It had been possible once upon a time to discredit NHS campaigners as merely NIMBY activists who couldn’t see the big picture of running the NHS. And yet they have been more than an eyesore to this current Government, which, like previous governments, has tried to promote ‘patient choice and control’. The philosophy of ‘think global, act local’ has clearly run into problems as local activists continue to argue correctly that the big picture has been uncompelling. They cite a lack of resolution in the costly PFI programme which has acted as a malign influence on the NHS since the late 1980s. It’s also impossible to ignore patient campaigners who complain about unsafe hospitals. So, whatever gloss political parties themselves want to put on the importance of the NHS, the reality is that many people in the general public have a very clear idea what has been going on. Whichever political party can capture the public mood will win the trust of many voters.

In as much as problems in the NHS have been rarely discussed by mainstream media who are either ignorant or wilfully neglectful, it is not easy to ringfence complaints from the last few years, since May 2010, as “one offs”. They represent, rather, fundamental faultlines in English policy. Whichever political party can do the least worst job of managing them will make a killing, but it’s clear now many voters are clearly sick of the endless crap. They should like to see a properly funded NHS from general taxation, and are particularly sensitive to any initiatives which sound nice but can lead to commissioning decisions cutting services in reality, such as ‘Big Society’ or ‘dementia friendly communities’.

Only last week, it was announced that controversial moves to offer the running of George Eliot NHS hospital in Nuneaton to private companies have been abandoned, as described here in this excellent article by Caroline Molloy. The barrage of foul-smelling media stories and focus on the hospital standardised mortality index have left many Trusts unable to come to the surface for air. But some Trusts clearly asphyxiated by the toxic attitude of some in the media have come out fighting to their credit. For example, the volte face in Nuneaton has been put down to an improved performance, with A&E and mortality figures now in line with the average or better. The George Eliot was to have been only the second hospital in the country to face a private franchise takeover. The final three bidders in the running were private companies Circle UK (the hedge fund backed ‘social enterprise’ ), fellow Tory donor-owned Care UK, and South Warwickshire Foundation Trust as the last NHS bidder standing. A second NHS Trust, Coventry, was controversially excluded from bidding last month due to the size of its PFI debts.

Proponents of patient safety nonetheless say there is unfinished business, with a need for a much safer culture for whistleblowers and a statutory ‘duty of candour’. And advocates of the HSMR will wish to point out that these metrics have identified problems which would otherwise have been hidden. But it would be impossible to deny the attractiveness of safe healthcare organisations. Whatever one’s ideological position on the rôle of the State, safety is an unifying issue for voters. The concern for critics of privatisation, the number of which are huge (not just from the NHS but from failures in other sectors such as energy), is that who runs entities in the NHS has a direct bearing on patient safety, because of lack of transparency through, for example, freedom of information legislation.

Ultimately, members of the public vitriolic about NHS policy might have three good routes in which to manage their anger. Firstly, they can vote out parties which they feel do not prioritise their needs. This could be good legitimate avenues for prominent NHS campaigners, such as Andy Burnham, Clive Peedell, Rufus Hound or Dr Louise Irvine. Labour, if it gets its response right, can capitalise on the way the NHS has been politically managed by Andrew Lansley and Jeremy Hunt too. The popularity of Andy Burnham continues to raise eyebrows, not least his own. The Health and Social Care Act (2012) can be repealed, and we can all start again, but the concern must be the further de-re-organisation doesn’t cause further mayhem.

Secondly, they can, if resources allow, members of the public can take the Government to court. Whilst this might seem a bit of a ‘nuclear option’, it’s an approach which has been highly successful. During the summer of 2013, a High Court judge ruled Mr Hunt acted outside his powers when he decided the emergency and maternity units should be cut back. The government turned to the Court of Appeal on Monday in an attempt to get the decision overruled, as Mr Jeremy Hunt had previously claimed the move would improve patient care. He lost, and the rest is history. The current government did manage to legislate on the deeply unpopular clause 119.

The current Government seems totally oblivious to the concerns of the general public, to maintain their cosy relationships with the corporate community. Parliament was assured that clinicians would be under no legal obligation to create new markets. However, the section 75 regulations accompanying the Health and Social Care Act (2012) promoted and permitted transfer of resources from the NHS to the private sector, and extended competition into every quarter of the NHS regardless of patients’ interests. The new reforms of which these regulations are a key part remove the legal framework for a universal, publically provided, publically managed, publically planned, democratically accountable health service. The Department of Health itself allowed insufficient time to set this system up properly and enable thorough scrutiny. The upshot has been to drive the NHS towards open market competition with inevitable fragmentation of services and an ever increasing role for private companies in the business of the NHS. I spoke to a train guard at King’s Cross, wearing a Virgin Trains jacket, expecting him to be very pro-privatisation, but he said that privatisation of the railways in parts of the UK had been a total disaster.

Thirdly, you can write an article in a GP magazine or make a film. Peter Bach made a very successful film, “Sell off: the abolition of your NHS” which is going through a final edit. Both Dr Jacky Davis and Dr Louise Irvine speak brilliantly in the film on the issues of the ‘democratic deficit’. Given that the mainstream media have continued to ignore the changes in the NHS traditionally, their opinions are clearly a polite (not desperate) plea for members of the general public to become informed and involved. My personal hunch is that people are more informed than they might first appear, and these European Elections and the General Election will not come soon enough.

Carville’s famous phrase started, “It’s the economy stupid”, but many people in fact forget the finish. That is, “But don’t forget about healthcare”. The response of the public may be to make a fast emotion-based decision rather than a slow cognitive-based decision, in the fashion of Daniel Kahneman’s “Thinking fast and slow”, but that’s why mainstream politics are in fact quite frightened of Nigel Farage. Farage taps into an emotional sentiment which overlaps with nostalgia, and for the man down the pub the NHS is a burning issue too. Politicians would therefore ignore NHS activists at their peril.