Only a New Democracy can Save the NHS

Protecting the NHS and vital public services requires radical change and reform of the UK's constitution.

Author: Gavin Barker

The battle for the future of the NHS is a battle for the future of democracy.

We cannot hope to win one without the other

As the last 8 years have shown no amount of campaigning will secure the future of our NHS unless we first fix our democracy. This is a point often missed by NHS campaigners who continue to protest, petition and agitate as though these tools alone will win the day. It won't. Nor can we place all hope in a Corbyn government, whose stay in power may be temporary. What is needed is not a change of government, but whole system change. Before looking at what can be done, let’s list the symptoms of failing democratic health:

1. Support for a publicly owned NHS and other vital services remains consistently strong yet government policy flies in the opposite direction.

84% of us want the NHS in public ownership; 76% want railways back in public ownership; 83% want water back in public ownership. These are not just recent figures but follow a consistent desire to see public ownership of essential services. Yet privatisation, outsourcing of services and the sale of NHS land and assets continues apace. The government completely ignores public sentiment.

2. Petitions and protest marches no longer work.

The 2003 anti-war protests is considered one of the biggest demonstrations in British History, with the London March attracting more than 400,000 people.1 It did nothing to change government policy. As Tariq Ali, one of the speakers in February 2003, said at the tenth anniversary: "I didn’t quite tell them 'Blair is going to go to war regardless of today' but I knew was a huge show of anger but that's about it. It left no lasting legacy in my opinion." 2

The 2011 Anti Cuts protest is considered the second biggest demonstration ever, with an estimated 250,000 people protesting against planned cuts to public services.3 Again this did nothing to dent government policy. As the then Business Secretary Vince Cable admitted "No government - coalition, Labour or any other - would change its fundamental economic policy simply in response to a demonstration of that kind."4

Petitions, while good at raising awareness, actually have limited political impact. The top ten most-shared campaigns from, despite accumulating millions of signatures and hundreds of thousands of shares, failed in their intended outcome - and four of the ten were denied a debate.5

3. MPs' and Lords’ interests in private health companies conflict with their alleged role to serve the public good.

At the time of the vote on the Health and Social Care Act 2012, Social Investigations established that over 200 parliamentarians had recent past or present financial links to companies involved in healthcare and all were allowed to vote on the Health and Social Care Bill, turning it into an Act. As they point out:

“Who cares that they have put it in the register of interests. This doesn’t excuse their interests, it merely highlights clearly why they should have no part in voting for what is fast becoming the dismantling of the NHS. It is privatisation, despite the media’s continued use of the word ‘reforms’. The question must be asked: are they public servants or corporate servants?”6

4. Lobby power and donations shape government policy, not democratic consent.

In theory, we elect MP’s to represent our interests; in practice they are part of a compliant political class who give unquestioning obedience to party diktat. Many also use their status as MP to win lucrative second jobs, or lobby for companies, not their constituents.

The close and corrupt relationship between corporations and governments is often blatant. Three years ago, in one of the largest privatisation deals in history, the government signed a £780 million deal with 11 companies. Half of these companies were found to have close financial links with the Conservative government and three of them had previously been slammed for providing poor quality of care.7

This is part of a larger problem of what the High Pay Centre has called the ‘corporate colonisation of government’ citing a number of different ways through which figures from business have entered into Government, via the House of Lords, private sector appointments to the civil service and extensive use of private sector consultants at a cost of around £800 mn. according to the Public Accounts Committee.8

5. Promises made at election time are broken in office

“There will be no more top down reorganisation of the NHS”.

This was a promise made by the former Conservative Prime Minister David Cameron, not once but several times, and also formed part of the Coalition Agreement in May 2010.9 What then followed was one of the biggest re-organisations of the NHS ever undertaken, described by NHS leaders as “so big, you can see them from space” and which the King's Fund describes as a disaster.10

We do not have to look far to find other examples.11 This constitutes nothing more nor less than the abuse of legislative power - where promises made at election time are broken in office. It completely undermines the whole integrity of elections as the chief means to call government to account.

6. Brexit is a moment of danger

There are two reasons: firstly the wide ranging powers acquired by government ministers to amend transposed EU law as a result of the EU Withdrawal Act 2018, with little or no parliamentary oversight. Secondly, the potential use of such powers to alter or undermine consumer standards, environmental protection and our rights.

The Trade Bill offers similar wide ranging ministerial powers to those set out in the EU Withdrawal Act. It gives ministers ‘maximum flexibility’ to make regulations they “consider [appropriate] for the purpose of implementing an international trade agreement”.12 Such wording is extraordinarily vague and allows enormous flexibility in interpreting and applying ministerial decisions.

This comes at a time when the government is pushing forward with trade deals with the USA which could open up the NHS to transatlantic market competition; “health services are an area where both sides would benefit from openness to foreign competition.”13

What we can do

The bottom line is this: If we are to save our NHS, we must first save our democracy. The first is simply not possible without the second. We cannot continue a business-as-usual approach and pretend to ourselves that NHS street demos and petitions make a difference. Nor can we place all hope in a Corbyn government whose stay in power may be temporary.

What is needed is not a specific NHS re-instatement bill nor even a change of government, but whole system change. In effect this means a new settlement between people and government in the form of a a “people's constitution”, designed at a citizens' convention, which restores real democracy and ends the power of money.

Such a constitution must do three things:

  1. Devolve real power to people and communities by putting local government on an independent legal footing - beyond the interfering reach of Whitehall. 
  2. Secondly, it must throw a protective firewall over a comprehensive Bill of Rights, including Social rights such as the right to healthcare, welfare and housing – rights that have legal teeth because they are enforced by the Supreme Court.
  3. Thirdly, it must permanently remove the NHS from the market: the NHS Re-instatement Bill must have constitutional force, not just legislative force.

Constitutions are deliberately difficult to amend. That is a strength not a weakness. They require a higher order of deliberative democratic approval for their amendment such as a referendum or super majorities in both houses. And referendums, as set out in other country constitutions, are carefully structured processes, not the ill-thought out, unilateral decision of one party seeking to resolve internal differences.

We are one of the last developed countries not to have a proper written constitution. Our present ‘unwritten’ constitution is not fit for purpose. Its celebrated flexibility in response to changing social conditions has always benefitted elites more than ordinary people. It is an outdated, archaic set of unwritten conventions and principles which have no legal force, combined with piecemeal legislation which can be changed with ease. It gives no protection over fundamental laws and rights, leaving us powerless to shape our own future.

We are told that Brexit is all about ‘take back control’. Instead we face increasingly autocratic government and ever greater power to the few. Either we remain in our campaign silos, be it the NHS, climate change, fracking or housing; or we join forces around a unifying agenda for change. Such a combined push directed at this single most important strategic objective has far greater possibility of success than a multitude of smaller, diverse campaigns whose achievements are small and short lived. It is the restoration of real democracy through a written constitution that will form the turning point on not just the future of the NHS, but on every other issue that we hold dear.

Brexit is about power, what its limits are and who wields it. It is a ‘constitutional moment’, a window of opportunity as well as real danger. To let this pass and do nothing is to see that window close and allow elites to decide our future.


  1. Protest has rattled Number 10, say march organisers Telegraph 17-Sep-2003
  2. 15 February 2003 anti-war protests Wikipedia
  3. Anti-cuts march: Tens of thousands at London protest. BBC News 26-Mar-2011
  4. London cuts march: Government sticking to plan - Cable. BBC news 27-Mar-2011
  5. Do online petitions actually work? New Statesman 30 Jan 2017
  6. NHS privatisation: Compilation of financial and vested interests. Social investigations Blogspot 18 Feb 2012
  7. Half of private firms behind NHS privatisation have links to Tories. Daily Mirror 17 Mar 2015
  8. The revolving door: how big business has colonised UK politics: report by The High Pay Centre 2015
  9. Cameron’s Betrayal of the NHS. A paper by Open Democracy that comprises a detailed list of broken promises on the NHS
  10. NHS reorganisation was disastrous, says King's Fund. BBC news 6-Feb-2015
  11. Six Broken Promises Made In Theresa May's First Speech As PM Huffington Post 10-July-2017
  12. See Trade Bill Briefing for Commons Report Stage. Joint briefing by Liberty and Amnesty International
  13. Rightwing think-tanks unveil radical plan for US-UK Brexit trade deal. Guardian 18-Sep-2018 - see also Cato Institute document quoted in Guardian article

The publisher is the Centre for Welfare Reform.

Only a New Democracy can Save the NHS © Gavin Barker 2018.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.

Article | 25.09.18

health & healthcare, local government, politics, England, Article

Gavin Barker


Constitutional Reform Lead

Gavin Barker


Constitutional Reform Lead

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