In his speech to the Conservative Party Conference, David Cameron vowed to protect current levels of health spending. He also stressed that ‘you can only have a strong NHS if you have a strong economy’ – something Labour 'will never understand'. In other words, the salvation of the NHS depends on a Conservative victory at the next election. That sentence has a strange ring to it. But everyone claims to be the saviour of the health service these days. Both camps in the Scottish independence debate claimed it. The Labour Party claims it. The Conservative Party claims it.

As it happens, Cameron’s commitment to maintain health spending in line with inflation would not be enough to avoid a funding gap of around £30 billion between now and 2021 because of ‘rising demand’ (a factor likely to be exacerbated by George Osborne’s planned £12 billion cut to the welfare budget). But the size of the budget is not the only issue. Privatisation reliably leads to worse services that cost more: the NHS is one of the most efficient health services; the US system is the worst in the developed world. A recent process to select among bidders for health services for the elderly in Cambridgeshire cost £1 million.

The fate of the NHS depends on whether or not certain proposed structural changes are allowed to proceed. And privatisation is exactly what those changes amount to. Cameron’s ‘reforms’ (the first rule of privatisation: don’t call it privatisation) will open up more health services to private bidders like Serco and Virgin, creating a two-tier, profit-oriented system on the promise of greater ‘efficiency’ and ‘choice’ – and the TTIP free trade agreement now being negotiated between the EU and the US threatens to make the changes irreversible.

Cameron claims that the current reforms to the health service are not about ‘ideology’ but about ‘what works’. All the evidence, however, shows that the NHS does work, that it is one of the most successful and cost-effective health systems in the world, and that privatisation never ‘works’ for the ordinary users of services, only for the stakeholders of certain corporations. The sell-off of hospital cleaning services has already shown the real effects of privatisation: apparent short-term savings at the expense of poorer hygiene, higher rates of hospital-acquired infection, the break-up of established ward teams and casualisation of the workforce.

The drive to privatise health provision is not new: the Tories are only finishing what New Labour began. There were protests from the start. In 2007, thousands of health workers marched against NHS reforms that would see services being sold off to private companies; in October 2011, around two thousand activists and health workers attended the Block the Bridge protest in London; in February 2012, demonstrations stopped traffic in Parliament Square, with protesters padlocking themselves outside the House of Lords; in May 2013, medical staff and union members marched from the South Bank to Whitehall; in September 2013, fifty thousand people marched against cuts and reforms.

In a speech to NHS staff in 2011, Cameron claimed that people were ‘on board’ with his plans: ‘It’s what patients expect. It’s what doctors and nurses want. And it’s what this government will deliver.’ A YouGov poll in February 2012 found that fewer than one person in five thought that increasing competition in the NHS would make services better; in the same month, an ICM poll found that a majority of voters believed the coalition should drop its plans to reform the NHS; and fewer than one NHS worker in ten thinks that the health service is ‘safe in the hands’ of the coalition government, according to a July 2013 poll conducted by 38 Degrees to mark the 65th anniversary of the NHS. The same poll reported that more than two-thirds of NHS staff think the government’s reforms have had a negative impact on patient care, with 83 per cent regarding the changes as motivated by a drive for privatisation.

Almost nobody believes what Cameron says. The problem is how to co-ordinate effective resistance. A number of organisations are trying to do just that. Alongside public sector unions such as Unison, which backed the recent Mothers’ March, there are groups like Keep Our NHS Public, which has branches all over the country and which anyone can join.