The coalition's health white paper represents a new and extreme threat to the NHS which must be met by grass-roots and national resistance. Luckily (or unluckily as the case may be) we're not starting from scratch. The pro-market policies of New Labour sparked considerable activity and there are already many health service campaign groups and networks in place, as well as lots of experience of which strategies are most successful.
There is a plethora of health campaign groups, ranging from national organisations such as Keep Our NHS Public to entirely local initiatives like East Riding Hospitals Action Group, and even single-issue political parties. This reflects different forms of campaign activity, with straightforward anti-cuts movements existing alongside more broadly focused organisations.
Camden and Islington in North London are good places to look for examples. The debate has been particularly heated here because London is where New Labour's reforms were pushed hardest and fastest.
The most visible and often successful form of health protest is the local 'defend our hospital' anti-cuts campaign. In summer 2008, services at the Whittington Hospital in Highgate were threatened with closure. This destructive proposal caused a groundswell of opposition. The Defend the Whittington Hospital Coalition (DWHC) was duly formed.
In February 2009 its protest campaign peaked in a vibrant 5,000-strong march. In April, as a follow up, the DWHC held a day of action to which it invited political leaders to speak. With the election just around the corner, then health secretary Andy Burnham made a dramatic U-turn and bowed to public pressure, overruling the NHS primary care trust (PCT). His Tory shadow Andrew Lansley, now the secretary of state, also pledged to honour that decision.
The Whittington campaign was a powerful community alliance driven by the real and acute threat of losing a treasured hospital. According to organiser Candy Udwin, 'We were successful because of the sheer breadth of support. We were also a highly visible campaign out on the street, in the paper and on line. We built broad links with other campaigning groups.'
Yet fears about the future of the Whittington are still palpable. Campaigners delivered a 25,000 signature petition to the Department of Health in July. The coalition white paper proposes to give GP consortia commissioning power, and health bosses have said they could resurrect their hospital closure plan if GPs agree. Despite the massive show of public opposition, Lansley may still oversee cuts, so the campaign is not over yet.
In the same area of London, a different form of health campaign has also gained a high profile. The Camden branch of national organisation Keep Our NHS Public was active in the Whittington campaign too, but it has a broader, more long-term set of objectives in opposition to the imposition of the market on the health service.
Camden Keep Our NHS Public has been a thorn in the side of the local PCT, frequently challenging the failure of NHS bosses to carry out their legal duty to consult the public when downgrading local health services. Most recently the PCT tried to award an out-of-hours GP service to Harmoni Ltd, a private company that plans to cut costs by replacing out-of-hours GPs with nurses. Keep Our NHS Public member Regan Scott made the case to the borough's health scrutiny committee that this represented a substantial change requiring consultation. As a result the tendering process has been delayed and at the time of writing is pending.
Meaningful consultation when imposing cuts and privatisation has continued to be a stumbling block not just for NHS Camden. North East Derbyshire PCT fell short in 2006 and was challenged in the High Court. Haringey PCT also failed to consult in 2008 when Hornsey Central Hospital was demolished in favour of a PFI health centre, and there are many other examples.
The North East
Another form of resistance is being employed in the North East of England, this time led by health workers directly. Earlier this year Unison in Durham successfully quashed proposals to turn the local NHS trust into a social enterprise - an independent body not part of the NHS proper. Unison insisted that before any decision was made a vote among staff had to be taken. Members campaigned hard to raise awareness about the negative impact this change would have on local health services and staff voted against.
This kind of action by health workers will be seen more and more if the government's health white paper becomes law, as forcing NHS bodies to become 'social enterprises' is a central plank of the coalition's health policy. One of the fears is that social enterprises are a soft cover for privatisation, breaking the NHS up into independent businesses that must compete with each other rather than collaborate for the good of patients. Social enterprises are likely to be easy pickings for profit-making corporations to buy up in the future.
Concerned locals in the North East also formed the Public Services Alliance (PSA). The PSA is a broad community alliance between organisations opposed to cuts and privatisation in general. At present it includes all the public sector trade unions and it aims to expand to include organisations in the voluntary sector, political and academic representatives, as well as public service user groups.
In the Northern Region one in three jobs are in the public sector. As Unison convener for the region Clare Williams says, "With the threatened abolition of PCTs, Strategic Health Authorities and NHS Direct as well as cuts in hospital services, there is a real worry what this means for jobs and the quality of services."
The PSA is not just about defending jobs. It has come together to challenge the pro-market agenda and to provide an alternative vision for the future of public services. "We have been leafleting and awareness-raising with health workers and the public," says Clare. "One of the first hurdles to get over is making people aware of the seriousness of the danger posed by the White Paper: that if more NHS Trusts become social enterprises this will take more NHS hospitals and staff out of public oversight. This will ultimately fragment services, resulting in a postcode lottery."
The PSA has already started branches across the North East, including in Newcastle, Gateshead, Durham and Sunderland. Branches are meeting regularly, a website is in the making and coalitions with other local groups are being built - support is growing.
On a national level, health campaigners are looking to the unions to lead the fightback, freed from any fetters now that Labour is out of government. Unison has launched an important legal challenge in the High Court, seeking a judicial review over the government's failure to consult on the white paper before beginning its implementation. Meanwhile Unite has started a Unite 4 Our NHS campaign.
Beyond resistance to government policy, campaigners are developing visions of how the NHS should look. A recent British Medical Association-sponsored roundtable event on 'An NHS Beyond the Market' called for a health service based on principles of 'risk pooling, free access and comprehensive care based on need alone' and an end to the purchaser/provider split, first introduced by Ken Clarke during the last Conservative government, which is the foundation of all the market reforms.
The campaigns outlined here represent a fragment of what has been going on in communities across the country. As the pro-market agenda becomes more aggressive it is imperative that a nationwide campaign mounts a robust and unified defence. Unions will have a key role, not just health unions, but all public sector unions. This campaign must be a broad one building on the strategies that have proved effective.
Health will be a big issue over this parliament. The most radical reforms since 1948 are being pushed through at the same time as £20 billion of cuts. If these two phenomena become linked in the public mind, and unions, local and national campaigns coordinate their efforts, there is a real chance of stalling government policy.