For the health campaigners, unions, medical professional bodies and others who opposed the Health and Social Care Bill, at varying volume and often in staccato style, the moment when it passed into law was demoralising. Their long-drawn-out battle against the Bill had been in vain. But through their efforts they had managed to establish in the public mind the sense that the Government’s health policy was controversial and unpopular. The question facing this very loose alliance now is how to build on this foundation as the Act is implemented, for an ongoing defence of the NHS.
At the ‘Reclaiming Our NHS’ conference in London on 23 June, campaigners will try to forge an answer. In advance of the event several important organisations, including the TUC and the big unions, the National Pensioners Convention, and pressure groups like the NHS Consultants’ Association and the NHS Support Federation, have put their names to a joint statement that warns of ‘the breakup of NHS services and the undeniable process of NHS privatisation,’ and commits them to ‘reclaim a publicly provided, funded and accountable NHS that continues to deliver comprehensive care to all in our society.’
But how to do this? One issue is whether a single organisation uniting the disparate groups is needed to continue the pressure. ‘I think we should have some big umbrella organisation,’ says Jacky Davis, a consultant radiologist and a founder member of Keep Our NHS Public. ‘It’s not effective for everyone to be doing their own small thing. If we put all the little punches together we’d have a killer punch.’
But this is unlikely to happen. Aside from thorny tactical differences and the inclination of organisations to guard their own identity, many believe that the ‘swarm approach’ to campaigning can be ‘a nimble and durable model,’ in the words of David Babbs, Executive Director of online campaigners 38 degrees. ‘I know some people feel that not having an umbrella organisation was a significant problem in the campaign against the Bill, but that's not my view and it's certainly not top of my list of reasons why I think we lost,’ he says.
One area where collaboration is essential is the task of monitoring the effects of the Act, which campaigners expect to be myriad, from the withdrawal of some services to the encroachment of profit-making companies into vital areas of care. There are already examples of opportunistic providers taking advantage of the new climate to impose charges on NHS patients, as happened recently for podiatry in Greenwich. And the deep cuts happening as part of the so-called efficiency savings will be extended by the dynamic of the Act.
False Economy, the new anti-cuts web resource (funded largely by the TUC but not strictly a union initiative), is one option to host such a database. ‘We are certainly interested in being that place,’ says False Economy’s Clifford Singer. ‘We do have the infrastructure and we have the most comprehensive list of cuts available at the moment so it makes sense for us to do it. We have the same problem that everyone has of resources, but if the TUC or anyone else wanted to fund a specific project it could be done.’
Proper collection and presentation of information is important because the theatre of campaigning is moving away from the national stage. During the legislative process all eyes were on Westminster, but now most campaigners believe the NHS will be won or lost at the local level. Long-standing campaigns, such as Keep Our NHS Public with its network of local groups, have vital experience of these kinds of struggles. For others who came to NHS campaigning because of the Bill, such as 38 degrees, it is ‘new territory,’ as David Babbs admits. ‘The most important resource you need for local campaigning is a network of inspired local campaigners,’ he says. ‘38 Degrees has one million members all across the UK and many of them have indicated a strong commitment to continuing the NHS campaign, including at the local level.’
Paul Evans of pressure group the NHS Support Federation believes that the success of local community campaigning will depend on how well a broad range of players are able to knit together in each area. ‘There are many who want to do something to keep the NHS alive,’ he says. ‘Some have national networks, others have research expertise or information, some have funding, others are poor but have highly motivated members who will organise meetings and take to the streets. The art is in creating a framework for them to work together in communities all over the country.’
This hope of broadening the campaign is fuelled by the experience of the last two years, when new groups like 38 degrees and UK Uncut joined forces with the traditional core of health campaigners. According to Lucy of UK Uncut, their distinctive style of direct action has proved surprisingly popular, even with health professionals. ‘We’ve had a lot of conversations with senior medical practitioners who are very supportive of direct action,’ she says. ‘These are what you might think of as unlikely people for civil disobedience.’ The influence of UK Uncut could be seen in the ‘Block the Bridge,’ protest on Westminster bridge, and the attempt to form a road block outside the House of Lords by activists chaining themselves together while Peers were debating the Bill. Lucy says the biggest impediment to more people joining actions and occupations is not lack of willing, but simply that people ‘don’t know how to go about it, so skill sharing is very important.’
If the process of opposing the Bill undoubtedly entailed branching out in new directions, it did not result in the kind of universal involvement across civil society that some had hoped for. In the view of Paul Evans, ‘Saving the NHS is still not mainstream. Some of our most powerful potential allies, like some of the national charities, whose users will really suffer under a fragmented and privatised system, really must step forward much more boldly.’
But a conversation with Neil Churchill of charity Asthma UK reveals just how far campaigners have to go before their analysis is shared by such organisations. According to Churchill ‘the Act is of secondary importance. The most important game in town is the productivity challenge.’ Churchill’s voice is significant because his views are representative of the Richmond Group of ten large patient charities. Even on the fundamental matter of competition the message of campaign groups and unions has barely registered: ‘The Act is not about open competition,’ Churchill insists, ‘it’s about managed competition.’
The people best placed to explain and thwart the most dangerous aspects of the Act are NHS clinicians, the majority of whom opposed the legislation. One example of a practical measure they could take is for GPs to push their Clinical Commissioning Groups (the new bodies that will buy care for patients) to adopt a ‘Fair Commissioning Charter’, committing them to resist private encroachment and act in an open way. This idea, which originated from campaigners like Health Emergency’s John Lister, has been endorsed by the GPs Committee of the BMA. Such steps are important – doctors who want to take a stand may feel exposed without collective backing (and, in this regard, pressure from patients through patient involvement groups is significant too). But passing a resolution is one thing; ‘without doing something about it and communicating it, it’s useless,’ says Jacky Davis, who sits on the BMA Council (the Association’s central decision-making body). She is scathing about the performance of clinicians’ professional bodies: ‘I blame the medical establishment for the Bill going through. I’m so angry about it. There’s no doubt in my mind that if the medical establishment had acted together the Bill could never have passed.’
Some doctors are taking a direct approach. The newly formed National Health Action Party plans to stand candidates at the next election. Clive Peedell, a consultant oncologist who in January ran six marathons in six days in opposition to the Bill, is one of the originators of the new party. ‘The aim is to win seats if we can, but mainly to make the NHS the second issue at the next election behind the economy,’ he says. ‘This will be a really exciting political development. The NHS is an amazing brand that people support, and we can connect with that through social media to harness that energy and reach out to a wider spectrum of people than normal politics can.’
‘Part of the strategy,' Peedell explains, 'is to make Labour rethink its health policy.’ Campaigners hope that a Labour victory at the next election could at least undo the damage done by the Act. But they have their doubts. ‘[Labour’s shadow health secretary] Andy Burnham has said they’re going to repeal the Act,’ says Jacky Davis. ‘But Miliband has said he’s going to deal with the three worst aspects of it. So come on guys, what do you mean?’
According to Guy Collis, policy officer at Unison, ‘repeal is probably unlikely because there are things Labour will want to keep. So it will be about reinstating a public NHS.’ Collis believes ‘if any party enters the next election promising another top down reorganisation it will be suicidal. But the big thing in Labour’s favour is the Act was so unpopular the public will be on their side if they take a bold stand.’
Clive Peedell, who thinks another reorganisation is necessary, nevertheless agrees that it cannot be done all at once: ‘I think it would have to be a longer term vision to restore the NHS. There is a clear first step to reinstate the Secretary of State’s duties, powers and responsibilities. That would be easy in terms of repealing part of the Act and it would have a big impact. Then other things would be done over time.’
Until then, as David Babbs of 38 degrees puts it, ‘The new legal framework threatens the NHS, so we need to campaign for that legal framework to be changed. But it's hard to see that happening this side of a general election, so we need to work hard in the next three years to make sure we still have an NHS worth saving.’
The ‘Reclaiming Our NHS’ conference will take place at Friends House, Euston Road, London on Saturday 23 June, 10.30am – 4.30pm. For full details and to book tickets visit http://www.nhscampaign.org/reclaiming.html
Alex Nunns is Red Pepper’s political correspondent. This article was sponsored by the NHS Support Federation and a longer version appears on their website: http://www.nhscampaign.org/reclaiming/reclaiming-the-nhs-analysis.html