We need democratic workers’ control of the NHS

Steve Score, Socialist Party national committee

Keir Starmer’s “project chainsaw” includes the closure of NHS England (NHSE) as well as cuts in the running of other NHS bodies – the Integrated Care Boards (ICBs) and the Trusts. These cuts threaten up to 30,000 jobs and follow a chaotic few weeks where cutbacks in NHS England were initially announced at around a 15% reduction, jumping to 50%, before the abolition was announced. Despite health minister Wes Streeting’s description of this as getting rid of duplication and bureaucracy, the Socialist Party opposes all job losses.

We are not talking about top executives on inflated salaries here, nor are we talking about unnecessary ‘pen-pusher’ jobs. The ICBs for example say that jobs under threat include the organisation of vaccination programmes, children’s dental health projects and other important tasks. Since a previous merger programme in 2023, NHS England is responsible for maintaining vital live services that are now key to NHS operations. Even when reorganisation is necessary to improve the way things run, workers should be transferred to other useful roles with no attacks on terms and conditions.

Labour has broken its promise not to carry out any major top-down reorganisation in the NHS. Over many years, governments of all stripes have pushed through reorganisation that has solved none of the NHS’s problems, while distracting from the real solutions. Here we go again!

The Socialist Party opposed the 2012 bill that created the NHS England quango along with Clinical Commissioning Groups (CCGs) in local areas. This continued the process of breaking up the NHS, developing the ‘internal market’, where different parts of the NHS buy and sell services with each other alongside increasing privatisation. This has escalated since CCGs were replaced with ICBs.

NHS England was meant to manage all of this in England: planning, setting targets, funnelling government money and other functions. It was also an opportunity for governments to try to distance themselves from unpopular decisions. When I was part of the Save Glenfield Children’s Heart Centre Campaign that successfully defeated a proposal to close the only congenital heart centre in the East Midlands, it was NHS England we were fighting. But we knew behind it was the government pushing for billions in ‘efficiency savings’.

Labour says it is putting more money into the NHS, and savings from these measures that will go back into ‘frontline services’. But it will not compensate for many years of underinvestment or solve the chronic staffing crisis or any other of the NHS’s problems. Pitting ‘frontline services’ against ‘back office functions’ creates a false decision to make – the wealth in society should be used to fund the NHS and all its supporting services.

Making things worse

In fact, Labour’s plans for greater private involvement in the NHS will make things worse. NHSE roles that currently are promoting privatisation will be replaced by government roles promoting privatisation.

Streeting also said that the abolition of NHSE would increase democratic accountability because it would bring direct control back to the Department of Health. This is not what Streeting and Starmer will deliver, and trade unions must expose this myth. Real democracy would mean control and management by elected committees at every level of all staff in the NHS along with the users of the NHS, i.e. all of us. It would also mean nationalising the private health companies and pharmaceutical companies and other associated industries to utilise their resources for the NHS and include them in a democratically run plan for health.

Many of the threatened workers could play useful roles in financial planning, software engineering etc, in assisting the running of that democratic control and management. Working together, trade unions must fight to save all jobs, and for workers to be redeployed with no loss of pay, terms and conditions in a fully funded democratic NHS.

• This is why the leadership elections in PCS and Unison are so important. Members have the chance to elect a fighting leadership that will stand against Labour austerity. Socialist Party members are standing alongside others in these elections.