The fight for our NHS

New wave of struggle faces new phase of crisis

James Ivens, Socialist Party national committee

The fight is on to save our NHS. The biggest strike in the service’s 75-year history brought tens of thousands of nurses and ambulance staff out together on Monday 6 February.

Thousands of physiotherapists and support workers have taken strike action this year too. As a national protest for the health service musters on Saturday 11 March, junior doctors will be readying a 72-hour strike up to the end of Budget Day.

The significance of all these actions is huge. The British Medical Association has only called strikes twice before – the Royal College of Nursing, never! Health workers feel this trade union fightback is overdue and very welcome.

It’s been needed for years. But now Covid and its fallout have opened a new phase in the NHS crisis.

Ambulance dispatchers can’t order responses because crews are queued for hours – even days – outside A&E. Safety investigators report them desperately asking: “How many people are we going to kill today?”

It’s not just emergency care. Waiting lists to start planned treatments more than doubled from three million in 2015 to seven million in 2022. The number of patients stuck more than a year without treatment exploded tenfold to over two million.

Leaders of doctors’ professional associations wrote in the British Medical Journal this January: “The concern of many colleagues is that what we have previously described about the situation being a crisis is, with hindsight, wrong.

“It was hugely challenging but now we are seeing what a crisis really means, with delayed and missed treatments, and unacceptable care and working conditions.”

Our NHS is being bled dry by profiteering companies. Every year, tens of billions of pounds flow from NHS funding into the accounts of private providers seeking to make a profit – 26% of NHS England spending in 2018-19, according to one estimate.

The tendrils of private profit penetrate all aspects of the NHS: huge profits for drugs companies are extracted at our expense and services outsourced to companies like Serco to employ workers on inferior pay, terms and conditions.

New ‘Integrated Care Boards’ (ICBs) commission local services – and give the private sector a direct say. Billionaires like Richard Branson snap up public funds to provide the least intensive services, leaving the complex, expensive cases for the NHS.

Then there’s ruinous ‘Private Finance Initiative’ debts. Decades of dues to private firms to pay off public buildings. Ten trusts spend more on PFI bills than drugs!

The NHS was built on three pillars: universal provision, free at the point of use, based on clinical need not ability to pay. What we’re seeing is a breakdown in universality, without which the other principles start to lose their effect too.

That’s why one in eight of us have had to resort to private healthcare despite the gut-punching bills.

More troubling still is that one in six who have tried to access the NHS have felt forced to treat themselves instead. There are horrifying tales of hard-up workers pulling their own teeth with pliers.

We all know the pandemic overloaded the system. But it wasn’t the fundamental cause. It simply laid bare decades of cuts, privatisation and de-integration. So what change do we need to rebuild and expand the NHS – and how can we win it?

Invest to end the staffing shortage

If you can get an appointment at your hospital or GP’s surgery, you’ll see exhausted staff dashing from crisis to crisis. There’s just not enough of them.

One in ten NHS vacancies are unfilled – including over 9,000 doctors and 47,000 nurses. Add to that staff who are off sick due to extraordinary stress or exposure to diseases like Covid – it’s a wonder anyone’s in at all. This in turn adds to the stress.

Closing that gap is a start, but not enough. The UK has around 31 doctors for every 10,000 people. Germany has 45, and Cuba 84! Particular fields, like mental healthcare, are especially short compared to demand.

Nurses have told Socialist Party members visiting their picket lines that the numbers their union delegated to go in for basic safety were higher on some wards than on non-strike days! Wouldn’t they make better decisions on staffing?

The Socialist Party says

  • Emergency investment now to hire and train permanent staff, including more GPs and mental health workers, to end the shortage and start expanding
  • Health unions and patient groups should have democratic oversight of staffing and safety

A big reason there are so many vacancies is that workers can’t afford to live on NHS wages. One in seven nurses relies on food banks.

Staff across the health service have lost the equivalent of a full year’s pay since 2010. For experienced nurses, wage packets are 20% smaller in real terms.

Support grades – like cleaners, caterers, security, receptionists – are often the worst-paid of all, worse still when outsourced. But the NHS would grind to a halt without them.

To add insult to injury, their private employers cream profits off the NHS budget in order to underpay them. But outsourced workers at Barts NHS Trust in London won a big pay rise and an end to outsourcing by striking last year. That’s the way forward!

The Socialist Party says

  • Inflation-proof pay rises for all workers
  • A minimum wage of £15 an hour
  • Insource all privatised staff and services on full NHS pay and conditions

Given the huge stress and poverty pay, it’s not surprising young people are reluctant to train for healthcare roles. Students enrolling on nursing courses are down 10%.

Back-breaking debt from uni fees and abolition of bursaries haven’t helped. Meanwhile, medical degree enrolment is capped by the government because it’s unwilling to pay to train enough doctors!

The Socialist Party says

  • Abolish tuition fees and debts, reinstate living grants and training bursaries
  • Scrap the cap on medical degrees – invest in fully publicly funded higher education for all

Health infrastructure, not cash cows

The lifeblood of healthcare is its workforce. But staff can’t do their jobs without infrastructure. Capital investment in the NHS is about half that of comparable countries as a share of GDP.

The problem of hospital bed availability is now chronic. You could fly halfway round the world quicker than get off the trolley or out of the waiting room.

One well-publicised cause is ‘bed blocking’ – medically dischargeable patients who can’t leave without care arranged for them. The appalling deficiency of social care is a result of local council budget cuts and privatisation.

But there’s also just not enough beds. The UK has 2.5 hospital beds for every 1,000 people. France has about 6 – Japan has 13.

Non-emergency care is increasingly farmed out to private hospitals that bill the NHS. Instead of opening more wards and beds, the Tories and Labour both want to hand more NHS cash to those profiteers!

The Socialist Party says

  • Nationalise and fully fund the social care sector to meet social need
  • Spend public money on more NHS wards and beds, not handouts to private hospitals

The next bright idea from the bosses’ politicians is abolishing some wards outright. Both Tories and Labour see ‘virtual wards’ as a cheap alternative to hospital investment.

Patients would be in bed at home, with clinicians checking in remotely. But efficient care requires in-person connection with health professionals, to maximise information and meet the emotional needs of patients.

It’s patently unsafe to have hospitalised patients scattered miles away from staff. It also shifts a burden of unpaid care onto families, especially women.

Instead, how about those 40 new hospitals Boris Johnson promised us? Hospitals are riddled with crumbling buildings and outdated facilities. The total cost to fix accumulated problems rose 11% last year, to £10 billion.

The Socialist Party says

  • Build and extend hospitals to provide in-person care, not ‘virtual wards’
  • Invest in repairs and upgrades now

Where new technology could help is in planning and coordination. The NHS still struggles to share medical records. And patient flow in most hospitals is run manually on clipboards. But digitised systems with patient wristbands have apparently improved efficiency.

Private tech suppliers will, of course, leech out profits from the NHS – and as we learned again during Covid, may never deliver the goods. Staff may also be wary, rightly, that management could use new tech to sweat them like Amazon workers.

Outdated technology, disjointed planning and poor communication are all symptomatic of a much larger problem. The NHS is fragmented and infested with private interests.

Successive governments have implemented artificial ‘internal market’ competition and broken up the service into isolated local ‘trusts’. This made planning and resource sharing harder, and increased expensive bureaucracy.

The pandemic showed us the truth. Public coordination and planning got us through Covid. Private contracts got the Tories’ mates richer and achieved little else. Let’s have the lot, fully coordinated, under working-class control instead of sticky-fingered capitalists.

The Socialist Party says

  • Scrap PFI and cancel the debts
  • Boot out the profiteers – renationalise all NHS services with no compensation to fat cats!
  • Scrap trusts, ICBs and the internal market – for coordination and planning at all levels, under the democratic control of health workers and service users
  • Invest in new tech to improve the service, but publicly owned and with democratic oversight from health unions and patient groups     

Capitalism makes us sick

To distract from their crimes of underinvestment and privatisation, one of the capitalist establishment’s favourite scapegoats is the sick. They bemoan the difficulties of treating an ageing population.

Over the next two decades, the proportion of over-65s in Britain will rise from a fifth of the population to a quarter. Surely ordinary people living longer is a good thing!

The problem is that capitalism stops valuing workers when they stop contributing to profit through production. Instead of paying for living pensions and quality public services to keep us well, they want those retired or unable to work removed from their balance sheets.

They may yet get their wish. Life expectancy growth started to slow ten years ago, and among some deprived demographics has gone into reverse. Researchers at Glasgow University have pinned the blame on austerity.

The bosses, of course, prefer to moralise about ‘lifestyle choices’. But if you’re working long hours, with low pay, little access to decent food and services, suffering constant anxiety about your job and home… they’re not really choices at all.

‘Affordable’ housing is overcrowded and often damp or clouded in pollution. Patients on NHS waiting lists get sicker while they’re waiting, in a vicious cycle.

The for-profit pharmaceutical industry charges the NHS extortionate rates for drugs. It also has little incentive to invest in cures, which after all mean you lose your customers. Profit, poverty and inequality kill – at all ages.

Added to this general physical and psychological strain, the government has slashed spending on public health departments aimed at preventing illness. That’s why the Tories can claim they (slightly) increased NHS spending. They raided the public health budget to do so, sawing off the branch the NHS is perched on.

The Socialist Party says

  • Reinstate fully funded public health schemes in all areas
  • Nationalise big pharma and medical supply firms to cut costs and invest in research, as part of a publicly owned, democratically controlled NHS
  • Fight for living wages, pensions and benefits for all
  • Mass building of safe, high-quality council homes
  • Reverse austerity! Fully fund all public services – take the money from the super-rich

Striking to save our NHS

NHS workers on picket lines this winter have made it clear that the strikes are about pay, but not just pay. They are striking to save the NHS.

The Tories’ splits on NHS pay, and Sunak’s latest hints at concessions, show that strikes can get results.

Further coordination between health unions and unions in other sectors would maximise impact. Coordinating strikes across all sectors could break this fragile and factionalised government.

The Socialist Party says

  • Coordinate the actions! Union leaders must meet urgently to name the date for further days of coordinated action bringing together all those with a live strike mandate. Build towards a 24-hour general strike
  • TUC and union leaders: launch a national strike fund, and appeal for public support to sustain strikers in hardship

Fight for socialism

This strike wave could be a force to bring down the Tory government. But would its replacement with a Labour government led by Sir Keir Starmer solve our problems?

Starmer has committed to almost all the Tories’ policies on NHS privatisation and general austerity. His health spokesman, Wes Streeting, took £15,000 from a hedge fund manager connected to vulture healthcare privatising.

NHS workers – and all workers – need political representation that’s controlled by and for our class, not big business.

The Socialist Party says

  • No trust in Starmer’s Labour
  • Prepare a trade union-backed workers’ list for the next general election
  • Build towards a new mass workers’ party

Nye Bevan, founder of the NHS, supposedly said that “the NHS will last as long as there’s folk with faith left to fight for it.” But why should we have to keep having that fight over and over?

The NHS – and whole welfare state – were won after the Second World War. The working class was fed up with abysmal social conditions. There was the living example of a recent revolution in Russia.

The bosses feared revolution here and reluctantly conceded reforms. An economic boom totally unique in its growth and duration, meant they could tolerate higher public spending against their profits. Even so, there were gaps. We pay for dentistry and prescriptions, for example – hardly ‘free at the point of use’.

They’ve been clawing it all back bit by bit ever since. And today, they face not world-historic upswing, but long-term stagnation and crisis. So winning the NHS we need – and making it permanent – means taking the wealth and power off them for good.

The Socialist Party says

  • Take the wealth and power off the super-rich! Nationalise the banks and big businesses that dominate the economy under democratic workers’ control and management
  • For a socialist NHS, fully publicly owned and genuinely free at the point of use for all health needs, as part of a socialist plan of production to meet the needs of all