Vol. 74/No. 32      August 23, 2010

But the 1 million, mostly working people, who use the NHS every day face declining care. The experience of journalist Judith Woods is typical. Writing in the Daily Telegraph, Woods who recently sought treatment for a fractured spine, reports: “First I was denied simple pain relief even as I wept and begged for it, then I was forcibly discharged, because I was taking up a precious bed—only to end up in A&E [accident and emergency] at another hospital 24 hours later.”

Now, with a government drive to reduce spending—the £105 billion (US$165 billion) health budget is one-sixth of total public expenditures—some of the most common operations face the axe. Examples include dying cancer patients told to “manage their own symptoms”; nursing homes for the elderly closed; the number of hospital beds reduced, including those for the mentally ill; pediatric, maternity, and elderly care being cut back; and services that provide breaks for long-term care givers being trimmed. Previously decided health construction programs are to be reviewed.

The measures are the result of government decisions to achieve £20 billion (US$32 billion) in “efficiency savings” by 2014. A similar proposal was made by the Labour Party when in power.

Tens of thousands of jobs will be cut. Specialist nurses will be forced to do general nursing tasks, endangering specialist care, according to the Royal College of Nursing. Figures published by The Times August 6 reveal that 11,000 job cuts have been slated for this year.

Dr. Peter Carter, general secretary of the Royal College of Nursing, warned of the danger of a “return to Maidstone and Tunbridge Wells and Mid Staffs”—hospitals in which hundreds of patients died due to hygiene problems.

Even with a government commitment not to reduce NHS spending, care will decline. Demands of an ageing population require a 6 percent rise in the NHS budget for each of the next three years just to maintain current care levels, according to a recent study. Prices for health provision are rising faster than average inflation. Companies take advantage of the state-funded NHS to raise their service and drug charges and rake in superprofits.

Moreover, large chunks of government money invariably lands in the coffers of the bloated bureaucracy that administers the NHS. When the last Labour government expanded the health budget, spending on management staff rose by more than 80 percent in four years.

In face of declining care, local protests have started. A campaign earlier in the year by the Defend Whittington Hospital Coalition won a government reprieve on cutting back services provided at the north London hospital. Hundreds took to the streets to protest proposed cuts, which included the closure of the accident and emergency department and cutbacks to maternity and children’s services.

Protesters called on people to save “our NHS.” The government cuts, however, underscore the fact that the NHS is not ours. Workers have no property rights under capitalism.  
 
NHS: a concession won by workers
The establishment of NHS was won by the working class—one of a series of concessions enacted by the post-WWII Labour government of Clement Attlee. That government won a landslide victory at the 1945 general election, as working people mobilized to advance their interests and claim the better life that the rulers promised the war’s end would bring.

The new service was hugely popular. Working people in their millions flocked to hospitals and doctors’ practices, previously denied to them. Tony Benn, former Labour Member of Parliament, characterized the NHS as “the most socialist … thing ever done by a government in Britain.” But it is socialist only in the sense of bourgeois socialism—the view that the state is like an empty sack that can be filled with capitalist reforms which, as they accumulate, will amount to socialism.

This reformist perspective gains support from sections of the capitalist rulers seeking to placate workers and divert independent working-class political action, particularly in times of rising class struggle. It has played a major role in politics in the United Kingdom for more than a century.

In fact, the original blueprint for the NHS was drawn up by the Conservative wartime cabinet of Winston Churchill, drawing on steps that had already been taken during the war.

The 1948 National Health Service Act, drawn up by Labour health minister Aneurin Bevan, differed from the Conservative proposal not in its stated objective of providing universal health care but in nationalizing the hospitals, and placing them under the control of regional authorities.

In order to win the acceptance of doctors at the top of the pay pyramid—the consultants, and surgeons—the government had to “stuff their mouths with gold,” as health minister Bevan put it, and protectd their private practice rights within the NHS. For providers of services and materials to the newly nationalized NHS—including the highly monopolized drug industry—state funds would guarantee gigantic profits over the long haul. In addition, workers were levied with higher tax burdens to fund the service, while care was class-differentiated according to region.

As is the case with all nationalizations by capitalist governments, the health service was taken out of the hands of individual capitalists only to return it to the capitalist class as a whole. Health provision remained a commodity, albeit a cheaper and more accessible one. It wasn’t long before Labour started to impose direct health charges, as government funds were diverted to the UK’s participation in the Washington-led war against the Korean people in the early 1950s.  
 
Coalition government plans
In July the Cameron-led coalition government introduced proposals for a structural overhaul of the NHS in England and Wales—the “biggest” since it was established, according to the Financial Times. Under the plan, regional authorities would be abolished and control of 80 percent of the health budget would be placed in the hands of consortia of local doctors. The NHS “will be run as a market” the paper says, creating lucrative openings for health maintenance organizations and insurers, in which staff would leave the NHS to sell their services back, and the existing cap on private patient earnings will be abolished. Eliminating national union pay bargaining for hospital workers is a target of the reorganization.

Measures to expand the market within the NHS began in the early 1990s, with the Conservative government’s Private Finance Initiative (PFI). The Blair Labour government took further steps, projecting that all hospitals would become stand alone, self-financing “foundation trusts”—raising money from government and from private capital. During this time, the number of NHS hospital beds declined by one-third.

Blair was unable to carry through his goals to the end in face of opposition from the Gordon Brown-led forces within the Labour Party who were connected to union leaderships, especially in the public sector. Today just half of the hospitals in England and Wales are Foundation Trusts. In Scotland, where health is the purview of the government, London was not able to even start the move to Foundation Trusts, blocked by a coalition of the labor officialdom and the Scottish National Party.

Even under the more limited PFI in Scotland, costs have rocketed upwards and patient care has eroded. A recent article in the Edinburgh Evening News reports that the private company Consort, which leases the Edinburgh Royal Infirmary to NHS Lothian, will have charged the government institution seven times the cost of the hospital by 2028. Consort—a consortium of the construction companies Balfour Beatty and Morrison’s, along with the Royal Bank of Scotland—the hospital owner, also profits from running the canteen, hospital shops, and car park.

The government’s new proposals are an effort to carry through what Blair couldn’t. The leaderships of five national trade unions have submitted motions for the annual Trades Union Congress in September calling for protests in the face of the government’s cuts.

Pete Clifford in Edinburgh, Scotland, contributed to this article.
 
 
Related articles:
U.S. bosses press wage cuts amid joblessness
Benefits end for growing number of jobless
Workers told to accept ‘new normal’  
 
 
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