We should have spoken out with more determination. After all, the NHS is our cherished national institution: research by British Future two years ago revealed it made us most proud to be British, coming ahead of both army and monarchy. We are quite literally born into it; it is our confidante for some of our most personal worries; it tends to us whether we have broken bones or are consumed with anxiety; and it is there, unconditionally, until we die. How could we have been so passive when it came under attack?

The King’s Fund has today given the definitive verdict on policies the electorate neither asked for nor were consulted about. The so-called reforms have proved “disastrous”, it says. Its chief executive speaks of three wasted years when the NHS desperately needed to focus on “growing financial and services pressures” but is now left with a structure that is “complex, confusing and bureaucratic” and “not fit for purpose”. For any organisation this would be a damning verdict. But this is our NHS which has been assaulted and traumatised.

How have they got away with it? In part, the government’s policies were shrouded in so much complexity it often seemed hard to understand what was going on. Ex-health secretary Andrew Lansley’s Health and Social Care Act 2012 was notoriously much longer than the original legislation that introduced the NHS in the first place. Then there is the lack of media scrutiny. The public’s affection for the NHS is not shared by many of those who run the British press, many of whom shun public healthcare and go private. For the left, a battery of government assaults – from social security to education – meant overstretched resources. Bread and butter issues, like disabled people forced to pay the bedroom tax, often feel like more of a priority than a complex problem with longer term implications.

Government apologists will seize on the report’s finding that although damaging marketisation has taken place, the feared mass privatisation has not materialised. Opponents of the government’s policies always pointed out that the legislation laid the foundations for long-term rather than immediate privatisation. The “National” was stripped from an increasingly fragmented National Health Service.

As Open Democracy points out, for example, the Tories have been promoting the sell-off of NHS property. And critics of the King’s Fund, such as National Health Action Party co-lead Clive Peedell, suggest it is undermined by previous support for pro-market NHS policies. Another pro-government defence is that Labour in power promoted privatisation, which is of course absolutely the case – and yet another reason why the leadership needs to draw a clear line with its past.

The NHS has been fragmented by this government’s policies: it is being squeezed of cash and resources; cuts to local authorities have heaped pressure on it; and it is being ever more stretched by an ageing population. This winter’s A&E crisis was a cry of pain from the NHS, and there will undoubtedly be many more to come. Labour has to be held to its pledge to promote integration rather than fragmentation. We need an NHS that focuses on prevention rather than managing disease.

But here’s the problem. There have been dedicated, dogged campaigners – but too few of them. We didn’t like what the government has done, we didn’t ask for it – but much of it has gone over our heads. We love the NHS – but we have been all too quiet as it has been fragmented and undermined. We have proved that it is even possible to attack our most treasured institution without causing too much fuss. It is a lesson that this and future governments will remember. Perhaps, then, it is time to speak out.