple - what kind of society leads to Donald Trump as President?
The battle lines are clear. Democracy is in peril and the left must take itself seriously electorally and politically. Ruth Potts speaks to Gary Younge, who was based in Muncie, Indiana, for the US election, about the implications of Donald Trump’s victory
Utopia: Work less play more
A shorter working week would benefit everyone, writes Madeleine Ellis-Petersen
Short story: Syrenka
A short story by Kirsten Irving
Mum’s Colombian mine protest comes to London
Anne Harris reports on one woman’s fight against a multinational coal giant
Bike courier Maggie Dewhurst takes on the gig economy… and wins
We spoke to Mags about why she’s ‘biting the hand that feeds her’
Utopia: Daring to dream
Imagining a better world is the first step towards creating one. Ruth Potts introduces our special utopian issue
Utopia: Room for all
Nadhira Halim and Andy Edwards report on the range of creative responses to the housing crisis that are providing secure, affordable housing across the UK
A better Brexit
The left should not tail-end the establishment Bremoaners, argues Michael Calderbank
News from movements around the world
Compiled by James O’Nions
Podemos: In the Name of the People
'The emergence as a potential party of government is testament both to the richness of Spanish radical culture and the inventiveness of activists such as Errejón' - Jacob Mukherjee reviews Errejón and Mouffe's latest release
Survival Shake! – creative ways to resist the system
Social justice campaigner Sakina Sheikh describes a project to embolden young people through the arts
‘We don’t want to be an afterthought’: inside Momentum Kids
If Momentum is going to meet the challenge of being fully inclusive, a space must be provided for parents, mothers, carers, grandparents and children, write Jessie Hoskin and Natasha Josette
The Kurdish revolution – a report from Rojava
Peter Loo is supporting revolutionary social change in Northern Syria.
How to make your own media
Lorna Stephenson and Adam Cantwell-Corn on running a local media co-op
Book Review: The EU: an Obituary
Tim Holmes takes a look at John Gillingham's polemical history of the EU
Book Review: The End of Jewish Modernity
Author Daniel Lazar reviews Enzo Traverso's The End of Jewish Modernity
Lesbians and Gays Support the Migrants
Ida-Sofie Picard introduces Lesbians and Gays Support the Migrants – as told to Jenny Nelson
Book review: Angry White People: Coming Face to Face With the British Far-Right
Hilary Aked gets close up with the British far right in Hsiao-Hung Pai's latest release
University should not be a debt factory
Sheldon Ridley spoke to students taking part in their first national demonstration.
Book Review: The Day the Music Died – a Memoir
Sheila Rowbotham reviews the memoirs of BBC director and producer, Tony Garnett.
Power Games: A Political History
Malcolm Maclean reviews Jules Boykoff's Power Games: A Political History
Book Review: Sex, Needs and Queer Culture: from liberation to the post-gay
Aiming to re-evaluate the radicalism and efficacy of queer counterculture and rebellion - April Park takes us through David Alderson's new work.
A book review every day until Christmas at Red Pepper
Red Pepper will be publishing a new book review each day until Christmas
Book Review: Corbyn: The Strange Rebirth of Radical Politics
'In spite of the odds Corbyn is still standing' - Alex Doherty reviews Seymour's analysis of the rise of Corbyn
From #BlackLivesMatter to Black Liberation
'A small manifesto for black liberation through socialist revolution' - Graham Campbell reviews Keeanga-Yamahtta Taylor's 'From #BlackLivesMatter to Black Liberation'
The abolition of Art History A-Level will exacerbate social inequality
This is a massive blow to the rights of ordinary kids to have the same opportunities as their more privileged peers. Danielle Child reports.
Mass civil disobedience in Sudan
A three-day general strike has brought Sudan to a stand still as people mobilise against the government and inequality. Jenny Nelson writes.
Mustang film review: Three fingers to Erdogan
Laura Nicholson reviews Mustang, Deniz Gamze Erguven’s unashamedly feminist film critique of Turkey’s creeping conservatism
What if the workers were in control?
Hilary Wainwright reflects on an attempt by British workers to produce a democratically determined alternative plan for their industry
Airport expansion is a racist policy
Climate change is a colonial crisis, writes Jo Ram
Momentum Kids: the parental is political
Momentum Kids is not about indoctrinating children, but rather the more radical idea that children have an important role to play in shaping the future, writes Kristen Hope