Workers Hammer No. 222
Tory privatisation: Labour paved the way
Mobilise union power to defend the NHS
For free, quality healthcare for all!
MARCH 25 — The Health and Social Care Act which takes effect on 1 April amounts to the biggest shake-up of the National Health Service in England since its foundation. For the first time since 1948, the government will no longer be obligated by law to provide universal healthcare. In place of a “duty to provide” this fundamental social service, the government now has a “duty to promote” it — an innocuous-sounding change in language meant to obscure a fundamental shift towards the private sector. After the Act was passed by Parliament, Dr Jacky Davis, co-chair of the NHS Consultants’ Association, said “we no longer have a national health service”.
Among the most controversial provisions of the new legislation are the clinical commissioning groups (CCGs), which will control the lion’s share of the NHS budget — roughly £65 billion out of some £100 billion this financial year. Ostensibly under the direction of GPs, CCGs will commission the provision of patient care, including by directing patients to private providers and refusing treatment that does not meet “reasonable requirements”. A recent study by the British Medical Journal shows that, of the GPs who are running commissioning groups, one in three help run or hold shares in private healthcare firms. But in reality, most GPs have neither the time nor expertise to “commission” care, so this will be handled by private consultants such as the giant management consultancy firm McKinsey. Under the guise of giving GPs more responsibility, CCGs in fact are a gateway for the outflow of billions in NHS funds to private firms.
Government officials claim that NHS services will still be free at the point of use. But as political economist Colin Leys points out: “This is seriously misleading. They fail to add a key proviso — provided the service is still available on the NHS. In reality, a growing list of services will not be available, and so won’t be free” (Red Pepper, April 2012). In fact this process has already begun. In 2006, Croydon Primary Care Trust put together a list of 34 procedures that need not be offered to patients, including surgery for cataracts, hips and knees, to save money. The “Croydon list” has quietly become widespread. People with non-life-threatening but painful or disabling conditions are told they must pay for treatment, if they can; otherwise, too bad. Some GPs are restricted in the number of referrals they can make in a week, no matter the needs of the patients they see. Referrals to specialists have been intercepted and denied by privately-run “referral gateways”. The US health insurer UnitedHealth, for one, has been prominent in vetting and sometimes overturning GPs’ judgments. And as more people are driven to the private sector for care, funds are leeched from the NHS, which threatens to become a dumping ground for the poor and chronically ill.
Working people deserve better!
Hospital closures are sweeping the country. A&E and maternity wards are being shut, or downgraded as in the case of Lewisham Hospital in south London. Despite being financially solvent, Lewisham was targeted as part of a restructuring plan when the neighbouring South London Healthcare NHS Trust was taken into administration. That trust had been crippled by £60 million a year in debt repayment incurred as a result of Private Finance Initiatives (PFIs), under which public building projects are financed by private debt. The government aims to slash the healthcare budget by £20 billion by 2015, so for hospitals not faced with closure or downgrading, swingeing cuts are on the horizon. The Whittington Hospital in north London has announced cost-cutting plans that include making 570 staff redundant and selling off several of its buildings to private bidders. There, consultants from former car parts company Unipart Group have been paid £500,000 so far to find savings.
In “The great NHS robbery” (opendemocracy.net, 31 January), science writer Marcus Chown explains: “Gradually, the government is starving the NHS of money. This is deliberate. As hospitals run out of money — and the exorbitant repayments on PFI deals are a major factor here — they become prey to takeovers by private companies.” The takeover last year of Hinchingbrooke Hospital in Cambridgeshire, an NHS hospital facing closure, by private company Circle Holdings has been eyed as a blueprint for the future. Circle — owned by companies and investment funds registered in the British Virgin Islands, Jersey and the Cayman Islands — intends to make £311 million in savings, and is cutting jobs. Others positioned to profit from hospital privatisation are Virgin magnate Richard Branson and Harmoni, which already runs GP services in many areas.
Privatising healthcare is so deeply unpopular that government spokesmen bandy about terms like “patient choice” and use stultifying vagaries and a dizzying array of initials to obscure what they are doing. Many details of the Health and Social Care Act are still in dispute. Regulations that would have put virtually all NHS services out to tender had to be amended following an outcry. But following each retreat, the government has returned to the offensive. For the British bourgeoisie, the NHS presents an unwelcome overhead — not to mention the easy profits privatisation offers the financial speculators in the City. The interest of the capitalist class in the health of the population comes down to maintaining a workforce fit enough to exploit and soldiers to fight their wars and imperialist adventures. In times of social upheaval, the capitalists may shell out enough to placate the population, but they will always attempt to take those concessions back.
To put the immense wealth generated by the labour of working people at the service of human need will require the expropriation of the bourgeoisie through workers revolution and the establishment of a workers state. A collectivised planned economy will have to be built in order to guarantee not only healthcare but all the other fundamental requirements of life, including a good diet, decent housing, recreation and full employment. The fight to get there must begin with defending what we have now, as inadequate as it is — and the NHS has become a battleground. The solution does not lie in lobbying parliament or bringing Labour into office in the next election. Healthcare workers, who have borne a great burden of cuts, do have the potential and the interest to bring real power to this struggle. Their fight would win enormous support and do more than a million petitions. But it has been hamstrung by the union tops who set as their political agenda putting Labour in government. These misleaders accept that the working class must help to pay the cost of the capitalist crisis but imagine they could negotiate better terms from Ed Miliband’s Labour Party.
Labour’s privatisation of the NHS
When Labour’s shadow health secretary Andy Burnham claimed the government was “trying to force through privatisation of the NHS by the back door”, Tory health secretary Jeremy Hunt accused him of scare tactics. Labour has promised to repeal the Health and Social Care Act, but opening the NHS to huge corporate profits was Labour’s policy long before the Con-Dem government came along. As Colin Leys and Stewart Player describe it: “The reality is that successive Labour health secretaries, working closely with the private sector, had already constructed almost the entire edifice of a healthcare market. The Tory plan merely speeds up the final stage and makes it more clearly visible” (Red Pepper, October 2010). Still, Leys concludes: “Unless Ed Miliband and Andy Burnham return to office and honour their promises to repeal the Health and Social Care Act we must be prepared to see more and more of our healthcare, including hospital care, provided by for-profit corporations, with the rise in cost and loss of quality that invariably follows” (Guardian, 16 January). Talk about persistent illusions in Labour! Everything Leys documents points to the fact that, should Labour win the next election, they will carry out essentially the same privatising policies as the Tories...only under a different name.
The policy of deliberately forming an “internal market” inside the NHS, hatched in the 1980s under Thatcher, came to life under the Blair government. Under Blair and Brown, NHS trusts were gradually transformed into “foundation trusts” borrowing on the financial market, entering joint enterprises with private companies and setting their own terms of employment. If a foundation trust lost money, it would be closed or taken over. Mid Staffordshire NHS hospital trust cut £10 million from its budget in 2006-07 in order to gain foundation status. In a horror story worthy of a Victorian poorhouse, somewhere between 400 and 1200 people needlessly died in Stafford Hospital between 2005 and March 2009, many of them denied pain medication, some left without being washed for up to a month. Feeding was left to family members, but many went hungry. Labour in office refused persistent demands from relatives for a public inquiry. One was conducted under the Con-Dem government, now cynically using the catastrophe to bolster support for its NHS agenda.
Labour oversaw the creation of “Independent Sector Treatment Centres” — private institutions — to perform low-risk elective surgery. These reduced waiting times for potentially life-transforming procedures like hip replacements (a procedure pioneered, in fact, by the NHS), but they guaranteed a minimum income for private companies. Millions of pounds of NHS cash has been paid for procedures that were never carried out. The Blair government also created the “Extended Choice Network”, allowing private centres to treat NHS patients for a handsome sum. In both cases, private institutions were free to choose the patients that would earn them the most money, while NHS hospitals struggled with debts, cut staff and services, and were threatened with closure if they failed to prove financial “viability”.
Labour in government was also responsible for the phenomenal growth of Private Finance Initiatives throughout the public sector. PFIs allow governments to borrow massive sums while keeping the debt “off balance sheet”. Begun under the Tories in 1992, under Labour PFIs became about the only way of financing the building of new hospitals and schools. PFIs turn public funds into a cash cow for construction giants like Balfour Beatty as well as for global moneylenders. Though sometimes described as “one hospital for the price of two”, in fact PFIs are not even that — extortionate payments are made for a facility which may never belong to the public sector. Today the NHS owes £65 billion for PFI loans; payments on loans and interest are rising at about 18 per cent each year and can be more than ten per cent of a hospital trust’s yearly intake. We can thank Labour for this.
What’s needed is a new leadership of the working class dedicated to the overthrow of the capitalist order. To halt the privatisation drive, a class-struggle leadership would mobilise the healthcare unions around a series of immediate demands, including the return of the privatised hospitals and other health facilities to the public sector and cancellation of the PFI debt. McKinsey, Circle, Harmoni, Richard Branson’s multifarious enterprises and the other capitalist vultures based in the City of London must be driven out of every section of the NHS that has been hived off to them! A revolutionary workers party would fight for the expropriation of the private healthcare, insurance and drug companies, and for free, quality healthcare for all, as part of the struggle for socialist revolution.
Union bureaucrats: cold showers and hot air
Hospitals shut. Health workers made redundant. Nurses worked to death in understaffed wards, then vilified by the government for “failing to provide quality compassionate care”. It could not be clearer that it is necessary to fight. Despite its shortcomings, the NHS is one of the most significant gains working people won from British capitalism and they want passionately to defend it. Angry mass protests against hospital closures have erupted around the country. But they have been channelled into the dead end of lobbying parliament, with politicians of all stripes campaigning from the speakers platform and local council members, celebrities and the likes of the Socialist Workers Party’s People Before Profit initiative setting the ultimate goal of electing a Labour government.
Hospital workers have come out to protest as individuals while their union misleaders act as though they are merely part of the “community”, not the force with the potential to transform the situation. Unison, the largest union in the NHS with 400,000 healthcare workers, proclaims on its website: “UNISON led the campaign against the Health and Social Care Bill, and we will never stop fighting to defend and improve our NHS.” How do the leaders propose doing that? “UNISON members have a very direct way of getting their message across to politicians — through political lobbying.” The leaders of the other main health service union, Unite, appeal for members to email Cameron and their local MPs.
When strikes do break out, such as recently in West Yorkshire, they are left isolated. There some 500 medical secretaries and receptionists struck repeatedly against Mid Yorkshire Hospitals Trust’s attempts to lay them off and rehire them at lower pay. Support poured in from patients, other hospital workers and unions around the country who rightly understood that this struggle was in the frontlines of the battle to defend public healthcare. The Unison leadership hinted they would ballot the rest of the union branch as the secretaries returned to work at the beginning of February. Some two months later, they are still equivocating. Unison national executive council member Paul Holmes told a strike rally in February: “This is the biggest dispute in the health services and every health trust in the country is watching you. And if you lose, they are all going to cut wages, too.” He’s right — but did he and the other union bureaucrats ever call out their other members?
The public sector union leaderships limit strikes to “days of action” a couple of times a year to blow off steam while wages and union protections are eroded. This is as true of “left” officials such as Mark Serwotka of the Public and Commercial Services (PCS) union as of the right-wingers. There have been many opportunities to launch a fight, not least the 30 November 2011 strike against attacks on public sector pensions. But as soon as the mass demonstration was over, then-TUC general secretary Brendan Barber and Dave Prentis, leader of Unison, called off any further action. Reflecting anger at the base, Unite members in the NHS (and local government) rejected the government’s offer, as did the main civil service union, the PCS. The PCS called a one-day public sector protest strike of its own 270,000 members on Budget Day, 20 March. Rather than bemoaning the refusal of the likes of Prentis to organise joint strikes, a class-struggle leadership would go over their heads and appeal to the members of the other unions in the public sector to strike together.
The general secretary of Unite, “left” talking Len McCluskey, was prominent last autumn in touting a motion calling for the TUC to “continue leading from the front” with “far reaching campaigns including the consideration and practicalities of a general strike” against austerity. It speaks volumes about the trade union bureaucracy that this motion was raised in the TUC by the Prison Officers Association. These thugs have no place in the workers movement! Yet they are embraced as “workers in uniform” by the Socialist Party and trade union misleaders, including in the PCS, which grotesquely includes immigration cops.
At the huge 20 October 2012 TUC demonstration — held on a Saturday — many workers cheered those, like McCluskey, who mouthed off about a general strike from the platform. Joint class struggle by all the major unions is desperately needed — but this is far from the intention of the trade union tops. Nearly six months on, predictably, the motion is a dead letter. The Socialist Party, which is in the leadership of the PCS, has not let the passage of six months diminish their touching optimism that the TUC will “name the day” for a 24-hour general strike. For these ostensible socialists, the perspective is back-handed support to Labour: “A 24-hour general strike, with more action planned to follow, could split the coalition government apart and lead to a general election” (Socialist, 21 November 2012). “Kick out the Tories” is likewise the perspective offered by the Unite bureaucracy. Under the title “Save our NHS” their website says: “In two years the country goes back to the polls. Help us make sure that the party that saves the NHS is the party that wins.”
The Old Labour “Spirit of ’45”
At its founding in 1948, the NHS famously promised universal healthcare, free to everyone at the point of delivery. With the health service and a national system of benefits, people were to be taken care of “from the cradle to the grave”. A new Ken Loach film, The Spirit of ’45, speaks powerfully to the impact the NHS made on the lives of working people, some of whom recall the horrors of life before the NHS — families unable to pay for the doctor to visit sick children; the needless death of a mother due to infection after childbirth; the debt collectors coming on Fridays to demand money for doctors’ bills. Loach eulogises the Labour government led by Clement Attlee that took office following a landslide victory in the 1945 election and then introduced the NHS.
British capitalism emerged from World War II with its empire in a state of disintegration and large chunks of the economy bankrupt. A wave of working-class militancy was sweeping Europe. Despite its deformation under the rule of the parasitic Stalinist bureaucracy, the Soviet Union, and by extension the mass Communist parties in the capitalist world, had enormous authority for having borne the brunt of the fighting to defeat the Nazi armies. Within a few years, capitalism was overturned in many of the countries in Eastern Europe that remained under Soviet military control. West European governments began to expand social programmes both to appease class struggle and to counteract the influence of the Soviet Union. As Tory MP Quintin Hogg put it in 1943: “If you don’t give the people social reform, they will give you social revolution.” In this context, the British capitalist class grudgingly acceded to the establishment of the NHS — on a plan drawn up by William Beveridge, a Liberal economist, during the war.
Labour in office remained committed to administering British capitalism. The postwar nationalisations amounted to a gigantic bailout of the bourgeoisie. Loach’s film does not show it, but the Attlee government called out troops against dockers on strike in 1945 — as any other capitalist government would. A willing servant of British imperialism, it also helped to found NATO, sent troops to fight against the North Korean and Chinese deformed workers states, fought a dirty colonial war in Malaya and presided over the bloody partition of India. Attacks on the benefits provided by the NHS began in 1952 when charges for prescriptions and spectacles were introduced to help finance the war in Korea.
Even at its best, the NHS did not provide adequate care for the needs of the population. In the 1950s, Marxist scientist JD Bernal captured its shortcomings:
“It is still a health service in name rather than in fact. Defence of national interests has seen to it that Britain has built few new hospitals and health centres since the end of the war. For the most part the National Health Service still depends on the old surgeries, where overworked doctors dispense ineffective drugs to queues of patients, and give them advice that they cannot take.”
—Science in History, Volume III (1954)
One of the more grotesque aspects of capitalism is that life itself — the number of years a person can expect to live and enjoy good health — inevitably comes down in good part to what social class he belongs to. In the poorer parts of Merseyside, where male life expectancy is 67, men are typically incapacitated by some kind of disability at age 44; in the richer parts of west London those numbers are 89 and 74. A male resident of Kensington or Chelsea can expect to live more than 14 years longer than his counterpart in Glasgow. Within the capital alone — the most unequal city in the developed world, according to Danny Dorling’s book Injustice: Why social inequality persists — it’s said that for every stop on the Jubilee Line towards east London, life expectancy drops by a year.
Capitalism: bad for your health!
In the 1990s, following the counterrevolution in the Soviet Union and Eastern Europe, the bourgeoisies of Western Europe made a push to dismantle what remained of the social welfare programmes instituted after World War II. Now those attacks are being redoubled, driven by the capitalists’ need to compete in a global market that is in profound crisis. Although we Marxists do not share social-democratic illusions in nationalisation schemes, we strongly support workers’ defensive struggles against privatisation which in practice amounts to nothing less than savage union-busting attacks on workers’ jobs and living standards.
For many working people in Britain, life is reaching the breaking point. The standard of living is dropping for the fifth straight year. The chasm between rich and poor is widening. Nearly half a million have been on the dole for a year or more, while those “lucky” enough to have jobs are expected to meekly accept stagnant or slashed wages, increased pension costs and overwork. Nationally agreed pay and working conditions for health workers are replaced by local agreements and “performance-related pay”. Jobs are slashed in manufacturing and retail industries, workers are dumped on the street. And the relative absence of any serious union fight-back against the attacks by this government — and Labour governments before it — has emboldened the capitalist rulers to keep coming back for more austerity.
The defeat of the miners strike in 1984-85 was pivotal in turning the tide against the working class. Thatcher provoked the strike, aiming to destroy the National Union of Mineworkers (NUM) which had been the militant backbone of the proletariat in Britain for decades, as she began to shut down the entire coal-mining industry. The TUC was overtly hostile to the strike, and the Labour Party leadership under Neil Kinnock condemned the NUM as it battled the full force of the capitalist state. From the TUC “lefts” there came plenty of hot air and even more backroom sabotage. Had the railways and dockers unions struck alongside the miners, they could have shut down the country and achieved a historic victory for the working class. But the “leaders” of these unions were not willing to take on the government. Their perspective was limited to replacing the Tories with Labour, and Labour was committed to strikebreaking. The miners held out for twelve months but were isolated and defeated. Arthur Scargill took the miners strike about as far as it could go within a perspective of militant trade unionism, but never broke from his Labourite political perspective.
The lesson that the trade union misleadership draws from this defeat — that it is not possible to fight — only underscores the need to build a new union leadership, not of Labour toadies overawed by parliament, but of workers leaders who rely on the social power of their own class and are committed to win what working people need, not what the bosses say is possible. The NHS relies heavily on agency workers. The unions must demand full union wages and working conditions for them and organise the unorganised. Particularly in the NHS, where immigrant workers have been a key component of the workforce from the outset, it is necessary for the unions to fight in defence of immigrant rights, including free access to healthcare. It is also necessary to address the needs of the many women workers, demanding equal pay, childcare and protection against discrimination.
Freedom of Information Act requests on PFIs have been rejected under the banner of commercial confidentiality, concealing the complex web of schemes British working people are paying for. We demand the government open the books on these backroom deals between the entrepreneurs, financial speculators and their government cronies. The working class has a right, as revolutionary leader Leon Trotsky insisted, “to determine the actual share of the national income appropriated by individual capitalists and by the exploiters as a whole; to expose the behind-the-scenes deals and swindles of banks and trusts; finally, to reveal to all members of society that unconscionable squandering of human labour which is the result of capitalist anarchy and the naked pursuit of profits” (The Death Agony of Capitalism and the Tasks of the Fourth International, 1938).
No matter which party is in government, capitalism means squeezing workers and boosting profits. Contrary to the dreams of reformists, the point is not to turn the clock back to the days of Old Labour, but to shatter the rotten capitalist order which has driven the working people into the ground and replace it with a workers government dedicated to building a socialist society. For this workers need a revolutionary party, not insipid reformists like the Socialist Party or Socialist Workers Party that tail the union bureaucracy and haggle over just how much austerity the working class should accept. As our comrades in the Spartacist League/US wrote:
“Health means much more than shots and pills and surgical knives: it is a decent place to live; plenty of good food to eat; knowledge of human biology; air clean of pollution; safe, decent working conditions; the principles of public health rigorously applied. Medicine can’t save lives ruined by poverty and malnutrition....
“When we have thrown out the vicious capitalist system which sells human life for dollars, we will be able to build a new socialist society where human life, human worth and human dignity count. Doctors will be servants of the people; hospitals will be havens to heal the sick; research on vaccinations, new medical techniques and improved drugs will be internationally coordinated and to the benefit of all. When the workers of the world are in charge of this planet, the only limits of human health will be scientific—and these will be constantly enlarged by thoughtful, energetic research.”
— Women and Revolution no 39, Summer 1991