This pamphlet looks at the need for democratic reform of the NHS through the direct involvement of the people who produce, create and use the service. The NHS is probably the most politically important public service institution for the centre-left social and political movement. It is seen by the overwhelming majority of British citizens as ‘the most valuable institution for this country’ and is one of the institutions in which the values of the left – those of equality, liberty and solidarity, and the resolution of the tensions between them through democracy – are protected, sustained and embedded in our society. However, the public also believe the NHS is now in permanent chaos. Neither the machine nor the market is working. A mix of competition and control is failing to deliver. The service faces huge social, economic and political pressures. Financial problems, closures, job losses, low staff morale and patient uncertainty about the quality and extent of service all add to an air of crisis about the service. And the establishment of 14 private sector companies to take over the commissioning of the bulk of NHS services is a very worrying trend back towards privatisation. This pamphlet is about how the NHS functions now in relation to those values of equality, liberty and solidarity and how it might function better in the future.