The NHS is the biggest reform ever won by the working class in Britain. Before it was established in 1948, working class people had to save, borrow or pawn their goods to be able to afford a GP. Thousands of people suffered and died unnecessarily.
The NHS was never fully publicly-owned and controlled, as GPs were allowed to continue private practice and the pharmaceutical industry remained in private hands. However, the establishment of the NHS utterly transformed the lives of all working class people.
But for more than 30 years the NHS has faced underinvestment and privatisation. The Tories introduced the 'internal market' and established Trusts outside of democratic control. Labour poured increased public funding into the coffers of private profiteers, through PFI (Private Finance Initiatives), Independent Treatment Centres and Foundation hospitals.
The Con-Dems' bill aims to take these steps to their conclusion and end the NHS. As legal opinion has exposed (see www.dutytoprovide.net), the bill aims to remove the duty of the government to provide a national health service in England. As analyst Allyson Pollock has explained, it turns the NHS over to the global health market, for multinational companies to make enormous profits. A universal health service, free at the point of use, could disappear.
To try to prevent this dire scenario, thousands of people have participated in local demonstrations. Campaign groups such as Keep Our NHS Public exhorted people to lobby Lib Dem MPs and to "adopt a peer", in the hope of scuppering the bill.
Lobbying politicians can be an important component of any campaign. When faced with massive opposition, even the political representatives of big business can be forced to backtrack. This weak coalition government has already performed numerous u-turns, including their "pause" on NHS changes earlier this year.
However, at the 'Block the Bridge' event on 9 October, the day before the Lords began their deliberations, some in campaign group UK Uncut declared this was "our last chance to save the NHS". This is not true.
It is understandable that there has been a sense of desperation as the bill has gone through the Commons and the Lords. However, while lobbying can force a u-turn on more minor questions, or on particular aspects of the NHS bill, to knock the government off course on the NHS altogether would require a much bigger movement. What is at stake for the representatives of the ruling class is a huge ideological and economic question: the opening up of the hundreds of billions of pounds in the NHS to private profit.
To defeat this requires a powerful mass movement that mobilises the anger at the destruction of the NHS. Such a movement should also call for an end to underfunding and privatisation, and for the rebuilding of the NHS as a fully public service under democratic control.
It would need, to start, a national demonstration called by the health trade unions. The authority of the trade unions was demonstrated on 26 March on the massive Trade Union Congress anti-cuts demo. This would be an important step in pulling together the local campaigns and building confidence.
Crucially, however, it would need the one and a half million people who work in the NHS to use their industrial might in strike action. If the power of workers in the health service was brought together with patients and communities, a movement would develop which could force the government into significant retreat. When linked up with other public sector workers in strike action against cuts, itself a step towards general strike action of all workers, it could cause this government to collapse.
Our health service
It was the power of the working class that won the NHS in the first place. Combative trade unions, formed through struggle towards the end of the nineteenth century, argued for state medical provision. This was followed by the formation of a new political party representing workers, the Labour Party. Trade union militancy led to the first national health act in 1911 bringing in health insurance. Then after the Second World War, mass movements of workers, determined not to go back to the deprivations of the 1930s, swept across Europe. The capitalists feared for their system. An election victory for the Labour Party allowed the introduction of the NHS.
Will this kind of movement happen now? It is one thing to pass a law through parliament; as the experience of the anti-poll tax campaign demonstrates, it is quite another to implement it. The poll tax was passed into law in 1989, but was defeated by a mass movement, led by the forerunner of the Socialist Party, in 1991. We should expect that when the effects of the NHS changes deepen, hospitals close and services are sold off hook, line and sinker, a big movement is likely to develop.
In 2006, when hospitals were suddenly forced to balance their budgets and big cuts were made, campaigns sprang up around the country and tens of thousands of people demonstrated. As the NHS attacks dig in, especially alongside equally savage cuts to other services, jobs, pay and benefits, we can expect a movement to rise up that could dwarf the 2006 campaigns.
Trade union action urgent
It is criminal that so far the health trade unions, held back by timid leadership, have done almost nothing to defend the NHS. Unite the Union has at least supported some of the protests. Up until now, Unison, the biggest health union, has not acted. This is a key reason for the feelings of despair amongst some NHS campaigners.
However, 30 November could change everything. For the first time since 1982, NHS staff are being balloted for national strike action. If built for vigorously, taking national strike action alongside millions of other public sector workers, the confidence of health workers could rocket. This in turn would give a huge boost to community campaigners who could start to see how a powerful national movement can be built and put pressure on the conservative union leadership.
A crucial factor in the winning of the NHS originally was the formation of a political party which could fight for that demand, and when in power, implement it. The Labour Party has long since ceased to be that party. While Labour has opposed the latest Con-Dem bill, the last Labour government increased the pace of privatisation in the NHS and paved the way for the Tories' latest steps. It is important that the campaign to save the NHS includes the demand for a new mass workers' party that will inscribe the demand for a fully-funded, democratically-controlled public national health service on its banner.