On Thursday 21st April, Notts SOS, Health in Your Environment, Keep Our NHS Public and 38 Degrees held a meeting at the Mechanics' Institute to oppose the Social Care and Health Bill.

The meeting was well attended, with around 100 people in the audience. This may not sound amazing, but it did fill the downstairs room at the Mechanics'. It is also substantially bigger than a previous meeting about the NHS, covering much of the same territory, held in the same room in February 2007.

The meeting consisted of 3 speakers followed by contributions from the floor. The first up was Professor Colin Leys, co-author of the book "The Plot Against the NHS". Leys discussed the ramifications of the Bill, arguing that if passed into law it would lead to a collapse in quality, a narrowing of the services provided, the payment of fees for some services and, increasingly, the provision of services by the private sector.

While strongly critical of the current proposals, Leys was keen to draw the links with the gradual and often secret marketisation process of the Labour Government. He described Labour as "very deeply complicit in preparation of the ground."

He noted the widespread opposition to the Bill which has come from some unlikely quarters. All the unions (Unison, Unite and GMB) have all come out against it, with the RCN endorsing a vote of no confidence in Health Secretary Andrew Lansley by 99%. The usually staid BMA have been vocally critical and even the LibDems don't like it. A recent motion to their party conference in Sheffield ostensibly supported the Bill, but suggested amendments entirely contrary to its actual purpose.

The next speaker was St Anns GP Chris Udenze. He Talked about the need to speak not only with people who already agree with us, but also with Tories. He discussed the possibility of defeating the bill, noting the relative lack of action so far against the Bill. This was dismissed out of hand by Martin Benn from Unison, but it struck me as an important point and unusually honest for a public meeting (these are normally unashamedly positive affairs, regardless of the political realities they confront). Udenze, also talked about various GPs actively involved in the "clusters" which are preparing for the restructuring of the NHS, implying that their financial positions did not necessarily make them obvious allies.

The third speaker was Martin Benn of the Nottingham University Hospital branch of Unison. He gave first hand accounts of the disasters which had resulted from the introduction of private companies into the NHS already. The treatment centre at QMC is a privately run centre and on more than one occasion, Unison have been denied access to their members in the facility. Benn was also keen to point to the impact the spending squeeze in the NHS was already having, despite being only a fraction of what has been seen in local government. (The NHS has actually had a slight increase in funding, but it is substantially less than cost inflation.)

At this point the meeting was opened up to the floor, which began a wide ranging discussion. Two main themes emerged out of this. Firstly, the extent to which (if at all), the Labour Party can be relied upon to support the campaign against the Bill and NHS privatisation more widely. Secondly, the role of trade unions. Points were also raised about the closure of the Hayward House daycare service.

While there is a clear and urgent need to discuss a strategy for beating the Bill and the Tories' agenda more widely, this seemed at times to be wholly disconnected from reality. One prospective Labour councillor even claimed that he would put pressure on the party, if elected, to re-nationalise any parts of the NHS which had been privatised, without compensation. Even assuming this was possible and there was anything left to nationalise, it is hardly likely to happen.

The last Labour Government was in power for longer than any other; had one of the largest Labour majorities ever; faced a particularly divided and weak Tory opposition until the last few years; and ruled during an unusually extended economic boom. In short: that's as good as it is ever going to get for the Labour Party. Anything they weren't able to achieve in those 13 years, probably isn't possible through electoral action. It goes without saying that not only did they not renationalise anything the Tories had privatised, but they actually expanded the policy, trying to flog off the Royal Mail and pumping billions into "private finance initiatives" and "public private partnerships."

It shouldn't therefore be a great surprise to learn from one contributor from the floor that during discussions with Shadow Cabinet members during a recent visit to the city, none had believed the Bill could be beaten nor that it could or would be reversed by any future Labour Government.

It isn't even clear that they necessarily think such a reversal would be desirable. Another contributor described a speech by the Shadow Health Secretary John Healey to a Unison conference. When asked whether he opposed the privatisation of the Blood Service, Healey had given a convoluted answer which seemed to avoid him making a commitment either way.

While in opposition, the Labour Party will often vote against government policy because that's what the opposition do. This shouldn't be confused with principle. They might vote against the Social Care and Health Bill now and mimic many of its worst aspects as soon as (or should that be if?) they get re-elected.

The job for those opposed to the privatisation of the NHS and the other aspects of the austerity drive is simply to make them impossible to impose. As one of the last contributors noted, the Poll Tax was not beaten by electing the Labour Party. Rather, a mass non-payment campaign, coupled with widespread direct action, culminating in the famous Poll Tax Riot in London, forced the government to back down and ultimately toppled Margaret Thatcher.

That strategy cannot be copied directly, but UK Uncut actions across the country and the property damage which has accompanied most of the big anti-fees and anti-cuts marches in London demonstrate that autonomous activity can shake the establishment. This should be continued and widened. The companies which will benefit from the sell-off of the NHS have offices with publicly available addresses. They deserve to be treated no better than Vodafone, Boots, HSBC or any of the other companies doing so well out of the Age of Austerity.