Link to this page: http://www.socialistparty.org.uk/issue/244/24886
What Future For The NHS?
THE NATIONAL Health Service is underfunded, understaffed and under great pressure from New Labour to look for private-sector answers. Health workers look at the NHS's problems and propose a socialist alternative.
Say no to the PFI!
WAKEFIELD UNISON health branch and the local Socialist Party branch have been campaigning for six years against a Private Finance Initiative (PFI) in the new local hospital development. Wakefield UNISON's health branch secretary, MICK GRIFFITHS explains why their campaign is important for the NHS nationally.
"I HAVE come to the conclusion that we need to bring about a complete separation of the NHS from the private sector, for the sake of preserving and developing the system of collectivised health care that the vast majority of the British public remain deeply committed to".
That's how Wakefield's Labour MP David Hinchliffe, a UNISON-sponsored MP who chairs the influential commons select committee on health, introduced a report by the think tank Catalyst. The report argues that there's no economic case for the government's Public Private Partnerships (PPPs), and PFIs.
It also says there's no evidence that private-sector involvement improves the quality of public-sector services and that guaranteeing profits to the private sector, for decades to come, won't help meet the public's health care needs.
Nonetheless, despite overwhelming public opposition to privatisation, the government is determined to sell off all our remaining public assets.
Members of Hinchliffe's health select committee openly disagree on whether PFI works. But the committee did agree - against Hinchliffe - that Professor Allyson Pollock (one of the report's authors) shouldn't work on the inquiry. But, they said, a special adviser from Newchurch and Co, a firm which stood to gain from PFI, would!
Allyson Pollock has produced many reports criticising PFI schemes and showing that some of the deals already signed are costing four to five times what publicly funded schemes would have cost.
Considering the higher interest charged on private capital loans and the fact that the private sector looks for 15-25% profit return, this is hardly surprising. PFI in the NHS will clearly lead to a Railtrack on the wards.
Our UNISON health branch is determined to argue forcefully for a publicly funded, public sector comparator (PSC) preferred option as the best value for the public's money, for the local hospital's redevelopment plan.
Thanks to years of hard campaigning, we already have an assurance from the Trust that certain non-clinical support services are expected to be best value for money, in in-house provided options.
We won't be satisfied until we win 100% publicly funded and provided, totally public-sector development."
UNDER THE private finance initiative (PFI) scheme, private companies have signed scores of contracts to build new hospitals which they then rent back to the NHS. New Labour are mortgaging the NHS's future with these 25-30 year contacts for private companies.
Services provided by PFI firms are so expensive that hospitals cut beds and jobs to pay their bills. In the Coventry hospitals, the health authority assessed the cost of refurbishment would be a one-off £30 million payment. Under PFI, a new hospital "would cost the taxpayer £36 million a year, for decades to come".
All this for hospitals with fewer beds. In Bedford and Durham PFI hospitals there has been a 40% drop in beds.
Union action beats privatisation
IN MAY 2000 our Trust Board decided to tender its catering, domestic and portering services. UNISON organised a 200-strong lobby at 24 hours' notice and the Trust board was forced to back down.
Adrian O'Malley, UNISON Wakefield and Pontefract hospitals branch chair
They also agreed to terminate Initial Hospital Services' contract for the three services at Pontefract Infirmary and 200 staff were returned in-house last April. This was a major victory in our branch's campaign against privatisation, especially as we're facing a PFI hospital in the near future.
Unfortunately everything comes with a price. The Trust board have cut £31 million from the non-clinical budget and the staff brought back in-house were put back in on their pathetic Initial Terms and Conditions.
This has meant department restructuring, new rotas and savings programmes whilst at the same time the union argues for more money for the staff. All this under the guise of "Best Value" and "Value For Money".
So far the staff have gained NHS pensions, sick pay, lieu days for Bank Holidays and a 25p an hour pay rise but they are still way short of full NHS pay and conditions. The fight for full equality continues.
But we have proved that you can beat privatisation if you are organised and determined to win. Our Trust now say they want to keep staff in-house under the PFI and threats of privatisation have disappeared. There's no reason why this cannot be repeated nationally.
UNISON has a big responsibility in achieving this. Unfortunately branches are being left to fight alone. Despite victories such as ours and in Hull, Lothians, Edinburgh and elsewhere we still hear of examples such as Grimsby where contracts are retendered without an in-house bid going in.
The scandalous exploitation of NHS ancillaries continues with no national coordination of ancillary activists. The contractors are vermin and need to be eradicated from NHS hospitals just as we get rid of bugs and infections!
New Labour have betrayed NHS ancillaries. UNISON wastes £31.5 million a year on the Labour Party while they should be supporting their members fighting privatisation.
THE GOVERNMENT are giving private firms an even bigger opportunity to make money from poor health. Health provider BUPA is getting government funds to run and manage a surgical unit next to an NHS hospital. NHS patients will use it, taxpayers will pay for it and BUPA will pick up the profits.
Private-sector contractors are hired to clean many hospitals but four out of the five trusts which run Britain's ten dirtiest hospitals get their wards cleaned by private contractors - hardly a recommendation!
Private sector wrecks community care
UP UNTIL the 1970s the vast majority of hospital beds were provided for chronic patients who needed long-term care - elderly, mentally ill, learning and physically disabled persons.
This care, usually in large institutions, was criticised because individual needs were often ignored. The responsibility was transferred from the NHS to local authorities. New smaller homes were opened but community care was more expensive.
The main cost was for staff wages and conditions. Staff were entitled to shift allowances, unsocial hours payments and a pension scheme. A political commitment to providing and paying for better quality care was needed but it wasn't there.
The sites of old hospitals were sold off to developers who made enormous profits building new housing but they were not required to provide affordable housing to vulnerable people.
In the 1980s the Conservative government changed the rules. Local authorities were required to spend 85% of their community care budget paying arms-length providers outside of the public sector.
This marked a major change to private care. New Labour has not altered this requirement. A significant proportion of the cost of care is no longer used to provide direct care but is taken out as profit by the owners of the business.
Staff wages and conditions have been cut ruthlessly. They are often paid the minimum wage with no sick pay. There is minimal training with home owners relying on public-sector trained staff to manage the homes.
There is no effective system to monitor the standard of care; local registration departments were advised to adopt a 'light touch' as new homes were set up. There is no planning of the number and type of homes needed.
The private sector can decide where to buy houses, they accept residents from any part of the country. They don't plan with local health providers and councils on the local services' capacity to meet extra demand.
In Wakefield, where housing costs are less than in large cities or areas further south, many homes have opened for people with complex health needs.
Most people there have moved in from elsewhere, often from London and the south-east. Charges are levied from £1,400 to £2,000 per week. These 'care' companies are now being sold for many millions of pounds.
Many families take on the care themselves rather than pay this sort of money, whilst some people are simply left to fend for themselves with no support in the community because they can't afford care.
The most vulnerable people in society, who depend on community care, are liable to exploitation and abuse. Money from local health services and local councils, funded from taxation and the council tax, is being used to boost business profits instead of being used for quality care. Privatisation is not progress.
Another tale of wasted opportunities
PUBLIC HEALTH and health promotion are undervalued. Most of the greatest improvements in the Victorian era came from better public health provision.
The same could be true today as poverty and inequality are still the biggest causes of ill-health in Britain, having a devastating effect on the poorest communities.
But public health worker LEE ADAMS explains how the government's proposed changes in health authorities take no steps towards making the service democratic and accountable.
SWEEPING CHANGES are happening in the NHS and in public health structures. From April the government is replacing the existing health authorities with far fewer new bodies called Strategic Health Authorities (SHAs).
Their role will largely be performance management of another new set of bodies - Primary Care Trusts (PCTs). The PCTs will do most of the old health authorities' "commissioning" work ie buying health services from NHS Trusts, the voluntary sector and increasingly from the private sector.
These changes are important for health ie illness services and for public health. The bodies that commission, run and 'performance-manage' illness services are not accountable to the general public but to the Department of Health.
New Labour has missed the opportunity of yet another reorganisation to democratise the NHS. The PCTs are run by boards and professional and executive committees. The SHAs have boards appointed by the Department of Health and far removed from local people.
Despite the rhetoric about increasing public and patient involvement, New Labour are abolishing the community health councils (CHCs), the NHS watchdogs, from 2003.
Many community groups and NHS staff think these new proposals will mean that community and patient reps won't have any power to change things.
Public health faces a major reorganisation - many existing local public health departments are being split up amongst PCTs. Some at least won't have enough staff to cover the work.
Many staff also fear that primary care organisations heavily influenced by GPs won't support broad programmes of public health that have to challenge inequalities in society to be effective.
Public health directors at PCT level won't have to be from a medical background so we might now see some public health programmes which try and address more social and economic issues.
However, public health directors at regional level will still have to be doctors - another missed opportunity. Public health staff there work with government offices and will have influence over many strategic planning issues, so a social, economic and environmental perspective could be more important than a medical one.
This major upheaval has already demoralised public health staff - some have been moved five or six times through past reorganisations.
Staff from the old health authorities have been expected to keep the NHS going, despite knowing that their roles would cease.
Blair now tells NHS workers we're doing a good job but we're still experiencing a "heads will roll if you don't deliver" culture.
This reorganisation is a massive experiment. Will the new PCTs be able to run the NHS? Certainly they won't be the driving force for public health that's so needed now with rising inequalities in health.
A socialist programme for the NHS
IT'S CLEAR to most people that the push towards privatisation of the NHS benefits no-one but big business. However after decades of under-funding it's also clear that there has to be a radical improvement in the way the health service is run.
The NHS needs to be better integrated (between hospitals, primary care, community care, social services, public health, occupational health, dentistry etc) with better communication and co-operation between the different sections in order to give people the best possible service.
It is essential that this is publicly funded and trade unionists and communities must step up the campaign for the elimination of profiteering from the NHS. We need a fully accessible service which provides for everyone equally, not the postcode lottery we have at the moment.
There's no doubt that extra funding is required. This could be raised by the re-nationalisation of the pharmaceutical industry, which makes billions in profit from people's illness. At the moment several different companies make similar drugs to compete against each other for the same market.
Nationalisation would mean that research would actually be directed at finding cures for diseases and developing treatments for less common diseases which don't make companies a profit at the moment because they don't constitute a big enough market.
Recruiting and keeping staff would be far easier if pay and conditions were improved and people felt they were achieving something useful for society rather than constantly 'fire-fighting'. All charges should be completely abolished. Elected teams of health workers and patients should plan and manage the NHS making the service democratic and accountable.
Of course, under capitalism, the bosses would try to stop many of these measures because they cut across their profits. Past governments have proven incapable of running the NHS to provide for our basic needs.
That is why the transformation of society along socialist lines is the only way foreward. Under socialism, not just the NHS, but the banks and industry would be under democratic workers' control.
This would allow society to tackle the very causes of ill health - poverty, poor housing, pollution - and give people the opportunity to lead productive lives in the knowledge they will be cared for properly by society in return.
The Socialist Party says:
- Fight for a fully publicly funded NHS with immediate cash to end the crisis of underfunding and stop cuts and closures.
- Eliminate the profiteers from the health service. End health privatisation. Abolish the wasteful private finance initiative (PFI). Scrap the Trusts.
- Stop the pharmaceutical companies' profiteering by nationalising them under working-class control and management.
- Rebuild the NHS as a service free at the point of use. Bring health management and medical services under democratic control.
- Fight for a socialist society where poverty and inequality - the biggest killers and the greatest causes of ill-health - could become problems of the past.
In The Socialist 8 March 2002: