"YOU CALL this cuts - I'm not scared to say cuts... The amount of money available to the NHS is decided by the government. We will have less money to meet rising demands... There are hard decisions to be made. I have to balance the books."

That was the £140,000 a year chief executive of North Central London NHS (NCL) trying to explain to 350 people at a protest meeting why NCL were discussing seven different "scenarios" to cut £560 million from its £2.27 billion budget by 2016-17.

These NHS bureaucrats, who blame the "global recession", plan to cut services at local hospitals, particularly closing some Accident and Emergency (A&E) departments.

Highly paid NHS officials put a positive spin on this, proposing to set up enlarged neighbourhood health centres ("Urgent Care Centres") outside hospital entrances and saying that long-term treatment for conditions like asthma and diabetes should move to new 'polyclinics'.

NHS demonstration, photo Paul Mattsson (Click to enlarge)

But, whatever the merits of polyclinics in an integrated health system, they are being promoted now as a way both of cutting spending and providing further opportunities to effectively privatise health services.

There is widespread opposition to these cuts - one north London hospital, the Whittington, treats 80,000 A&E patients annually. With a general election and London borough elections pending, all the local political parties have been protesting, but none gets to the root of the crisis in NHS spending.

Some election candidates just say: no cuts in 'my' borough. This helps NHS bureaucrats play a 'divide and rule' game.

So while Labour leaders insist that the National Health Service is safe, proposed cuts in services countrywide threaten to hit the NHS hard.

Campaigns against local NHS cuts and closures need to be linked to the wider battle. The economy's decline and the huge amounts spent bailing out the banks have brought mounting pressure for cuts in working peoples' living standards and services.

Demonstration against cuts in the NHS, 1 November 2006, photo Alison Hill

Determined local campaigns with protest rallies, meetings, lobbies and demonstrations can save particular NHS facilities, and such victories are welcome.

But as national cuts are being prepared, we also need a generalised nationwide campaign that challenges the government's policies; otherwise repeated anti-cuts campaigns will be unavoidable.

The Tories will probably be worse than Labour on the NHS, but this is no reason to go soft on the Labour government's plans. Unfortunately this is what many trade union leaders and backbench Labour MPs have done.

Alongside local campaigns, the longer term battle to save and improve the NHS needs a real socialist alternative to the Labour, Tory and LibDem parties' pro-capitalist policies.

In the coming election, candidates from the Trade Unionist and Socialist Coalition (TUSC) can vitally help link together different local campaigns. This should be part of a drive to build a national movement to resist the bosses' efforts to make working people pay for the economic crisis.