Campaigners' conference 20 January 2007

Keep Our NHS Public national conference organised by NHS Support Federation - 20 January 2007

Balloon launch, Friends' Meeting House, Euston Road, London

In a packed central London venue 250 health campaigners from around the country gathered to plan the next steps in the national campaign and to share their local experience. Delegates from 38 local campaigns joined trade union members, NHS staff and patients in this Keep Our NHS Public campaign event organised by the NHS Support Federation.

Up front on the agenda was the need for national activity, to back up widespread local campaigning. The public response around the country shows that they have grasped the dangers of the cuts and closure programme, yet the marketisation and privatisation policy that lies beneath has not had the same recognition or scrutiny. This remains one of the key challenges nationally which campaigners can take on together.

Media coverage on the morning of the event prominently covered the launch of a Keep Our NHS Public report - The 'patchwork privatisation' of our health service: a user's guide. For the first time this report lists the numerous types of private sector involvement that together produce an undeniable process of privatisation. This document was recognised by the conference as an important step in achieving wider public debate.

The conference listened to two excellent scene setting speeches from NHS consultant Jacky Davis and local campaigner and health academic Sally Ruane. They summarised the way in which recent reforms were undermining the service and outlined the importance of national collaboration and some of the ways that this might work. The conference then split into groups to consider several key strategy questions:

  • What KONP is trying to achieve;
  • What activity is needed nationally;
  • Ways to reach a wider audience;
  • Building alliances.

Wendy Savage, John Lister, Tony Benn

The afternoon session was chaired by Wendy Savage and opened with an explanation of the KONP steering group's reluctant acceptance of the unions' decision to hold regional rather than a national demonstration on 3rd March. The position that KONP does not have the resources to mount a successful demonstration alone was forcefully endorsed by John Lister of Health Emergency. Volunteers were requested for three KONP steering committee working groups - fund raising; Parliamentary lobbying; an alternative future NHS. The possibility was raised of a KONP AGM to discuss proposed constitutional changes and support was requested for the Manchester NHS staff who are fighting cuts to mental health services

Feedback from the four breakout sessions was then presented with the main points raised being:

  • Disappointment about the decision on the 3rd March day of action and timid TUC leadership;
  • Educating the public (using local media) is vital, highlighting NHS financial structures and taxation decisions, the cost of PFI, resultant redundancies;
  • The need to stress the links between the financial situation in the NHS and the privatisation programme as set out in The 'patchwork privatisation' of our health service: a user's guide;
  • The need to wake up MPs and use councils' Overview & Scrutiny Committees;
  • Local union branches should be encouraged to put pressure on union leaders.
  • Write to MPs with The 'patchwork privatisation' of our health service: a user's guide and follow this up with a meeting.

Suggestions from the floor included:

  • Use legal aid to fight decisions to cut services. Not just pensioners but also children are entitled to this;
  • Lobby Strategic Health Authorities;
  • Put up candidates in local elections;
  • Use Lymington Hospital as the focus for Hampshire demonstrations on 3rd March rather than having several small demos;
  • Hold a national demonstration in May.
  • Unity is important - we must not allow ourselves to be divided into different factions.
John Lister from Health Emergency followed up the discussion with a description of his experience speaking around the country. John is optimistic that the tide is turning and people other than pensioners and KONP activists are beginning to get the message. This is clearly having an effect on MPs with 13 ministers supporting local campaigns whilst going along with government policy.

John Lister                                                      Tony Benn

Tony Benn rounded off the meeting with a thoughtful speech reminding us that Bevan had resigned in 1951 when charges were introduced so that defence spending could increase. He spoke about the external forces affecting government behaviour - EU directives, the Public Sector Borrowing rate and the World Trade Organisation and said that optimism was the core of any successful campaign and urged people to continue their efforts to keep the NHS public.

Conference speech - Jacky Davis

Download PDF of speech

It is a pleasure and an honour to be asked to open this conference today. The Keep Our NHS Public campaign started just over a year ago with a few people around a table. From those small beginnings the campaign has spread the length and breadth of the country. There are now over 30 local campaigns up and running, with more springing up every week. Wherever people see their local NHS services threatened the campaign has provided a rallying point.  

It is of course a matter of regret that, 10 years into a Labour government, the campaign is needed at all.. But the new report produced by KONP shows that it has never been more urgent that we get out there and fight to save our National Health Service. Much of the local campaigning inevitably focuses on what is happening to local services, but as the new report reminds us, it is important not to lose sight of the national picture. Under the mantra of patient choice, care closer to home and greater efficiency through contestability the government has begun to break up the health service and hand it over to the private sector. The privatisation agenda has never appeared in any party manifesto, and requires no new legislation. The process is going ahead without meaningful debate. Hardly surprising, since where it has been debated – for instance at the Labour party conference – it has met with almost universal opposition. KONP has produced this report so that health professionals, patients and the public can look beyond the spin and obfuscation and understand the true agenda, and in the hope that the public and the media will begin the debate that the NHS deserves.

Why is privatisation bad? Simply put, a fragmented health service run by private companies in competition with each other is no longer a national health service. When the service is commissioned by and run by the private sector it is no longer a national health service. An NHS built hospital in Lymington has recently been handed over to the private sector to run. That is not an NHS hospital. And when the NHS is  privatised  competition, fragmentation and profit seeking  replace the co-operation, collaboration and the public service ethos that have served patients so well.

And this damage is being inflicted because of an ideological belief in the unproven benefits of the free market. This government operates in an evidence free zone. We are told that the market will save money, improve quality and introduce innovation but all the evidence to date suggests quite the opposite. Money is being wasted, billions of pounds of it. A report this week shows that the quality of care in ISTCs is giving rise to grave concerns. The reforms are incoherent and it’s beginning to show.  Most people would stop if they saw smoke billowing from under the bonnet of their car, but the government’s response is to step on the accelerator.

Let’s look at money. Patricia Hewitt tells us that every penny wasted is a penny stolen from patients. So how much money has the government wasted and stolen from patients?
We have seen millions wasted on PFI projects, which have saddled hospitals with huge bills and uncertain futures.
We have seen millions handed over to management consultants. Last year the bill for management consultants was equal to the NHS deficit.
We have seen millions wasted on diverting work to the private sector. Millions paid for work it has not done, while NHS hospitals are having to close wards, cut services and sack front line staff.
Let’s ask patients where they would have preferred the money to be spent.

And now we are seeing millions wasted on the costs of a free market in healthcare. Administration costs stood at 6% before the introduction of the internal market. They rose to 12% under Margaret Thatcher. And just as there is to be no limit on the participation of the private sector – so there will be no limit to the amount of money we pay to administer the ‘free’ market. Millions for billing every procedure, for accounting, auditing, legal services, advertising and of course shareholders profits.

It costs an estimated $400 billion to administer the American healthcare system, where further billions of dollars are lost every year through healthcare fraud. We are told that one of the advantages of the free market is that we will see efficiency savings. How could theoretical savings made through the unproven benefits of competition possibly offset the astronomical costs of the free market?

PFI, management consultants, encouraging the private healthcare corporations and the astronomical costs of competition. All of it money squandered, stolen and lost to the front line care of patients.

But money is not the only resource that the government have squandered. They have squandered the good will of the healthcare workers. The frontline workers who have always placed the patients first, who have a long term interest in the service, the frontline workers who will be struggling with the consequences of these reforms long after the architects have retired to write their memoirs. The government have made no attempt to consult us, let alone listen to our concerns. Any business guru will tell you that you can’t create successful change unless you take the workforce and the customers with you, but the government have yet to learn that elementary lesson.

As a hospital doctor I was asked to say something today about the challenges facing hospitals. They are too numerous to list in this short time. I have already mentioned PFI hospitals tied into expensive contracts. Reconfiguration is driven by financial rather than clinical considerations. Patients  are being diverted to ISTCs and CATS schemes when there is no lack of local NHS capacity. The world famous Nuffield orthopaedic centre is under threat because orthopaedic patients have been sent to the local ISTC, which has been paid up front. A patient’s choice to see a hospital specialist is being frustrated by referral management centres. Eye watering financial  strictures are leading to short term solutions with loss of services, closure of wards, sacking of staff.  Newly qualified staff are unable to find jobs. Staff with jobs are unable to work because the PCTs have run out of money. We’re threatened by the government if we don’t meet targets and by the PCTs if we overperform.  If you had made this up, you would be laughed at.  If you were the one who did make this up, you should be ashamed.

None of us would be here today if we thought these reforms were good for patients. But they aren’t. The old, the young, the chronically sick will suffer. And patient choice? The real choice of patients is a local hospital which is comprehensive, accessible and above all which is open. Yet around the country those hospitals are under threat. Local hospitals will be replaced by privately built and run polyclinics. And we ask the government – what is the point of some patients having a choice of 5 hospitals for their elective surgery if others have lost their family planning services, their pain clinic or stand to lose their local hospital?

The irony is that huge improvements have been made with the extra money invested in the NHS, improvements which have been largely brought about by the NHS, not the private sector. The tragedy is that the government risks losing what has been achieved in an uncritical pursuit of the market. Provision of healthcare is being tailored to meet corporate demand rather than public need. And the public has not been asked if they are happy to have the NHS as a logo attached – indeed, now sold to -  services commissioned by and delivered by the private sector, nor have they been told the long term consequences.

Over the last year this campaign has been responsible for taking these messages out to patients and the public, and for supporting local action where local services are threatened. We were told that patients would lead the way in the NHS. Well, they are leading the way, in their thousands – patients, pensioners, healthcare workers – onto the streets in protest at what is happening. We now need to extend the campaign both nationally and locally, to involve communities, to reach beyond activists and those who watch the health service. Our challenge today is how to do that, and it is a challenge worth meeting. The prize is the restoration of an integrated and publicly delivered national health service. We cannot afford to fail.

The NHS, for all its imperfections, is an important achievement, more popular than any political party, and politicians would do well to remember that. It must be strengthened and developed not torn apart by market forces.  As Nye Bevan said – the NHS will keep going as long as there are people left with the faith to fight for it. Our message today is that we are ready to escalate that fight.

Conference speech - Sally Ruane

Download PDF of speech

Campaigning around the NHS: Taking Stock
I am a member of  Keep Our NHS Public Leicester, Leicestershire and Rutland. The views I give here are my own.

The moral character of the NHS
The National Health Service has never been merely a system for meeting health care needs. It has never been merely a technical approach to combatting disease or promoting health. The NHS has always been a profoundly moral institution because it has always embodied a view of how human affairs should be ordered. It was founded on the principle of equity or fairness: that we should all contribute to its funding on the basis of our ability to pay; that we should all have access to its services on the basis of need alone. And it was founded on the principle of solidarity: the pooling of funding; the pooling of risk; acting collectively to meet one another’s needs.

Despite its shortcomings, because it has never been a perfect service, this fundamental fact of the NHS - its intrinsically moral character - has not escaped political observers. Health policy Professor Rudolph Klein described the NHS as the ‘only service organised around an ethical imperative’  and the historian Professor Peter Hennessy claims the NHS ‘is the nearest Britain has ever come to institutionalising altruism’ .

The NHS is a contradiction of our age. It is not about ‘I want this’ but about ‘wait your turn’; it is not about profit, but about service; it is not about ‘this belongs to me’ but about ‘all of this belongs to all of us and to future generations’.

The NHS, with its focus upon care and service rather than profit and consumerism, is a contradiction of our age. And it is a contradiction that the New Labour leadership are no longer prepared to tolerate.

It is because of this contradiction - this exemplification of the right ordering of human affairs - that we now face the threats we do.

Threats to the NHS
I see broadly three different kinds of threats.

First, there is the threat of privatisation - not the selling off of the whole service after floating it on the stock exchange, but the piecemeal, gradual transfer of services, activities, assets, resources and staff to the private commercial sector. I’m not going to go through the full range of developments because they are very effectively discussed in the Patchwork Privatisation Report launched by KONP  today but to put it bluntly the service is being restructured in a way which offers entry points to capital. Government ministers tell us that it doesn’t matter who provides the service so long as it remains free at the point of use. Nye Bevan had a different view. Bevan  was convinced that where you had commercial gain and private acquisitiveness, you would have conflict with public service.

There are several problems with the involvement of private companies in health care but one of the most important is that their material or financial interests are fundamentally different from those of the local NHS or the wider NHS. Their interests lie with maximised profit and maximised share value - they are required by law to prioritise the interests of their shareholders, not the interests of patients or the interests of the NHS as a whole. The management of the company looks for guidance, validation and future direction not to the local NHS, but to its HQ, whether that is in Minneapolis, Chicago, Johannesburg or Stockholm. As a result of this, I believe these companies lack an ethical commitment to provide the best possible health care to NHS patients and do not fit into the NHS on either a moral or rational basis.

Another threat is to our access to health care is the way in which particular services and procedures, services and procedures which conferred implicit entitlements, are being undermined. This includes the withdrawal of local services through downgrading local hospitals and the ‘reconfiguration’ of services. The Chief Executive of the NHS, Sir David Nicholson, and the Secretary of State for Health and their allies are trying to persuade us we don’t really need a lot of services at our District General Hospitals, that some of these services are better concentrated into fewer hospitals; that others are better relocated to the community. They are trying to make us loosen our grip on our hospitals and to let them go.

But there are other ways in which our access to health is being threatened. Traditionally, if a GP referred a patient to a consultant, the patient went to see the consultant. Now if a GP refers a patient to a consultant, the referral is likely to be intercepted by referral management people who monitor all the referrals and where possible head them off to other, typically cheaper, services. There may indeed be instances where access to alternatives is preferable but I’m worried that these interceptions are finance-driven and that the principle that the patient has a right to access a specialist when deemed by the expert gatekeeper, the GP, to need a specialist is a right that we are in the process of losing.

Democratic Accountability
And a third kind of threat is the threat to democratic accountability. This has been traditionally weak in the NHS but significantly strengthened by the creation of Community Health Councils in the 1970s. The abolition of CHCs in 2001 and now the abolition of the much weaker Patient and Public Involvement Forums which came after them plus some of the proposals currently going through Parliament weaken further what little purchase we, as citizens, have over the service.

In many respects, these threats mean that what we are mounting is essentially a conservative campaign, conservative as in conserving and protecting. We are defending services, we are defending rights and entitlements through marches, protests, rallies, letter-writing campaigns, lobbying of decision-makers, participating in consultation exercises, asking awkward questions at public meetings and so forth.

Rebutting claims made by the other side
One aspect of this is rebutting proposals and analyses which come from the other side. This can be done through staff side responses to workplace consultations; through written submissions in community consultation exercises; and in other ways.

The importance of rebutting misleading claims has been highlighted for me and a fellow campaigner recently following the publication of the IPPR’s report, The Future Hospital , in January 2007. The IPPR is a think-tank which claims to produce academically sound analyses of policy issues. It claimed to make the case for hospital reconfiguration, especially for the concentration of some services (such as care for those suffering heart attacks) into fewer hospitals and the transfer of others services (such as diagnostics and some treatments and some routine surgery) out of DGHs to the local or community level.

What has preoccupied us  is the way in which the IPPR uses - or doesn’t use - the evidence. For example, it leaves out two major systematic reviews  of the evidence. A systematic review is an analysis of all the relevant high quality research on the topic in question - in this instance, whether there is a link between high volumes of cases (which you can get by concentrating services into fewer hospitals) and the quality of care or better outcomes. These important systematic reviews were omitted from the IPPR report but in fact both of these reviews concluded that we do not know whether it is better to concentrate services because the evidence is not clear. And one of the reasons the evidence is not clear is because the research methodology which produced the evidence in the first place is often not of a high enough quality.

I am perplexed by these omissions and what this has signalled to me is that the IPPR’s report cannot be taken as a reliable guide to the desirability of relocating services.

Going onto the offensive
This kind of arguing back and rebuttal of what we perceive as misleading or unsubstantiated claims is an example of defensive campaigning. But we need to go onto the offensive as well. For example, I think we should make funding part of our agenda. Bevan wanted a system of funding which broke the relationship between ability to pay and entitlement, one of the flaws of an insurance approach, and he wanted a system in which there was progressive redistribution. General taxation, with just a small proportion of funding coming from National Insurance, was the solution for him because in the 1940s and ‘50s, we had a progressive tax system - that is to say, the better off paid a higher proportion of their income in tax than the less well off.

The same, unfortunately, cannot be said today. If we look at the figures available on the Office of National Statistics website , with some simple statistical analysis we can find out what proportion of household income is taken in tax. The graph  given here shows UK households, ranked in ten deciles (or groups of equal size) by size of equivalised disposable household income. It show what percentage of gross household income (i.e. original income from such items as wages, self-employed earnings and investments plus cash benefits) is taken in total tax, including direct and indirect taxes. The graph shows the average percentages for the whole New Labour period until 2004/05.

There are two key points about this graph. First, it is clearly wrong that the households in the poorest income decile should be paying out a greater proportion of their gross income in tax than every other decile and it is clearly wrong that those in the highest income decile should be paying out a lower proportion of their gross income in tax than every single other decile save the second and the third.

The second point is that the brunt of the tax burden is clearly being borne by these middle deciles - in other words, by middle England. Now, Tony Blair is always saying how important it is to appeal to middle England: in fact, middle England seem to have done particularly badly under New Labour. Not only are they bearing this tax burden but they now find themselves also paying for long term care for older relatives, for the children when they go to University.

We should be going onto the offensive and exposing this injustice, demanding that the tax system be made progressive so that the NHS is fairly funded, demanding that long term care be funded through general taxation.

How we need to make our campaign more effective
Disseminating ideas
The examples I’ve given above about rebutting false claims and creating our own agenda are examples of getting our ideas into circulation. I think we cannot underestimate the importance of ideas. When you look at the generation of ideas about the NHS by think-tanks over the past few years, you find that most of these ideas - for markets, for breaking the NHS up into mutuals, for creating so-called public interest companies, for changing the funding basis of the NHS - most of these new ideas and blue skies thinking are ideas which a few years ago would have been considered the exclusive province of a right-wing fringe. There is almost no, (not quite none because the Democratic Health Network , for instance, has been doing some very interesting work), but almost no creative new ideas about how to develop the NHS coming from those who support the founding principles of the NHS. So during New Labour’s period in office, the dominant ideas in circulation are ideas which are inimical to the essential NHS. We need to get our alternative ideas into circulation.

Coherent organisational form
We also need a more coherent organisational form - I don’t think we should get bogged down in our own organisation and processes but I think we are at a point where we need to develop the way we operate in relation to each other. What I’m thinking of here is the need to address how KONP nationally relates to local affiliated campaigning groups and how these groups can relate to each other.

We need to think through our structures and processes a bit more - what kind of structure will enable local groups to participate in and help shape a developing national strategy and action?
Do we need or want some kind of federated structure whereby local groups come together on a regional basis - perhaps in a regional structure which mirrors the NHS’ reconfigured Strategic Health Authorities - and the regional body then nominates/elects an individual to the national steering or co-ordinating committee? Do we need more communication between the national and local bodies - more dialogue, sharing of information?
Do we need a more formal structure to enable local groups to support each other more directly - the People United Saving Hospitals initiative in late 2006 was trying to address this.

Of course, there is little point in making this an academic exercise - this isn’t about the perfect organisational form. I’m thinking, if we keep firmly in our minds the realistic constraints of finances, geography, time and energy, what kind of structures can we make work for our practical purposes.

I think there is some sense that we need clearer political direction nationally but this needs to be developed in a way which reflects/takes into consideration/relates to local concerns and views. I think we have definitely reached a point where, given the growth in the numbers of local campaigning groups over the past year and the diversity of actions they are involved in, we need to put our structures and processes onto a more democratic and effective footing. What kind of structure will make us - at a local and national level - more effective? This of course includes openness to working with local campaigning groups which aren’t affiliated to Keep Our NHS Public but do want effective and constructive collaboration. I’m hoping that the discussions today lead us to a clearer position on these questions.

The trade unions
And in relation to the question of working with others, we should mention especially the trade unions. There is a lot of effort being put into developing strong working relationships between campaigning groups and trade unions at both a local and a national level.

I would like to see the unions:
  • publicly declare their support for KONP and demonstrate that support with financial backing;
  • withdraw support from New Labour, disaffiliating if relevant, and stop paying for these policies which are destroying the NHS and their own members’ interests, instead backing political candidates for office who declare on an explicitly pro-public platform;
  • encourage and support their members in the upholding of professionalism. Professionalism ought to be a safeguard of the service through protecting standards for patients but, particularly where cuts in services are savage, professionalism is jeopardised. I would like to see professionalism used more explicitly as a defence for the service. It is up to the representative bodies of health professionals to enable individuals and groups of staff to fulfil their professional duties and aspirations.
And I would like to see greater encouragement to rank and file members to resist the implementation of damaging policies. And I think this conference should send a message of solidarity to the 90% plus of staff in Manchester’s community mental health teams – nurses, occupational therapists, senior support workers and admin workers – who have voted to take strike action in defence of the services they work in.

Concluding remarks
However, realistically we have to acknowledge that, in a context of deindustrialisation and the shift of the New Labour leadership away from labour and towards capital, the labour movement is fairly weak. It is difficult for workers to take a stand in isolation.

It may be that it is a mistake to think that the greatest power lies in the hands of the workers. We may well be in a situation here where the greater power lies in the hands of users through their ability, when organised, to threaten the job security and political careers of their elected representatives, especially given the fragility of many Labour MPs’ majorities.

It is local campaigning groups, groups whose composition and character vary across the country but which are able to mobilise local people, it is these local campaigns which seem to have startled the government into a propaganda onslaught to justify reconfigurations. Local battles over reconfigurations have the potential to build up the pressure.

We are right to focus so much of our attention on organising and building capacity at the local level. It is when people are angry, when they get organised and try to understand what is happening to them, this is when they start to become powerful.

Sally Ruane
Contact –    
or 07930 113319    or 0116 2703053


Our issue based websites:



Our issue based websites:



Our issue based websites: