CUT government funding, “make sure that things don’t work,” wait for the people to get angry, blame the public sector and then hand the assets over to private capital.

Noam Chomsky’s analysis of the method used to privatise publicly owned wealth and services over the last 40 years holds true for the NHS.

It has already been salami-sliced into a multitude of local hospital trusts, with contracts and services outsourced to private providers. And yet the failures of the private sector to deliver adequate PPE and to test and trace during the Covid-19 pandemic can be contrasted with the selfless dedication shown by NHS staff working on the front lines and by the enormous success of the vaccination programme, which has enabled the gradual reducing of restrictions. 

It is fair to say that the NHS underpinned – and effectively saved – civil society during its most serious peacetime crisis. People saw that and showed their appreciation through spontaneous outpourings, whether by the nightly doorstep clap to thank NHS workers or by the myriad of brightly painted rainbows that appeared on driveways, garages and gateposts throughout the land.

When push came to shove, it was clear for all to see who was doing the work, and making the sacrifices that really counted and which safeguarded the nation’s health, wellbeing and basic survival.

This registered in a shift in the language. Suddenly, the “key workers” — the nurses, ambulance drivers, NHS cleaners, porters and contractors — were recognised for the vital work that they did. 

Today’s demonstrations up and down the land, have been called to mark the 73rd anniversary of the founding of the National Health Service and combine three inter-linking strands: the safety of patients, the demand for fair pay and the call for a halt to privatisation.

The voices of our union members — who have contributed the most to the national good and run the highest levels of personal risk in caring for others during the pandemic — deserve to be heard, understood and acted upon by those at the heart of government.  

Already the messaging has changed. The last lockdown was justified in order to “protect the NHS” from being swamped by hospital admissions — rather than being a practical response to a further spike in infection rates and the escalating loss of life.

One liberal commentator, looking at the course of the pandemic in Wales, concludes that it has “become common for journalists to write of the NHS as a prime example of an underlying health condition.”

The proliferation of well-meaning fundraising campaigns that captured the nation’s imagination during the lockdowns has been allowed, whether through accident or by design, to suggest that the NHS is a charity dependent upon individual donations as opposed to a universal service paid for by the tax returns of every adult in the land. 

If we are not to succumb to Chomsky’s grim model — or to the fate of the poor crab, gradually falling into a fatal slumber as its cooking temperature is imperceptibly increased — then today’s marches and protests are a good place to start.

GMB members, concentrated in the core of the NHS — the ambulance service, porters, cleaners, contractors and nurses — is currently embarked upon a campaign to restore pay levels and conditions.

Essentially, the wage shortage in the NHS is the cause of the staff shortage in the NHS.

Our members understand that and are deserving of a pay offer that recognises their dedication, professionalism and sacrifice over the past 18 months.

If they are the cornerstone that supports the health, wellbeing and functioning of our society — as their designation as “key workers” readily acknowledges — then, common sense as well as basic decency requires no less.

This said, no-one is under any illusions about the effectiveness of moral arguments upon a Tory government.

What it understands is the firm application of power. Demonstrations are useful — sometimes vital — but if they are not to be simply performative they must be part of a wider co-ordinated strategy and rolling campaign across the trade union movement.

Just as on the demonstrations, union must stand beside union in the negotiations with employers and, if needs be, on the picket lines.

The fracturing of the national pay bargaining mechanism has already happened.

After being challenged by unions over their own initial below-inflation pay offer for NHS Scotland, the Scottish government smelled the political opportunity offered by the Tories’ paltry pay freeze for NHS staff by bringing forward a 4 per cent increase for staff north of the border.

For some NHS Scotland unions, like GMB and RCN, that didn’t go far enough after a decade of real-terms cuts to pay left the likes of nurses as much as £5,000 out of pocket. But the divergence on pay is a sign that “business as usual” is no longer an option.

Unions must now capitalise on this by organising across the sector on a steady drumbeat for proper value of staff and significant investment in services, not just to address the crisis in recruitment and the pay restoration gap, but to ensure our NHS is also part of the recovery agenda. That means campaigning, organising and bargaining from the local level upwards. 

The situation begs the immediate question: that if the Scottish government can manage 4 per cent: then why not Westminster, Stormont and Cardiff?

However, 4 per cent is not the limit of our aspirations in Scotland, or elsewhere.

We need to put the employers, and governments, on notice that we will be coming back for more next year in order to make up the widening pay gap.

Furthermore, we need to address — the chronic levels of underfunding that harm the efficiency of the NHS.

We need to dispense with the privateers who sap the vitality of the NHS.

And we need not just to halt the creeping privatisation of our greatest national asset but renationalise all that has been, hitherto, hived-off and lost.

Bevan’s founding genius was the creation of a national health service, through the nationalisation of all the existing municipal and voluntary hospitals.

We should look to restore that vision through the return of services in-house and the ending of internal markets and quasi-autonomous trusts.

Then we will look to go after the “black-marketeers,” as Bevan described the peddlers and profiteers in private medicine. We need to remember that our NHS is more than a safety net but a symbol of hope and pride, that is the most cost-effective deliverer of healthcare anywhere in the world. 

When the unions march, today, it is because they care about it and about the people that it serves — and has served — so ably for more than 70 years.

Its worth lies beyond any private bank balance or minister’s spreadsheet and rests in the health and dignity of everyone in our nation: it is what makes us truly civilised, as Aneurin Bevan pointed out to a young girl on the day of its creation.

That was what was recognised by the people during the lockdowns and our task, on today’s demonstrations, is not to let it be forgotten as the colours on all those painted rainbows inevitably weather, fade and run.

Our task for tomorrow is to begin a rolling campaign in order to achieve our core demands and to prove – just as a playwright had Bevan say – that “the NHS will last as long as there are folk left with the faith to fight for it.”      

Gary Smith is GMB general secretary.