Nothing short of unity will do

The opponents of Andrew Lansley's Health and Social Care Bill have lost the fight to stop it becoming law - but they have not lost the argument.

In the end it was the bare facts of parliamentary arithmetic and the shameless commitment of the Liberal Democrats to carry through a thoroughly Tory piece of legislation that won the day - irrespective of the holes that had been shot through Lansley's credibility.

Within hours evidence began emerging of how flimsy was Lansley's case for the changes and how much of a reckless gamble it was seen to be, even by the Department of Health's own bureaucrats and advisers.

An early draft of the risk register which Lansley so stubbornly refused to release, was finally leaked to Private Eye's Phil Hammond. It glows garishly with red ink where serious risks were deemed to be likely, with no green at all for risks that had been addressed or dismissed.

This leak was closely followed by an alarmingly superficial and unconvincing business case for the Bill, drawn up in October 2011, which again confirmed campaigners' arguments that there was no convincing case for the Bill and that the entire exercise was driven by hard-line Tory ideology favouring market competition and expansion of the private sector, regardless of the cost and dangers to publicly provided health services.

There was more confirmation of campaigners' concerns as news emerged of plans to privatise £550 million worth of non-acute health services in Bristol and Gloucestershire.

The Guardian exposed the disastrous consequences of awarding physiotherapy services to "any willing provider" in Nottinghamshire.

And research from False Economy revealed the huge proportion of GPs leading clinical commissioning groups who have links and personal stakes in private providers and companies.

In Yorkshire the Competition Panel opened the door for Virgin Healthcare to rip apart community services and slice off the bits it wants to bid for.

And the Health Service Journal revealed plans for a "tsunami" of trust mergers driven by the £20bn cuts - raising a massive threat to continued local access to services in many areas.

We can expect a steady stream of similar announcements and revelations on the chaotic market that Lansley's Bill will now create.

All this shows how far doctors, health workers and the wider public were fed for almost two years on a diet of lies and deception by Lansley, Cameron and coalition ministers from the first publication of the white paper, ludicrously entitled Liberating The NHS in July 2010.

There have been repeated attempts to lift the lid on the real facts of the case - Unison's legal challenge to the white paper in 2010, opinion polls commissioned by Unison which revealed the lack of public support for the Bill early in 2011, comprehensive critiques of the white paper and the Bill published by campaigners, trade unions and later by professional bodies and royal colleges and the fight last summer against the removal of the cap on foundation trusts' private patient income and then against the new 49 per cent limit.

Plus of course there was the splendid work of 38 Degrees in building an unprecedented online mobilisation, with petitions, huge sums raised to fund adverts and lobbying efforts right up to the passing of the Bill.

Nonetheless the effectiveness of the opposition effort by campaigners, the trade unions, Labour's Andy Burnham, and - increasingly from last autumn - health professionals was limited by the lack of co-ordination between them, as demonstrated by the confusing multiple petitions and separate campaign efforts, often narrowly focused.

The divided nature of the opposition meant there was no co-ordinated press and publicity effort to make the most of each initiative and to ensure that the amazing outflow of research and analysis refuting the Bill could make the maximum impact.

And the unions had to prioritise the fight on the pensions issue and work for the massive November 30 strikes.

But where the opposition to the Bill did work together, most notably for the TUC rally on March 7, the strength and potential could be clearly seen.

Lessons need to be learned from this in the next stage of the fight, which will be to resist the Act's implementation and build on the public opposition to the Bill which strengthened in early 2012, as well as support for Labour's pledge to reverse the Act when it returns to office.

We need closer links and hopefully a common approach between the different strands of opposition to the Bill - campaigners, trade unions and the political opposition.

Nobody should expect all these diverse organisations to see eye to eye on everything or even agree on every tactic on issues of timing in this particular campaign.

But we do need to find ways to work together on what should be common aims.

These include monitoring the implementation of the Act in every locality - itemising the services put out to tender or opened to "any qualified provider" and compiling online dossiers on every company and social enterprise that is included on Monitor's list of "qualified" providers.

We also need to build broad support for the "pledge" through which GPs opposed to the Bill can commit themselves to press in their local clinical commissioning group for it to adopt policies which would preserve the NHS and frustrate the drive to the market and competition.

GPs can for example propose that the clinical commissioning groups - which they are obliged to be members of - should take their role seriously and effectively refuse to accept the imposition by central government of "any qualified provider."

Commissioning groups can also commit to maximum transparency, refusing to accept contracts which have to be kept secret, discussing all significant decisions on local services with the local communities affected and taking decisions on services in public session.

They can reject the logic of the £20bn cuts programme by declaring their commitment to maintain local access for their patients to the existing services that they need, trust and rely on.

Unions, campaigners, councillors and communities can rally behind any clinical commissioning groups that take a stand, defying the NHS Commissioning Board to intervene.

Joint efforts by campaigners and health unions can also help to compile a database listing:

• Examples where grasping GPs running clinical commissioning groups plan to pay themselves bonuses

• Hospital consultants and others who aim to profit from expanding private patient income

• Management collusion with private companies

• Instances where competition law is being invoked by the private sector to help carve up the NHS

• The fragmentation of community health services and other services as they are carved up between various providers

• The extent to which clinical commissioning groups' support services and commissioning work are being delegated or contracted out to private management consultants, which firms are involved and how much their services are costing

All this will help to reveal the real cost of the Tory health market.

Campaigners and health unions can also pool resources to challenge foundation trusts which follow Monitor's advice to pull out of services that don't deliver a surplus and to identify the gaps in care that will emerge where this takes place.

There are divisions on how to respond to wholesale cuts and closures of local services and job losses in the quest for the £20bn "efficiency savings."

This is complicated by the fact that the target, and many of the policies being rolled out, emerge from document commissioned by Labour from McKinsey's and Labour's line has been to challenge the pace of spending cuts rather than the logic of the cuts themselves.

Yet to attempt to build resistance to the Bill without tapping into the energy and anger that the threatened cuts and closures inevitably arouse among local communities would be to weaken both fights.

The argument that the wholesale merger of trusts and ever wider rationalisation and closure of services is "reconfiguration" and simply relocating into "new settings" is mistaken and misleading.

The drive for cutbacks and closures is concrete and specific, but the plans to replace hospital care with community or primary care services generally lack substance, specifics, timescale, cash and political will to deliver.

Only in cases where local people and local health workers are completely happy with the reconfiguration plans and there is firm evidence that the replacement services are viable, funded and backed by training and recruitment of appropriate staff can these schemes be viewed as anything other than cutbacks.

In every other instance cutbacks threaten to undermine services - and we need a united effort to oppose them, to reject the arbitrary £20bn cuts target, and a fight for progressive policies to raise additional tax income to fund health services, rather than accept the constant erosion and fragmentation of our NHS and the drift towards private-sector alternatives.

These tasks are challenging even with combined resources of health unions, Labour and campaigners. They are impossible if this effort is fragmented and each organisation runs a separate and parallel effort.

It's important that the frustration and disappointment of defeat we all feel and residual anger at some of Labour's policies in government do not lead to continued divisions and mutual suspicion between campaigners and unions, each underestimating what has been done and feeling the others should have done things differently.

The common enemy right now is the coalition government, a brutal neoliberal Tory policy and the frontal onslaught on the NHS.

Together campaigners unions and opposition political parties can hope to challenge, in some cases frustrate and delay, and in other cases publicise and expose, some of the worst policies.

Divided we will be reduced to spectators. Let's hope the Bill's opponents can find the political strength and courage to unite the resistance.

John Lister is director of Health Emergency