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From The Socialist newspaper, 1 November 2007

NHS: Time to fight for a national strike

The health service is being attacked in a piecemeal way - one hospital forced to close wards here, community services cut there - but these attacks are part of the government's national policies, which need to be challenged nationally. They want to strip the health service down into convenient chunks, which can be privatised and run for profit.

We need to defend the whole health service. The NHS should be designed to meet the needs of everyone in society, not what the government's 'balance sheet' can withstand.

The government declares that health trusts are 'in deficit', or that they have missed this or that target. They use this as an excuse to demand massive cuts and closures and to bring in private companies to drive health workers' wages down and provide an inferior service.

But how can a hospital or a community trust be in deficit? If people need health care it should be provided. We are living in the 21st century not the nineteenth, when if you couldn't pay you were left to fend for yourself.

The Tories introduced the market into the NHS in 1990. New Labour have picked up where the Tories left off - with further nonsensical 'marketisation' of health care, targets instead of real monitoring and accountability and the wholesale hiving off of successful and efficient services to the highest bidder. The Private Finance Initiative (PFI) started as a convenient way to hide public spending 'off the books' and provide profits for private companies. It has turned into a financial disaster for the health service, actually forcing cuts to be made. Priorities are being decided by accountants and management consultants, not health care professionals.

PFI - a financial disaster for the NHS

Private Finance Initiative capital development schemes use 'commercial confidentiality' to fleece the NHS.

Mick Griffiths, Wakefield and Pontefract Hospitals Unison, branch secretary, personal capacity

Our trust's Final Business Case (FBC) was approved on 28 June. It is mandatory in the NHS that FBC documents are published within one month of being signed. We are still waiting!

FBCs contain the contract details. They should demonstrate how 'value for money' is to be achieved. But it is clear that the companies involved in PFI schemes hide behind 'confidentiality' to cover up their profiteering.

Our Unison branch has requested disclosure using the Freedom of Information Act.

But publication is being resisted on the spurious grounds that certain information is a 'trade secret'.

The PFI procurement process inevitably 'proves' private-financed deals as better value for money, despite costing much more than publicly funded alternatives.

And the government's Private Finance Act guarantees profit returns to the private sector for the duration of the 30-60 year contracts!

Our trust recently declared that the new build will cost £300 million. However a commercially confidential document also states that the latest cost is now £311 million.

When finances are tight and profits are protected it is staff, patients and services that are always hit.

We must oppose the whole concept of 'commercial confidentiality'. It should have no place in public services.

The NHS trade unions need to organise a campaign to expose, bring down and ultimately abolish this disgraceful legalised robbery.

NHS - the home of low pay

The National Health Service more and more resembles a national wealth service for the rich under New Labour. That's the reality of privatisation and the ideology of neo-liberalism.

Len Hockey, joint branch secretary, Whipps Cross Unison, personal capacity

A recent report cited Whipps Cross Hospital as the lowest-paying NHS Trust in London! It serves a population of 250,000 predominantly poor people with a large elderly population. The area lacks decent and affordable housing and has a high incidence of poverty related illness.

What a damning indictment of both the Trust board and a system based on inequality in health and wealth, that those who care for the poor and working class are themselves among the most exploited and impoverished in their jobs as care workers!

The 3 November demo in defence of our NHS, coming late as it does and after so many cuts, provides a national focus for opposition to these attacks and privatisations. It also offers the opportunity to develop unity in action on the ground, linking health workers and other workers with the community campaigns in developing a strategy to build effective resistance.

But in fighting for the kind of health service we need, that affords us dignity and quality care, then inescapably we run up against the question: 'What type of society is required in order to make it possible and to sustain it?' And we have to ask: 'What organised working-class political representation do we need to attain it?'

That society is one based on need not greed, on cooperation not competition. That society is a socialist society.

PFI + payment by results = super profits for big business

In April 2007 there were 85 PFI schemes in the health service. There are 41 other schemes in the pipeline. These 126 schemes are worth £15.5 billion.

By 2013/14, when all these schemes are in operation, the NHS will be paying £2.3 billion a year to the private companies involved.

Under the Payment by Results system, trusts receive most of their income through a standard tariff for treatments, which includes an element for capital costs. But the capital costs incurred by trusts with large PFI schemes are higher, so they end up incurring a deficit.

To deal with the deficit, trusts then make cuts. But because of the inflexible nature of PFI contracts, these cuts don't just fall on the trusts with the PFI schemes but on adjacent services where there are realisable NHS assets.

In South east London, for example, Bromley and Queen Elizabeth Hospital trusts have ended up with £180 million-worth of debts. Local health officials are now looking at where to make the cuts.

When building for the 3 November national NHS demonstration, Greenwich Unison branch secretary Onay Kasab said: "In Greenwich and Bexley, we are seeing first hand the effects of the government's policy on our health service. PFI at Queen Elizabeth is a financial disaster and the proposals for Queen Mary's have led to an outpouring of protest from the public, but this situation is not local, it is national.

"This demonstration gives us all the opportunity to make our voice heard, on a national basis. Potentially, it could be a massive step towards building a huge national campaign, bringing together the many excellent local campaigns that exist. It will also provide inspiration, as we will be able to hear about how campaigns around the country have successfully fought off attacks on our health service."

Working in the community - for free!

This week I calculated I had done 7 ½ hours unpaid overtime - a whole extra day's work.

A district nurse

This overtime meant starting work early, finishing late and missing lunch to ensure I was safely able do my job and see the people who needed to be seen. This is against a backdrop of the media accusing nurses of being lazy and standing around chatting - resulting in rising infection rates for MRSA and Clostridium difficile. But I'll come back to that one.

I can report the only unproductive conversations I've had this week have been telling people: "Sorry I'm going to be late" or: "Sorry we can't see you today" or even: "Can you change your own dressing?" or: "Can your husband with severe arthritis in his hands manage to install your eye drops?"

Also this week I've resorted to ingenious methods of eating. A bag of chips fits in the side door of a car and you can eat these while driving. A sandwich can be eaten while filling in a specimen form. And if you store it hamster-like in your cheek you can hold a phone conversation with a patient, their relatives or social workers, without any of them ever knowing.

My team is short-staffed because a person who has been off sick for five months is still being paid, quite rightly. But apparently this means there is no money available to get more help.

But I was wondering, perhaps this person isn't aware of the Trust's incentive of £25 a year if no sick days are taken? Or perhaps they've worked out that that's less than a day's pay and they are actually genuinely ill.

On the recent CWU picket line I was talking with one of the postal workers. We compared the situation in our workplaces, all being public-sector workers and that. We agreed you hardly go into our areas of work expecting to be well paid.

But there was always sick pay, paid holidays, a pension scheme and job security. But these are precisely the things the Labour government is destroying - so you're left with crap pay and crap conditions.

Also, as I said to an inpatient at the hospital over the road, when I was on a health campaign stall: "I used to feel proud to work for the NHS but now I feel embarrassed."

This man pointed out how he saw the staff all working very hard on his ward and he went on to say: "I don't know what the answer is to keep and improve our health service".

My answer was: "Kick out the private companies who're just out to make a profit and keep the NHS a public service".

Coming back to hospital acquired infections - I see these as being directly related (in part) to the privatisation of hospital cleaning and laundry services.

Maybe over time I have developed an idealistic view of my past time spent as a nurse in a hospital. But back in the 1980s and before, all wards had their own cleaning staff.

I remember they were pretty scary if, as a student, you dared to leave a cup in the sink. But this is because the cleaners were part of the ward team and took pride in their work.

Overnight these staff were shifted to a private contractor. They reported to us that they were told to water down cleaning products and were given one cloth and a pair of gloves to clean the whole ward!

They were shifted daily to different areas and they suffered at the hands of bullying supervisors for daring to ask for the necessary equipment to do their job.

Where next for the campaign?

To force the government to change its policies, we must build for a national one-day strike of all health service workers, with emergency cover determined by the trade unions.

The health trade union leaders have done their best to resist the pressure from below to organise even a national demonstration.

And they will do their best to avoid national industrial action, either over pay and working conditions or to defend the NHS itself.

They pay £ millions of their members' money to the Labour Party, saying this will give them 'influence' over Labour's policies. But all that millions of pounds-worth of 'influence' has not kept one nurse's job or prevented the closure of one ward.

The Labour Party is now a big business party, of privatisation and cuts - the same as the Tories and the Liberal Democrats.

In many areas, MPs are jumping on the 'save the NHS' bandwagon because they are scared of losing their seats. But they still back the key policies of their party leaders - which inevitably mean the cuts and privatisation we are fighting against.

That's why the Socialist Party argues for the building of a new workers' party which represents the interests of the working class, that fights for the public services we all need, not just what capitalist political leaders think can be afforded.

The only way the health service can be defended and rebuilt into the service we need for the 21st century is to fight around a socialist programme. £10 billion a year - 14% of NHS expenditure - is taken by the pharmaceutical industry. The big construction companies like Balfour Beatty, Tarmac and Jarvis are all making fortunes out of NHS contracts, especially through the Private Finance Initiative.

Accountants and management consultants like KPMG and PricewaterhouseCoopers have all found themselves lucrative niches in the health service. And of course private health care companies like Kaiser Permanente are now flooding over from the USA to join their pals in BUPA and the others in taking a profit from the health service.

These companies should be taken over and run democratically by elected committees that include representatives of health care workers and the wider community. Instead of their profits being used to line the pockets of their shareholders, these billions could be used to provide a modern health service we can all be proud of.

A socialist democratically planned and run economy could provide good housing and education, a safe environment, a shorter working week and a real living wage for all. And an end to the profit system is the only way an efficient and effective health service can be guaranteed.

The Socialist Party says

Not one more penny of public money to go to big business profiteering out of the NHS.

End and reverse privatisation.
Medical advice, treatment, investigations, management, administration, cleaning, catering and all other health services should not be run for profit.
For all NHS services and buildings to be under public ownership.
Rebuild the NHS as a publicly funded service free at the point of use.
Abandon the Private Finance Initiative (PFI).
No more profiteering from the NHS by building companies and banks. All new hospitals to be built with public funding and employment, not using private construction companies.
Take private hospitals, clinics and Independent Sector Treatment Centres into public ownership and integrate their services with the NHS.
Compensation to be paid only on the basis of proven need.
Restore the NHS as a service - abolish the business competition of internal market, trusts, and 'payment by results'.
Local health services should be run and planned by democratic committees that include representatives of NHS workers and the local community. The NHS should be run and planned nationally by health workers and a government that puts health before private profit.
Cancel the debts.
Inject immediate cash into the NHS to end the crisis of under-funding.
Stop the job losses and pay health workers an above-inflation pay increase.
Nationalise the pharmaceutical and medical supply industries under working-class control and management to end the massive subsidy these parasites drain from the NHS.
Integrate these services into a democratically controlled NHS. Compensation to be paid only on the basis of proven need. Plan their resources to provide needed treatments.
A socialist programme to end poverty and inequality - the biggest killers and causes of ill-health.
For a mass campaign to defend the NHS and other public services!