Defend the NHS – fight for socialised healthcare. By Felix Sabot.

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Defend the NHS – fight for socialised healthcare.

Everything is possible, nothing is probable

This is extrapolated from a talk I gave at Bristol Bookfair. It’s simply an exploration of how things might take shape. It comes across a lot more prescriptive than I intended but that’s just my writing style, in part borrowed from the historic text that inspired it.


The title is clearly oxymoronic, and I didn’t write “save the NHS” because of course it’s too late for that. The system is contracted out and mortgaged to the hilt; the loans are being traded by gangsters in tax havens as I type. It really is “the kidney machines that pay for rockets and guns” as Weller put it.

The trouble is that we, and ‘the left’ whoever they are, are playing for a draw. Every time there is a threat to our dignity or well being, if we manage to stave it off without anyone dying or getting locked up we call it a win, and the bourgeoisie just haul off and attack us somewhere else.

I urge everyone to read ‘The Miners’ Next Step’ and inoculate themselves with the spirit of the Great Unrest, that current of revolutionary syndicalism that spread like wildfire around the globe. That was the generation before Bevan that created the self-help mechanisms he drew inspiration from. Before their vision was poisoned by Bolshevism, corporatism and military Keynesianism.

It will be pointed out that capitalism has evolved greatly in the interim, largely as a result of those factors and their technological spin-offs. It’s important to know how it’s changed, but that’s a subject for another paper. Suffice to say that the shift from reliance on surplus-labour to reliance on fictitious capital means we don’t have to care too much about economics. Capitalism was never about the allocation of resources or the production of things but about the suppression of human activity. Even the production and accumulation of value is simply a vehicle for the reproduction of power relations. If we are ever to escape the perverse death machine that denies and extinguishes every feature of humanity, we have no option but to attack those relations directly and purposefully.

The labour theory of value is dead and they killed it. The labouring classes however, are still here and we’re still responsible for everything of importance. All we have to do is accept that responsibility.

– That a continual agitation be carried on in favour of increasing the minimum wage, and shortening the hours of work, until we have extracted the whole of the employers’ profits.

– That our objective be, to build up an organisation, that will ultimately take over the [mining] industry, and carry it on in the interests of the workers.

– ‘The Miners’ Next Step’. CHAPTER V. P0LICY

My italics.

As a point of interest, the Miners fiercely resisted nationalisation, and refused to even negotiate centrally. Because their industry was essential, they knew that as the bosses felt the pain, they would beg the state to take over, which:

“… simply makes a National Trust, with all the force of the Government behind it, whose one concern will be, to see that the industry is run in such a way, as to pay the interest on the bonds, … and to extract as much more profit as possible, in order to relieve the taxation of other landlords and capitalists.”

Which is precisely what happened.

The strategy.

I use “Defend the NHS” as a working slogan under which a range of people might comfortably organise. But our end should not be a return to the Bevanite vision of a centralised National corporation – characterised by Letwin and Redwood as “Britain’s biggest enterprise” – it should be expropriation. Working Class self-management by councils of workers and service users.

A bold ambition so how to achieve it? A culture of sufficient militancy can only be built in struggle. The idea is to put in place a defensive infrastructure capable of reacting swiftly and effectively against any threat to any part of the system. It will be built from the ground up: “Begin in the workshop” as Connolly put it. It will fight to win; it will become a force to be reckoned with politically but will take no part in politics.

As it grows in size and strength and pervades the system it will approach a dual power situation. It will take the fight to the enemy, making demands of management that they can never quite satisfy. Along the way its members will be training themselves and each other to operate horizontally, democratically and boldly in the spirit of mutual aid and solidarity. We will equip ourselves to take over.

So there are two parts to this: the defensive and the offensive. I’ve tried to pitch the first part initially to workers in the sector, and to anti-cuts activists who identify as ‘left-wing’, to avoid the A-word getting bandied about too early. In the tradition of adopting a hero who’s dead and can do no more damage, we could call ourselves ‘The Friends of Nye Bevan Group’ for all it matters.

The OODA loop

O.O.D.A. is a mnemonic devised for fighter pilots in 20th Century conflict, but it applies to any process of attack and defence, it stands for:

Observation – Orientation – Decision – Action.

Suppose somebody has Decided to mug you. They have Observed you and rate you as a likely victim (their Orientation to you). They are now moving from D to A. You are, if you’re paying attention, at O – O, having Observed that something is amiss*, you are Orienting yourself, in other words, recognising that it’s something you need to concern yourself with, you really don’t have time to Decide what to do about it. However fast you are, unless you have an effective pre-programmed response you are fucked.

* I’ve watched this on video captured from the street cameras, you can tell from the body language they know the person entering their peripheral vision is up to no good but they’re doing their best to deny it, at that stage all they had to do was find another cash point.

If you Act with unexpected ferocity your opponent’s OODA loop is reset to O – O and you take the advantage. Since they are there to perform a specific task rather than counter a threat, in practice they have no option but to withdraw.

Without stretching the analogy too far, there are all kinds of techniques on either side of an ambush, like distraction or scare tactics to reset the loop or draw out the D part. The point I’m making is everything needs to be set to go before the situation arises.

Class struggle is being waged by the ruling class at its own pace on its own terms. They’ve had years to prepare for this and we all know the next attack is on its way. Ad hoc reactions to well-planned assaults that rely on drumming up mass anger from scratch simply aren’t good enough.

The existing structure.

I owe this concept to a fellow wobbly who presented a paper to the IWW strategy conference in 2011, no names no packdrill. It was concerned with education, but it will be seen that the model applies just as well to healthcare. I see a triangular pyramid, at its base the three corners are: medical staff, support staff, and patients. The apex of the pyramid is made up of bureaucrats, C.C.G.s, accountants, employment agencies, executives, management consultancies, politicians and ultimately their corporate investors.

The apparent separation of service providers from users, ‘consumers’ is just the reification of health or education presented as a commodity to be traded, and it is this we must overcome*. Our campaigns are skewed towards the service users, but of course the providers are users as well, and our interests are coherent. If we co-ordinated activity on the inside and out we could get a tight grip on the situation. It matters not for this purpose whether these workers are directly employed or sub-contract, unionised or not. As my comrade put it: “unite the base and we will cut the top off”.

* This is true of any industry under capitalism, in transport for example, there is a greater alienation, so it’s more of an isosceles triangle, but worth bearing in mind with all the talk of nationalisation, which institutionalises your alienation.

Let’s get started.

It seems to me the best place to start is where there is a pre-existing ‘save our … services’ campaign, preferably one that has been successful in seeing off a threat (like the Dorset Kingfisher mums). Many of the basic elements will already be in place and they will have learned a lot about what works and what doesn’t. Rather than everyone pack up and go home we must instil the idea that this is only one battle in a long war of attrition, let’s put in practice what we have learned and spread the idea.

Principles and structure.

This is of necessity an outline sketch, but there are tried and tested organisational and ethical principles that will be familiar and these make a good starting point.

Every site of healthcare should have a permanent defence committee, whether or not there is an apparent existential threat to it. It will apply not just to hospitals and clinics, but to community-based services such as addiction and mental health, social care and anyone else who sees themselves as part of it. The politicians are not defining our scope, we are.

The hardest problem we face is getting workers of different grades to recognise a common interest and act coherently. That arises from a siege mentality; complacency is the bosses’ friend. It must be assumed and emphasised that every service is under imminent threat. Our aim is to get everyone on a war footing.

The composition of the committees will be a matter for the committees themselves, but it’s vital they are balanced between the three base elements noted above. Each group of workers and service users should have at least one delegate*. Care must be taken to include cleaners, agency workers, sub contractors, e.g. electricians, plumbers, the people that take the laundry away and so on. Nurses, physiotherapists, ambulance crews and radiographers are medical staff, we don’t have to go chasing after consultants. Don’t forget office staff, we’re going to need them. Service user delegates will have to include any groups with a special interest in a given facility: heart and kidney patients, the elderly, mentally ill, the chronically sick and disabled etc.

* One delegate to ≤ 15 workers is a fair ratio. The nature of the work makes mass meetings difficult or impossible but that might not be a limitation for the user groups. In any event no delegate should attempt to speak for hundreds of others.

We must establish a culture that no worker or patient is more important than another. There will be no bargaining or competition for resources or services. We will not pander to artificial scarcity.

Operate safe spaces with agreed codes of conduct. Oppressive behaviour and language must be censured but not dwelt upon, nor should we indulge in hair-splitting. This is a single-issue campaign informed by syndicalist principles, it isn’t the place to lecture a swappie about comrade delta or a R.C.G. member about Cuba. Discussion of Jeremy Corbyn should be avoided at all costs.

If anyone consistently diverts the meeting from the work in hand, the simplest remedy is a motion to invite their sponsor group to appoint another delegate. That measure alone may be enough to make them shape up.

Unlike the enemy we aim to nurture human strengths rather than manipulate human weaknesses. Delegates should encourage and help each other take on administrative roles: taking minutes, handling e-mail enquiries, social media, writing press releases, organising social events. Skills and work must be shared, care must be taken to get the best from people that have been ill-served by the education system or disturbed by their experiences. The easiest way to involve people is give them something to do that they are comfortable with. Adopt a ‘village’ mentality; it makes no sense to break the weakest link, let people accomplish small tasks that increase their confidence. “From each according to their ability, to each according to their needs”

No one will sit on a committee who is in a position to hire, fire, discipline or reward another worker. Delegates are to declare any political affiliation on taking their place. Elected politicians and paid union officers may become involved from time to time but will not vote on policy or perform any administrative function. As a matter of protocol they would speak only for themselves, not for an organisation and be ruled out of order if they did so.

I can imagine circumstances where it might be advantageous to stand someone for a council, a hospital board of governors, or officer position within a trade union but this must be carefully managed. As a minimum they would need to resign any party affiliation, relinquish voting rights and any administrative role within the defence committees. They must be prepared to accept the mandates they are given and stand down if required to do so by their sponsor committee.

Militant members of trade unions may act as a valuable conduit of information between sites and services, or put pressure on their representatives to act, but union bureaucracy will not participate in decision-making.

The aim will always be to federate the committees, first in clusters, then by region and eventually across the island. Policy will be made locally, then at federal conferences.

It’s been the bosses’ tactic to isolate each campaign, make it a purely local issue, when in fact the same rigmarole is performed every time. We can use social media to show this up, and where sites are set against each other to compete for a given facility, their committees should immediately meet to agree a plan of action and act jointly.

In time regional and federal executive committees will be established. These would be purely administrative bodies and members of executive committees would not have a vote in their local committee.

Negotiate locally, fight centrally. Each local committee will be autonomous, to run its campaigns as it sees fit. It will first try to tackle the situation itself, which builds confidence, but with the benefit of a central publicity department. This will become easier over time as the system is established. If ever its efforts are stalled, the entire network will be brought to bear on the problem. We’ll bring back secondary picketing.

In the event of campaign escalation, E.C.s would co-ordinate publicity, transport, solidarity callouts, legal support, the distribution of literature and other sundries. They may put technical advisors or even experienced negotiators at the disposal of the local committee but they would have no power to vary its demands.

There will be no national negotiation or demands, no committee will be asked to concede a single job, a single bed, ward or service. We’re not looking to make healthcare pay because it’s a social duty.

Activity of the defence committees.

In the absence of an immediate threat there is still plenty to do.

Intelligence gathering, seeking out dirt on management. Invite everyone to anonymously share evidence of financial irregularity, conflict of interest, or incompetence. We want to undermine them as far as possible.

Maintain regular and secure lines of communication with local and regional anti-cuts activists, anarchist groups, troublemakers, students, lefty football firms, anyone willing to turn out for a row.

Map workplaces, identify strengths and weaknesses in the management structure, look for informal hierarchies and stress points. Actively seek out militants inside and out.

Create and maintain detailed plans of each facility and grounds, noting which doors are habitually locked, who keeps the keys etc. Mark the position and arc of cameras, power switches and fuses. Try and take in any service tunnels, below ground structures etc.

Also have timetables of deliveries, collections and shift patterns.

Send regular bulletins to the executive committee once it’s set up so they can map the overall situation and prepare for trouble by allocation of resources etc.

Spread the idea, help others to set up their own committees.

Maintain a blog and/or a newsletter, that could be brought into the hospitals by patient delegates who can’t be disciplined.

Help to publicise campaigns elsewhere, stay in touch with other committees and offer support where practical if called for.

Have a social life, put on fundraisers, meet in person not online. People don’t fight together unless they care about each other personally.

Train! I.T., languages, self defence, legal, first aid, if you’ve got something pass it around.


These will be familiar to anyone of a syndicalist background.

Since the patients are part of the collective, nothing can be done to compromise their care, so mass walkouts and go-slows probably won’t be much use.

Focus instead on defeating the bureaucracy, e.g. failing to collect, or losing statistics and performance metrics that enable the bosses to get paid. It will hurt them far more than a dead patient anyway. This technique was used with effect in a dispute by ambulance crews in Yorkshire.

Bombard the employer with grievance claims to back up their paperwork, anyone asked to do unpaid overtime should immediately raise a grievance. Don’t do unpaid overtime, obviously. Anyone faced with a disciplinary or even a casual bollocking should immediately raise a grievance.

Comm’s blockades, nowadays they all run twitter and facebook accounts that can be spammed.

Dual Power, squeeze the boss out. The more the workforce organise the work to suit themselves – and usually make it more efficient in the process – the less of a handle the boss has on you. Find out what the boss thinks the chain of command is and subvert it in every way possible.

This is best practice in any job anyway, never volunteer information to a manager. Never tell them where anything is kept, how anything is done, or where anyone is, even if they’re where they’re supposed to be. Make them work for it. Then when you throw a sickie the boss, and everyone else, will find out how useless they are, and how much they depend on your goodwill. I don’t know how this applies to your job, that’s up to you. Independence from the boss is preparation for when there isn’t one.

Work to Rule, opposite of the above, do everything by the book, cut no corners, follow all the procedures, await instructions, take no initiatives.

A selective mix of Dual Power and Work to Rule can really screw things up. You could have one group of workers doing one tactic while another does the opposite. If you count a task as important it’s Dual Power if you don’t, Work to Rule.

The Open Mouth or ‘whistle blowing’ – so much easier when you’ve got a ready-made intelligence gathering and propaganda machine.

Remember any conflict is between one group of individuals and another. Know everyone’s strengths and weaknesses, your side and the enemy’s.

Powerful individuals have higher public profile. Identify the players on their side and have a dossier on each one. They may be trustees of a charity, directors of multiple companies, governors of a school or members of a church. This gives you lots of scope for disruption. If they live in a posh area they wouldn’t like you stickering it or flyering all their posh neighbours. If you force them to shut down their social media accounts find their secondary interests and rubbish them there.

Patients can bring propaganda into the hospital waiting rooms and stick it on notice boards.

The Good Work Strike, giving a better service than you’re required to, medical staff are pretty stretched but kitchen staff could increase the portion size or give free food to visitors. Fill prescriptions for nothing, over-order sundries.

Sabotage, again, nothing that could affect safety, but office equipment and cash registers are fair game, so is the boss’s car. Nobble the parking meters so people can park for free.

A March on the Boss by a mass of medical and other staff accompanied by hundreds of patients would be something to see.

Occupy/picket the offices of contracted-out providers, C.C.G.s and politicians.

Work-ins against redundancies and closures, these require a lot of community support.

While you’re waiting on the pitchfork-wielding mob, you need to conserve your energy. If your action’s only going to last an hour or so, do it at lunchtime in the town centre so more people can come.

Sympathy strikes, it may sound far-fetched but most workers are pissed off about something and all are health service users. Ask your local grass-roots unionists to help. A one hour town centre sit down strike in support of a victimised worker or against a ward closure might appeal if it’s presented well, and they could tack their own demands on to it. Or get Uber shut down for a couple of hours, set the bourgeoisie against each other by just lashing out at any bourgeois target.

Calling a march if you don’t know who’s coming is a hostage to fortune. Worse, if you’re going to publicise it you have to liaise with the cops – which isn’t how we operate. You don’t need to inform anyone for a static rally, which gives people plenty of time to assemble and get in the mood.

Hold a rally quite close to one of the sites at issue, then if you get enough people, use discreet ‘crowd talkers’ to persuade everyone to take the road (not the pavement) and march to it. “Ah, it wasn’t us, tempers were running high”. Disperse the crowd if necessary when the cops arrive – if they do – know when they change shifts.

Responding to a threat.

The machine springs into action!

Fortunately you already have social media/email accounts and people to run them, a mailing list, secure communication channels, some printing facilities and up to date intelligence.


Call a public meeting, capitalise on the shock value of any announcement before people have time to adjust to it. It’s amazing what you can get used to and the most outrageous proposals can become normalised after a couple of weeks of inaction.

Issue a press release from … Defence Committee*, along the lines of “we’re not having it” and pass that to the network so it goes out everywhere.

* In the initial, defensive phase, chances are the suits will never have heard of you.

Brief the unions and activist groups.

Have a public phone line for enquiries/volunteers and a clean phone hub for activists.

Get your blog posts up and spam them out, put flyers and posters around. Graffiti-up the town, drop banners from bridges.

Start a rolling programme of direct action inside and outside the organisation using the tactics above. Make it unpredictable and fun to participate in.

There is no such thing as a fait accompli.

You need to create at least an impression of massive popular support so invite everyone to get involved in the campaign but keep them in a holding pattern until you’ve had a chance to sus them out. Some will be members of organisations with their own agenda, some may well be cops or paid corporate spies – yes they do use private dicks! Get them banner-making, give them flyers to hand out or something.

You will have to deal with – gasp – middle class people! It will likely be their first experience of activism let alone direct action and they will need careful handling. If they can’t take the pound, give them the ounce. Some will be utterly useless, don’t let them waste time or sap your strength.

The enemy will be astonished at the speed and volume of the reaction and will probably want to talk to you. Tell them to fuck off. There is absolutely nothing to be achieved by bargaining except a worse position than the status quo.

Public consultations are a complete waste of time and where possible should be shut down.

The Internet is a double-edged sword.

I’m coming to the conclusion that it’s a job for specialists – the ruling class thinks so too.

Each platform has its own time-response curve, these need to be studied by people who can be arsed. There is probably even an optimum time of day for maximum coverage.

There are optimum timings for publicising events, for example: too late and people will have made other plans, too early and they will forget or lose interest.

News needs to be timely, I’ve seen blog posts get thousands of hits in a few hours then watched it drop off geometrically like the decay of a radioactive isotope. The half-life is rarely more than 24 hours.

You want to control the propaganda narrative locally, so agree on precisely what you want to say and have Internet communications delegates release it through social media platforms. These shouldn’t be hard to recruit as so many people love playing around online.

You don’t need a facebook group with everyone squabbling, confusing the issues and posting a load of crap about the illuminati.

Nor do you want the network to standardise your propaganda. The objective is to create the impression of spontaneous brush fires, more of a franchise than an organisation. Or I’ll get locked up like Bonanno did for postulating a hypothetical insurrectionary army.