Jacky Davis is a member of the council of the British Medical Association (the doctors' trade union) and chair of campaigning organisation the NHS Consultants' Association.
She spoke to Solidarity in a personal capacity.
It's important to understand why we lost on the Health and Social Care Bill. Until we understand we won't be able to regain the upper hand.
Partly it was the simple mathematics of the Coalition. The Lib Dems are so unpopular now they can't afford to leave the Coalition, no matter the political price. And they give the Tories a very solid majority.
But we also have to look at the response from the unions and professional associations. Unison did nothing, as far as I can see. Unite was more active but isolated. And medical organisations like the BMA did not step up in time and sharply oppose the Bill.
The government was very clever, pitching their plan in terms of GP commissioning; it was very attractive to GPs until they finally understood it, too late. That muffled any response.
The media also played a terrible role, with the only the Guardian even providing serious coverage. The BBC was so bad that there are rumours that it did some kind of deal with the government. I remember a headline on the BBC website calling it a "Bill to give power to GPs and patients”. BBC workers reported that stories about criticism of the Bill were raised internally, but never taken up.
Partly because of the media, I'm not sure how much public understanding there was, or is, about what the Bill means. The government has kept the debate focused on the idea that the NHS will still be free at the point of use.
I think one thing which disoriented the unions was the fact that the screws on the NHS had already been unloosened before the Tories came to power. Lansley had some truth on his said when he described the reforms as “evolution, not revolution”. To some extent Labour has not even known what its position should be, given its own record, and that disoriented the unions too.
Beyond that, we face the fact that unions are often run in the interests of the people who run them, not their members. That is hard to change when there is not much pressure from the grassroots. In the NHS, staff are very apathetic and unorganised, because they see no fight being led from above and without that they are frightened of losing their jobs.
Even before the Bill passed, Hinchingbrooke hospital in Cambridgeshire was taken over by Circle. Now Virgin is taking over services all over the shop. In Camden we have an inquiry because of a practice given to United Health by the PCT. United Health pulled out, and then another “partner” pulled out, with the result that the practice has now closed down, leaving 4,000 people without a GP. This was all done without any democratic process or transparency. So there is an inquiry, but doctors have been told not to testify to it!
The point about transparency is crucial. Take Lansley's figures he gave the RCN conference about nursing numbers. If [RCN general secretary] Peter Carter had been less polite, he would have told Lansley his numbers were lies. But what's even more important is that Lansley dismissed responsibility for any decisions, saying, well, it's down to the PCTs. More and more, as the service becomes more and more fragmented, we'll see a dispersal of responsibility, away from the government and the Secretary of State and onto Clinical Commissioning Groups, which means GPs.
GPs are supposing getting a lot of power in the new system, but in fact they'll be the ones made responsible for carrying out the £20 billion spending cuts the Tories are insisting on, and for the measures of marketisation and privatisation necessary to carry that out.
Already in Ealing I heard a local councillor blame a hospital being shut down on local GPs. Of course if GPs are judged to fail, then the private sector will be brought in directly, by which I mean even faster.
Even the idea that the NHS is free at the point of use is already being challenged. Services that were free are ceasing to be so, and I'm not talking about things like tattoo removal, but hip replacements and cataract operations. The question is, if it's free, what's actually on the menu. If the only thing that's free is, say, a burst appendix, then talking about a free health service is ludicrous.
The first thing is to get the information out there, to the wider public, which means particularly into doctor's surgeries. Keep Our NHS Public has produced a postcard which patients can give to their doctors objecting to private treatment but there are obvious limits to this, as it's potentially unfair to ask patients to forego treatment for their principles.
Then there's the GPs' pledge written by John Lister of Health Emergency, which opposes GPs being pushed into privatisation.
I think we may also see more local campaigns around private beds in NHS hospitals. The Bill raises the cap on private beds from something in the order of two percent to 49 percent. Hospitals will have to become Foundation Trusts, and their basic obligation will be to stay out of the red - not to provide any particular services. They will shed services, both to Clinical Commissioning Groups and to direct private sector provision, which will take on more and more of the low-cost services and procedures. More private beds are the obvious way to make this up, but of course there can be a fight about that. There are already local campaigns linked to many hospitals and this is an issue they can take up and campaign on.
There may or may not be legal limits to what a Labour government can reverse. But our basic tack should be to demand they reverse the Tory “reforms”, cancel as many private contracts as fast as possible — but also go beyond that.
The crucial thing here is the “purchaser-provider split”, the basis of the internal market which was introduced by Thatcher.
With this split, admin costs soar. There are no longer exact figures, but we are talking about a rise from 6 to something like 16 or 18 percent. And the waste of money is not just a question of bureaucracy. When money is allocated in this way, it creates perverse incentives, where different bodies seek to attract patients in order to attract funding. There is evidence this creates false, unnecessary demand.
This situation doesn't exist in the devolved nations, which do not have the internal market [which was scrapped by the Blair government and then reintroduced in England after devolution]. As the NHS degenerates and fragments in England, that contrast will become even sharper - because what exists now is not really an internal market, but an external market, a market pure and simple.
Scrapping the market set-up would save enormous amounts of money which could be ploughed back into frontline services even if funding was not increased. In my area, radiology, for instance, the Blair government ignored the views of professionals on how to overcome bottlenecks with MRI scans and instead went to the private sector at enormous cost. The same goes for enormous PFI bills hospitals and trusts are saddled with. A straightforward, publicly funded health service is not only more equitable, but cheaper and more efficient.
The point is that there are a few fairly simple demands we can make on Labour, which would be a very big deal if they were carried out. If Labour were willing to campaign on these issues it would win enormous support among NHS workers and hundreds of thousands if not millions of new votes.
A number of campaigners have founded a National Health Action Party to raise a protest about how the Bill was bulldozed through. I think it will have a broader agenda in defence of education and the rest of the welfare state too.
There will be a careful discussion about the right people to challenge, which seats to stand in. It’s possible they will stand against prominent individuals like Cameron or Lansley. The aim isn’t to take seats away from Labour. In fact, one aim would be to put pressure on Labour to take a strong stand on the NHS.
KONP is probably the best established campaigning organisation on the NHS. Its strength is its local organisations. If people start new groups, it would be ideal for them to come under the banner of KONP.
A national demo is a good idea; it could help galvanise public opinion and activism. But we can’t rely on a demo solving everything, even a very big one — look at the Iraq war. We need a much broader campaign, including creative use of social media.