Well, it’s depressing: the government got its Health Bill through. The NHS has been abolished in all but name. All the work and effort that went in to building it up, all the money that people have paid in to it, all the ties of social solidarity that it has fostered - just squandered away in a right-wing spasm.
The campaign against the Bill – brilliant as it was – failed. The campaign against the Act can’t afford to. Up to now the battle has been fought largely at the national level. The next phase will be about local action. Here are some of the early ideas that health campaigners are discussing for how to move things forward:
1) Local campaigners want to do something – fighting the Bill generated huge amounts of energy that must be sustained – but it’s difficult to know where to focus in the new system. GPs will be the group with the most power to frustrate the implementation of the Act, and they are much more likely to do so if they feel pressure from their patients. So we should have a campaign to get people to ask their new CCG (Clinical Commissioning Group) to adopt a statement that commits it to treat the NHS as its preferred provider to protect local NHS facilities, to refuse to sign contracts that involve commercial confidentiality, and to take all decisions openly in public. There is no reason for clinicians, who all opposed the Bill, to disagree with these pledges. And if the government intervenes it will give the lie to all the talk of local control and their denials of privatisation.
2) Encourage people to get involved in patient participation groups at their GP surgery, to tell their GPs to resist the market elements of the Act by favouring local NHS hospitals over private facilities. Health Watch bodies and foundation trust boards also offer some opportunities to influence how the Act is implemented, or at least to monitor what is happening.
3) We need a central point for people to report local cuts and the loss of services (when patients are told they can’t have a certain treatment), so we can keep track of the real effects of the Act after the media has moved on. Somewhere like 38 Degrees would be perfect for this – a high profile website that can store and display all the information.
4) Every time a service is cut or removed, we should contrast government statements saying that this wouldn’t happen with a quote from a patient who is suffering. This should be disseminated in every way, via the internet, mailings, billboards.
5) ‘Occupy Healthcare’ – physically occupy facilities that are threatened with closure, in a way that doesn't obstruct patient care. Hold local anti-cuts protests, always making the link back to the Act.
6) Expose which facilities are run for profit, and make local patients aware of it. Where a choice is available (which may not be the norm once the legislation is fully implemented), encourage patients to choose NHS-provided care.
7) Labour has pledged to repeal the legislation once it is power. This is possibly meaningless, since by the time of the next election the realities on the ground could mean it is impossible to simply repeal it. But it’s a symbolic commitment and we should hold them to it. While the NHS is a big political issue there’s an opportunity to pressure Labour to re-adopt its 1997 manifesto pledge, when it stood for a publicly funded, publicly provided health service. That did a fat lot of good last time, but right now it could have the beneficial effect of making the private sector – upon whose involvement the real purposes of the Act rest – more cautious and risk-averse, stalling the Act in practice.
More ideas will be needed and new strategies will emerge as the Act becomes reality. One thing is guaranteed: there will be chaos in the health service. This will not be one of those battles that fade into memory once the legislation is implemented; it will remain urgent and visible. Things were going to be bad in the health service anyway, with the NHS being required to make £20 billion of cuts. Combine this with a messy transition to a new system that hasn’t even been fully invented yet and the outcome will be manifested in many individual disasters. As Richard Horton, the editor of the internationally respected Lancet medical magazine writes in the April/May edition of Red Pepper, “People will die thanks to the government’s decision to focus on competition rather than quality in healthcare.” Those are the stakes.