As the TUC meets in Brighton we have just six months to stop as much as we can of the hugely controversial Health and Social Care Act, which will end the NHS as we know it.
TUC commitments to build community-based campaigning, monitor and highlight the damage the Act will do and continue the All Together for the NHS campaign are welcome.
But we really need more of an urgent clarion call to resist the privatisation, cuts, closures and wage reductions which we all know are coming in the next few years.
Let's make no mistake. The Act aims to fragment the NHS, marketise it, commercialise it and privatise the services that offer profits, while leaving the rest as an underfunded, understaffed shambles.
In case anyone thinks the looming chaos in the NHS is an accident or mistake, take note of the plight of the private health insurance industry - and remember this is a Tory government with Lib Dem hod-carriers.
According to market analysts Laing & Buisson, private health insurance is at a historic low ebb with just 10.9 per cent of the population covered - the lowest for 20 years.
For a third successive year fewer people are covered. Premiums are rising more slowly and profits are being maintained only by paying out fewer claims.
What is the only bright spot on their horizon?
"Expected cracks in NHS performance under constrained funding" could stampede some customers in their direction, thanks to Andrew Lansley.
The insurers will expect the same from the new Tory privatiser and axeman Jeremy Hunt. They will be delighted at Hunt's CV, showing servile compliance with Rupert Murdoch, and his co-authorship of a right-wing tract a few years ago arguing for the NHS to be denationalised and private insurance to be established in its place - of course with subsidies, to ensure the poor are required to buy low-value policies and neutralise any popular outcry.
Hunt has all of the neoliberal politics of Lansley and none of his declared attachment to the NHS.
As culture secretary he even opposed the NHS being included in the opening ceremony of the Olympics, and as an MP he has voted to restrict abortion.
He has made none of Lansley's conciliatory gestures and promises to GPs during the progress of the Bill through Parliament and will no doubt find all of its worst proposals most congenial.
His appointment as part of a rightward lurch by Cameron seems likely to result in accelerating the implementation of the Bill, while no doubt briefly diverting the energies of the British Medical Association and others who will feel obliged to give him the benefit of the doubt for a few weeks, wasting a bit more time before recognising the need to crank up the fight.
The pace is already ferocious. This month every locality is required to hand over at least three of its community health services to "any qualified provider," and from next April more and more services will be opened up to this most outrageous form of privatisation in which any fly-by-night company that can satisfy the minimal requirements of Monitor, the new omnipotent regulator of the NHS, can have their names added to the approved register as "qualified."
This means they can freely bid for contracts wherever they see fit and demand to be included among the choices which GPs will be required to offer patients - whatever the GPs may think about them.
There will be no local voice or control over this process, and no clear mechanism for GPs to have poor-quality providers removed from the list.
If a company feels it has been excluded from a local market it has a mechanism to complain, invoking competition law.
Lansley promised GPs in February that the new clinical commissioning groups (CCGs) would not be obliged to open up services to any qualified provider.
But sadly few CCGs seem to have taken advantage of this - and of course Hunt has made no such commitment.
GPs have allowed themselves to be herded feebly, some bleating, into the pens - and they are being used to implement an Act that most of them opposed.
Some are even signing up to support hospital cuts, clearly oblivious to the deluge of extra work these plans will land on them and their colleagues in primary care.
At the same time community services, which account for an £11 billion slice of the NHS and until recently employed 250,000 staff, are being carved up, contracted out and privatised - to the glee of Richard Branson's Virgin Healthcare, all-purpose privatisers Serco and other profiteers and self-interested "social enterprise" bosses, all eager to carve off a slice from the NHS budget.
In the hospitals, some of the wealthiest and most prestigious Foundation Trusts are already gearing up to cash in on the Act's new provision for them to make as much as 49 per cent of their income from private medicine, treating wealthy queue-jumpers from home or abroad or doing deals with private hospitals and health insurance companies.
With NHS funding squeezed and less being paid each year for each NHS treatment, they will logically see private patients as the priority, relegating NHS patients to second-class citizens.
And in preparation for the takeover by CCGs next April, skeleton teams of managers in doomed primary care trusts (PCTs) are rushing through plans to axe A&E units, reduce bed numbers, "centralise" services and cut staffing in hospitals so that the departing PCTs can take the blame.
GPs will be in the hot seat for future cutbacks - although of course their options will all be drawn up by management consultants in "commissioning support services" and subject to approval by the Commissioning Board.
Each of the plans put forward, posing as "local," "driven by clinicians" and tailored to health needs, is in fact a clone of a national template in which actual and specific cuts and closures are disguised by a cosmetic veil of general talk about public health, preventive measures, smoking and other issues.
Plans for alternative services in "more appropriate settings" or "closer to home" turn out to be completely insubstantial, unfunded, vague or imaginary.
In reality all of these plans are cash-driven, cynical efforts to meet Lansley's £20bn target for "efficiency savings."
On top of this there are the basket-case trusts effectively bankrupted by exorbitant costs of PFI contracts, with 20-30 years still to pay and commitments often totalling billions.
Most visible of these is South London Healthcare with two crisis-ridden PFI hospitals. It's now in the unkind hands of an administrator with unlimited powers but limited local options given the constraints of PFI.
Determined to prop up PFI rather than scrap it and cut the flow of guaranteed profits, ministers have sent "hit squads" of accountants into seven PFI trusts to see what can be cut or renegotiated.
This is no more a solution than putting Circle Health, a front for private equity companies, in charge of the floundering Hinchingbrooke Hospital. Already the company is in deep trouble, abandoning its whizz-kid rhetoric and planning old-fashioned cuts.
By far the biggest component of the £20bn "savings" forced on the NHS are cuts in real-terms pay for staff, both through the continued national pay freeze holding pay below inflation and now potentially through trust bosses - led by the cartel of foundation Trust bosses in south-west England - looking to cut back on the national terms and conditions agreed in Agenda for Change, or, in mid-Yorkshire and elsewhere, through forcing staff onto lower pay bands.
So what do we want from the TUC?
Yes, a firm rejection of the Act and the £20bn in cuts, pay cuts and closures.
Yes, publicity to raise public alarm at the imminent danger to our most popular and universal public service.
And yes - the October 20 demonstration is important as a landmark and must highlight the lethal threat the coalition poses to the health service.
We also need active support for the campaigns already up and running to defend local services. Unions can bring coherence, strength and resources that can transform these campaigns and help spread the word.
But we also need a more active and combative lead from the TUC - to link up the unions together and build broad alliances where possible with the Labour Party.
Some Labour MPs and councillors have been idle or have even actively obstructed campaigns to defend local services.
The TUC can also reach out to local communities, pensioners and others. Unions should be taking a lead - and working confidently and openly with anyone and everyone who values their NHS and wants to stop the onslaught.
Too often local campaigns are having to be built with health union branches standing on the sidelines, as if it is not their members' jobs and services we all use that are at stake.
We need to get people aware, angry, campaigning and reclaiming our NHS before the private sector reclaims the bits they have wanted since 1948 and dumps the rest into permanent crisis.
A real fightback will strengthen the unions, build a mass opposition, and rebuild some confidence in political action. We need to hear the TUC insist that campaigning is not just for October 20 but for the life of this government - and for as long as it takes to defend our NHS and keep it public.
John Lister is director of Health Emergency.
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