SOON after the establishment of the NHS in 1948, efforts were made to dilute its provisions and undermine its principles from the introduction of charges for prescriptions, for dental care and for spectacles in 1952 right through to Margaret Thatcher’s internal market, the closer collaboration with the private providers and PFI under the Tony Blair government and the removal of the duty on the secretary of state to secure and provide healthcare for all in the 2012 Health and Social Care Act.

The assault was incessant resulting in significant erosion of NHS provisions and a gradual undermining of the core principle of the NHS as outlined in the 1948 Act which placed a duty on the secretary of state to provide key universal health services throughout England.

This core principle was deliberately subverted and substituted with “free at the point of delivery,” promoted energetically by the Blair and subsequent governments which went unchallenged at the time.

It was argued that workers do not care who delivers their health care, be it private or public, provided it is free at the point of access. But workers do.

Apart from the exorbitant cost to the nation, private health is extravagant and wasteful. It is morally repugnant that someone should make a profit out of someone else’s misfortune or ill-health.

Regressive reforms continued unabated, there was no respite.

Before workers could catch their breath, consolidate and work out their next move, another attack was launched and morale sank very low with trade unions’ only hope to limit the damage.

The incessant attacks gradually but decisively took their toll as workers had to retreat to fight the next reform.

Saving the NHS became synonymous with opposing reforms. So when the new government says the NHS must “reform or die,” we recoil in horror, the default response to any suggestion of NHS reforms. But the government is right — the NHS must reform, it must change to bring it back to its founding principles.

The 2012 Act must be repealed and the duty of the secretary of state restored to bring back public control and accountability. And when Wes Streeting says the NHS is broken, we should not enter into a futile argument whether it is or it isn’t.

We should say Yes and that’s why we must end the internal market, cut out the unnecessary admin work associated with it and devote resources to where it matters — care for patients.

And when they say the private sector has a role to play to reduce the waiting list, we should not retreat in terror and scream No, but say Yes, private hospitals and clinics are a national resource but they are costly and wasteful.

They should be taken over, integrated within the NHS to treat NHS patients. They should be commandeered in the same way as the WWII government commandeered land and factories to integrate them within the national war effort.

Owners of private health provisions could be compensated as agreed by Parliament.

In this way, we are certain that when we ask for more funds for the NHS, the money spent will not go to line the pockets of the owners of private health companies.

Today the NHS is at a tipping point. It can go either way: back to its original founding principles or march towards a US-style health service. The stakes are high.

The election of a Labour government promising to reset the NHS offers the trade union movement the best, and maybe the last, chance to prevent our beloved NHS from drifting towards a US-model of mixed public and private funding.

It would be an unforgivable dereliction of duty if this chance is allowed to slip away. For this reason, we must construct our own plan, a credible, concrete plan for the renewal of the NHS and fight for it.

This manifesto outlines five fundamental reforms that are critical to achieving this.  

Five immediate steps to reset the NHS:

• Repeal the 2012 Act. Reinstate the secretary of state’s statutory duty to secure and provide healthcare for all and re-establish a simple line of responsibility, parliamentary oversight, and accountability.

• End the internal market in NHS England (Scotland has opted out of this quintessentially Thatcherite reform) and direct resources to where it matters; care for patients.

• Stop the use of NHS premises by private health companies. NHS premises and resources should be for the exclusive use of the NHS and not put at the disposal of profiteering private companies. It is an affront that NHS patients facing long delays are enticed to go private and then to be treated by the same consultant at the very same hospital, only to return to the NHS for subsequent treatment.

• Commandeer private hospitals and clinics. Private hospitals and clinics are a national resource, but they are extravagant and wasteful. In a time of emergency, with a “broken” NHS, they should be taken over and integrated into the NHS to serve NHS patients.

• An immediate uplift in British health spending to the average of EU nations.

Fawzi Ibrahim is national officer of Rebuild Britain.