AS ANYONE who has worked on the front line of the NHS and ambulance trusts knows, comprehensive healthcare in this country is being eroded by aggressive cutbacks, restructures and privatisation. 

Recent national strike action shone a light on the unprecedented scale of the struggle to deliver care safely. After decades of cutbacks there are not enough staff or beds to cope with demand in the NHS. And the policies of successive governments are to blame.

It is simply staggering, and reflective of decades of lull in trade union activity, that field medicine conditions are becoming normalised in one of the richest countries in the world.  

The NHS once worked well for everyone. But it doesn’t now, and this is by design, not accident. An ageing population, the politicians’ excuse of choice, does not explain why healthcare has fallen off a cliff in this country.

Morale among staff couldn’t be worse, many have had enough and are seeking alternative work or moving to other countries with better conditions and more favourable career prospects. 

The unprecedented numbers of nurses and others leaving the NHS is a serious warning indicating serious consequences for both NHS staff and patients.

The struggle to defend NHS wages and conditions is vital to protecting the NHS itself, and that is why this struggle will continue. 

If the Tories genuinely cared about the NHS delivering for patients, they wouldn’t continue to erode pay levels and drive out the front-line workforce. 

The Tories have not offered the pay restoration that is so urgently required to stem this mass exodus. Furthermore, politicians of all stripes are supporting cuts and privatisation, even though they all know that services are cut or destroyed and that workers are super exploited when they are outsourced. 

Instead of calling for all services to be brought back in-house the talk from Labour is about contracting out offering “social value.” This simply isn’t true.  

Any politician peddling privatisation as a solution to a collapsing NHS means a continuation of the Tories’ disastrous policies.

NHS staff increasingly question why their pay is plummeting when they have worked so hard to secure degrees and gain a high level of professional expertise and competence. 

More staff than ever can see that politicians and their cronies in big companies are to blame for the state of the NHS as they make political choices to enrich themselves at the expense of staff and patients. They know it is the consequence of decades of cuts and privatisation.

In these conditions unions must develop and deepen their work in the NHS.  Nurses and other NHS workers are becoming more active and engaged in their trade unions and this is still a beacon of hope.

Many are angry and more willing to turn their anger into action. During the national dispute the picket lines were large and solid where the committed activists were. Wider and more intensive organising is required to ensure that the NHS never dies and is in fact strengthened.

The Tories and the bosses will do everything to break solidarity between unions and we must resist this. Activists should never fall into the trap of attacking trade unions that don’t win a desired position or get over the line in ballots. 

Failing to win a ballot or a position is a failure of organising, it’s as simple as that. Union activists seeking to cynically poach each other’s members by undermining other unions weaken the overall fightback.

There are good organisers in every health trade union who seek to engage workers in their own hospitals.

The key to winning the battle for the NHS over the long term is to seek out many more committed activists and to have all health unions co-ordinate with each other at grassroots level and beyond. This is difficult to achieve, but necessary.  

There will be multiple opportunities for trade unionists to organise in their own hospitals and team bases as national bargaining structures break down and NHS trusts break away from Agenda for Change. 

Where this happens, we will have even more scope to enter into local disputes. Inspiration can be taken from outsourced workers in South London and Maudsley NHS who have already taken two days of strike action against transnational company ISS. 

While senior executives at South London and Maudsley NHS trust bury their heads, pretending the treatment their outsourced staff receive is nothing to do with them, these exploited workers will fight back. A further four days of strike action is planned from May 17. 

Picket lines have been solid, and if this group of hospital workers can organise successfully, any group of NHS workers can do the same thing with the backing of their unions.

It is the unions who offer NHS members further opportunities to challenge the status quo that will grow in the next period. It is clear that there will be no getting back to a “business as usual” approach as unions will still come under increasing pressure from members and activists who realise that they have no choice but to fight.

Battles will break out, at local as well as national level. Struggles will increase and be fought locally, NHS trust by NHS trust as more and more staff and patients realise that they don’t just have to accept repeated attacks on the services they need and deserve, and staff and patients will join forces in the common interest.

No experience is ever wasted. Whether we win or lose disputes, the most valuable lessons are learnt from organising workplaces and becoming active in unions.  

Successfully organising workplaces cannot be taught in a classroom or read out of a book. Serious trade unionists commit themselves to taking risks. 

They get right into the middle of workplaces to win the argument face to face, worker by worker. Those are the people who will build the structures workplace by workplace that will make a decisive difference in the battles to come.

One of the key gains from the NHSpay15 campaign and the national NHS pay dispute is that we have a far more knowledgeable activist base right across the NHS than ever before. 

The task ahead is to keep it together and build even further. Yes, there have been disappointments and setbacks but the best reps never get knocked off balance. They learn, they grow in confidence and come back into the fight harder and stronger the next time.

Helen O’Connor is a trade union organiser and former nurse. Follow her on Twitter @HelenOConnorNHS.