Why we need a national campaign now to defend
the health service
SPENDING ON the health service has doubled since Labour was elected
in 1997. From 6.8% of GDP in 1997, spending has risen to 9.2% of GDP,
higher than the latest average in the European Union.
Alison Hill
But why then are more than 50 trusts in England facing major deficits
– and the prospect of devastating cuts? Why are important community
hospitals being threatened with closure? And why is this happening now?
New Labour has never done anything about the deficits the Tories
created by strangling public spending in general and spending on the NHS
in particular. In fact, chancellor Gordon Brown is proud of sticking to
his pledge to maintain Tory cash limits for three years after the 1997
election.
During this time hospitals and health authorities were forced to
continue to use capital funds and postpone debt repayment to keep going.
In fact, there has been a campaign of asset-stripping by some trusts,
where hospital land is sold off for housing and other developments.
And when the government allocated extra spending, it came with a raft
of targets and other measures which absorbed much of this extra funding.
Some of it had to be used to raise wages for some health workers but the
scandal of low pay still haunts the NHS.
After dumping the Tories’ internal market, Labour reintroduced it in
England in 2002 in a more vicious form. They are now opening up the NHS
to plunder by the private sector in a much more blatant way than the
Tories ever did.
Once the general election was out of the way, health secretary
Patricia Hewitt could let the cat out of the bag by warning: "If
services aren’t attracting patients because they’re not good enough then
of course everything possible has got to be done to improve those
services so they do attract patients. If they can’t do that then yes,
they may have to close."
So the next couple of years will see a headlong struggle by the
government to force through its most unpopular plans for closure and
privatisation in the NHS – hoping the dust will have settled before the
next election. That is why there must be a vigorous and united campaign
by the health service trade unions and community campaigners to stop
these plans before they destroy what cannot be easily brought back.
The internal market
Labour’s version of the Tories’ disastrous ‘internal market’ hinges
on the principle that hospitals are paid according to how busy they are.
The attractive-sounding proposition that ‘money follows the patients’
actually means that hospitals will be paid according to a national
‘tariff’ based on average hospital costs.
But what if your hospital is not average – if it’s in an area where
many people have poor health or it’s suffered from years of
under-investment already?
The tariff itself is far from perfect. As the finance director of
Homerton University Hospital in east London told The Economist:
"The tariff is still very unstable."
Some trusts have already run up deficits under the new system.
Bradford Teaching Hospitals is running an annual deficit of £11 million
on a turnover of £210 million. So the government has been forced to
postpone its full implementation. It will only apply to elective
(non-emergency) treatment in 2005-2006.
Foundation hospitals – those which are given more financial autonomy
– are allowed to keep surpluses they build up. By March 2005, 25 out of
the 173 acute-care trusts had gained foundation status. But by building
up surpluses, foundation hospitals will be able to attract staff more
easily and thus extra patients, through the government’s other buzz word
– ‘patient choice’. All the ingredients of a two-tier hospital system
are there.
Privatisation
Shortly after the last general election, health secretary Patricia
Hewitt announced that the use of the private sector to carry out NHS
operations will double in the next five years. She wants between 10% and
15% of operations to be carried out by the private sector – rising from
around 5% now.
This is being done in the name of reducing waiting lists and patient
choice. But the British Medical Association has already warned that this
could destabilise the NHS. The private sector will only be interested in
taking on the most straightforward cases.
The professor of clinical biochemistry at the University of Surrey
put it more bluntly: "This is really the destruction of the NHS.
Once you start farming it off into private enterprises the NHS as we
understood it will gradually disintegrate."
The full implications of this policy have begun to be revealed.
Confidential documents have been leaked which spell out Labour’s
sell-off plans. Private sector bidders are being invited to bid for
contracts worth £3 billion to treat NHS patients.
The contracts being offered include:
Running all surgical facilities at the new NHS treatment centre in
Birmingham – up to 9,500 operations a year.
Turning Ravenscourt Park hospital in west London into a
"surgical hub" for a network of diagnostic and treatment
centres. Ravenscourt Park was bought to be run by Charing Cross hospital
as a specialist centre for joint replacements. Campaigners fighting for
the future of Charing Cross have identified this purchase as a factor
leading to Charing Cross’s financial crisis.
Leasing off part of the new New Forest Lymington hospital, which is a
PFI scheme anyway. This will be used to carry out 5,000 operations a
year.
These documents reveal another government ‘U’ turn. There were rules
to prevent the poaching of NHS staff by private companies. These have
now been shelved, except where there are staff shortages.
The chair of the BMA consultants committee told The Guardian:
"…we are moving quickly towards a position where a lot of NHS
staff will have to work for private firms or lose their jobs. This is
being done without any real debate."
Primary Care Trusts
The other potentially devastating change which the government is
planning is the reorganisation of the "purchasers" in the
internal market – the primary care trusts (PCTs). These 303 bodies
commission care worth about £54 billion a year for NHS patients in
England.
The plans are to merge many of the PCTs down to about 150 and strip
them of their role in providing services themselves. The private sector
will then be invited to provide services like district nursing, health
visiting, cancer screening and much else.
The changes are being pushed through on a very short timetable, which
even NHS trust chief executives describe as "rushed." Their
other descriptions of the plans include: "crass, ill-informed,
destructive, knee-jerk and irresponsible."
Already this has threatened local community hospitals (see articles
on Wiltshire and Hampshire.) And all seven district council leaders in
Devon have published a joint letter opposing the plans.
>
A socialist programme for the NHS
- End privatisation. Bring all healthcare into one nationally
planned and properly financed service. - Nationalise the pharmaceutical industry,
the pharmacy chains and medical supply industry and integrate them
into a democratically controlled NHS. - Abandon PFI, no more profiteering by building companies and
banks. - Fund new hospital building programmes
with public money, using direct labour. - Genuine democratic control of the NHS, involving the trade
unions, patients, carers, and elected representatives. Senior
managers should be accountable to elected bodies. - A minimum of £8 per hour and a 35-hour
week for all health workers. - Free and accessible dental care for all.
- Abolish prescription charges.
- 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.
>
Wales – different jargon, same privatisation
ONE IN ten people living in Wales are on an NHS waiting list as Welsh
hospitals are clogged up, unable to deal with the demand for healthcare.
Dave Reid, Cardiff
A doctor in a South Wales accident and emergency department emailed a
plea for help to a member of the Welsh Assembly: "Our emergency
departments are indeed ‘third world’, with patients waiting for more
than 90 hours on hard trolleys for a bed… staff can no longer deal
with circumstances where they have dying children in their arms and
nowhere to put them… Please help us not have to refer another
‘corridor’ death to the coroner."
In Wales the Labour government in the National Assembly claims to
take a different route to New Labour in England. There are no foundation
hospitals or primary care trusts but privatisation of NHS services
continue.
Now all new NHS services are put out to tender to allow private
companies to take over. The Cardiff out of hours service was recently
tendered out to a private software company and sold on to an American
healthcare corporation. The result has been chaos, as people wait days
for a service that should be immediate.
And decades of under-funding and hospital closures have meant that
the NHS in Wales just cannot cope. Instead of expanding hospital
capacity, building new hospitals, taking on more doctors and nurses,
developing new facilities, Labour in Wales is sending patients to
private hospitals to clear the politically embarrassing waiting lists
and going for the cheap option of trying to treat people outside of
hospital.
These "new models of care" are supported by all the parties
in the Assembly but are increasingly understood to be the cheap way to
avoid building new hospitals. Dave Bartlett, secretary of CRISIS, the
campaign to re-open Cardiff Royal Infirmary (CRI), dubbed them the
"cheap and nasty model".
However people all over Wales are fighting back for their health
service. In the summer CRISIS took a step forward when its years of
fighting won £5 million funding for the CRI site. And last week 1,000
people marched through the small North Wales town of Blaenau Ffestiniog
to stop the closure of their hospital.
>
Fighting the cuts in Wiltshire
IN WEST Wiltshire the primary care trust (PCT) has announced the
closure of hospitals in Bradford-on-Avon and Westbury.
Roger Davey, senior UNISON steward, Swindon and Wiltshire Health
branch, personal capacity
Also three hospitals in Trowbridge, Warminster and Melksham are
likely to be closed or downgraded in 2006. The PCT has told the unions
that 130-plus jobs could be go.
Yet there’s a real shortage of hospital beds. All the hospitals
threatened with closure have bed occupancy rates of above 90%, while the
nearest major hospital in Bath is regularly on "red alert" –
full to the brim.
If these closures are implemented, patients will be trapped at home,
reliant on already overstretched community nurses, friends and
relatives. Many others will be inappropriately placed in nursing homes,
where they will face means testing and receive lower quality care. Those
fortunate enough to obtain a hospital bed could end up being discharged
early due to the shortage of beds.
UNISON has begun organising members across the five hospitals and co-ordinating
action to defend jobs and services. A demonstration held outside
Bradford-on-Avon hospital attracted over 400, while 600 staff and
members of the public marched against the cuts in Westbury, one of the
largest protests ever in that small town. Hospital workers have drawn
confidence from this and are determined to carry on the struggle to
defend services. Industrial action has not been ruled out.
We are regularly asked why beds are now closing at such a rate. It’s
because the government has told all PCTs that they must break even by
April, despite massive historical debts. The situation is made worse by
a rapidly growing percentage of NHS money going straight into the
pockets of wealthy shareholders.
Small community hospitals cannot be made easily profitable in this
cut-throat market. There’s not much dosh to be made out of the elderly,
long-term sick patients we care for.
New Labour is happy to grease the palms of the private sector as it
breaks up our health service, yet UNISON still passes on members’ dues
to these privatisers. My members are asking why and are demanding
answers.
As the fight goes on to protect our hospitals, more of them will
realise that it’s time to break the trade union link with New Labour and
put our energies into building a new workers’ party that will defend and
expand the NHS.
>
Crisis in Hampshire
THE NHS budget deficit in the Hampshire/Isle of Wight area is over
£60 million, but the figure grows all the time in the press.
Nick Chaffey, Southampton
Hospitals had previously set deficit budgets but this has now been
stopped. Senior civil servants have written to hospitals trusts
demanding they set balanced budgets and health secretary Patricia Hewitt
has written to worst offenders with the same message. What was already a
crisis has now been enormously multiplied with big cuts being announced
everywhere.
This has provoked an uproar in the areas such as Emsworth, Andover
and the New Forest. Big meetings have been held and 2,000 rallied in
Lyndhurst to protest at the cuts in the New Forest.
More worrying is, on top of these cuts, we have cuts in beds in
Southampton General hospital and hundreds of redundancies as well as a
decision to close Haslar hospital in Gosport, just along the coast!
With a crisis at the Southampton General already, if these cuts go
ahead the pressure on the remaining regional NHS centres will be huge.
Trust spokespersons are trying to allay fears by promoting "care in
the community" as an alternative but we know from speaking to staff
that these services have been cut to the bone and are at full capacity.
Trusts then say that private providers can take up the slack. Staff
suspect there are hundreds of NHS managers lining themselves up for a
future in picking up this slack.
>
Public health not private profit
IN APRIL, it was leaked to the press that Charing Cross hospital in
west London might be closed. Hospital management dismissed the claims
and insisted that services would continue.
Elizabeth O’Hara
But plans then came to light to pump public money from the NHS into
hospital services which would only be available for private patients.
The local Socialist Party branch have organised a weekly stall in
Hammersmith. We have leafleted local estates and gone door-to-door
seeking signatures for our petition against the cuts and the
privatisation of the hospital.
We have been hugely encouraged by the number of local residents and
hospital workers who have signed our petition and expressed disgust at
the idea of running our health care services for profit. So far we have
gathered 750 signatures which we are presenting to the management on 26
September.
The battle for the NHS is on. It is essential that we continue to
build support for campaigns on the ground. Otherwise the future of our
NHS will be determined in the boardrooms by those who are unelected,
unaccountable and who themselves stand to benefit from privatisation.
>
Building a campaign to win
THERE IS an urgent need to link the existing campaigns against
hospital closures and cuts together into a national campaign involving
the NHS trade unions. In 1988 the Tory government was forced to water
down some of their plans to attack the NHS when nurses and other health
workers took strike action, which was backed by action by miners,
shipbuilders and other industrial workers.
At the time, the socialist’s predecessor, Militant called for a
one-day general strike rather than just the demonstration and ‘day of
action’ which was all the trade union leaders called for.
In spite of the lack of leadership, there was a 100,000-strong
demonstration through London on 5 March 1988, where workers showed their
support for the health workers and the NHS.
This needs to be repeated now – building a campaign for a major
national demonstration which will lay the basis for a campaign of strike
action to stop the privateers in their tracks.
UNISON’s reaction against this government’s plans consists of a
propaganda campaign amongst the membership and putting an emergency
resolution to Labour Party conference. But this campaign will have to
include united strike action for it to be effective.
- Unite the campaigns to defend the NHS, involving local
activists and the trade unions. - For a national demonstration to build support for industrial
action to defend the NHS.
Get involved
If you would like to join with other trade unionists and campaigners
fighting for the NHS, send your details to: [email protected]
or contact us though our website
Come to the Socialist Party’s Socialism
weekend, where there will be a discussion about how to develop the
campaigns.
>
WHEN CAMPAIGNING against cuts at Southampton’s hospitals, one
patient told us how elderly people on her ward are sometimes forced to
lie in soiled sheets as they are unable to go to the toilet unaided.
Kieran Roberts reports
"I am the only one on the ward able to get out of bed" she
told us, "so I am the only person there who can help sort them
out".
Among the patients and workers we have spoken to, there has been
widespread agreement that a campaign of mass action is necessary, led by
the health trade unions, to stop the cuts.