How do we defend the NHS?

Only by appreciating what brought the health service into being in the first place can we understand what measures are going to be necessary to provide a permanent public health service of the highest quality for workers in Britain.

Proletarian writers

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Proletarian writers

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The following article is based on a talk given by a CPGB-ML member at a public meeting in Bristol on 24 October.

How do we go about ‘defending the NHS’? It’s not as if there aren’t enough people who care about this national institution. Both those who use it and those who work in it are typically passionate in their attachment to the system of public health care established after the last world war, and many over the years have campaigned vigorously to defend it – in some cases with temporary and partial successes.

Yet 30 years on from when Thatcher began the drive to privatisation, this sociopathic act of vandalism continues to run its course, advancing relentlessly under Tory and Labour administrations alike. More and more, the NHS is becoming a hollow shell within which the privateers are free to strut at will. What has prevented us from saving the NHS; from being driven down this road to ruin?

As a recent example of a really lively campaign of resistance, we could take the fight to see off the government’s attempt to close or downgrade core activities at south London’s heavily-used Lewisham hospital, including the A&E, acute admitting wards and Intensive Care Unit.

This was a grassroots campaign which proved able to mobilise very sizeable demonstrations, drawn both from the local community and further afield. There can be little doubt that this groundswell of public outrage had a salutary effect on the high court judge when he ruled on 31 July that the health secretary Jeremy Hunt had exceeded his authority in his eagerness to mug the hospital.

Campaign supporters are justifiably proud of the contribution that their strenuous efforts made to this temporary victory, and we should salute them.

However, we should never forget that what one bourgeois court gives with one hand, another can soon enough snatch back – if not from Lewisham then from some less stoutly-defended corner of the crumbling health service.

After all, what the judge in the case primarily objected to was not the proposed butchery of an NHS hospital, but the fact that Mathew Kershaw, the hatchet man (sorry, Trust Special Commissioner) was only supposed to be bullying the neighbouring South London Healthcare Trust, not the quite separate Lewisham Healthcare Trust, which is responsible for Lewisham hospital.

The bullying itself wasn’t the problem; it was just a question of making sure that the ‘right’ victim was getting bullied. The Trust Special Commissioner had recommended cuts beyond his jurisdiction, and Jeremy Hunt had in turn sought to implement them. The judgement rested on a technical question concerning jurisdiction, and in reality offered no likelihood at all that the demolition of the NHS would stop or even slow down across the board.

So the question remains: how are such spirited battles as that around Lewisham hospital to be extended into a class-wide resistance against the relentless destruction of the public health system in this country?

In the struggle to save their local hospital, campaigners understandably stressed Lewisham’s credentials as a high-achieving and popular hospital that is not in any obvious financial difficulty. Yet it is clear that an effective defence of the NHS can only be mounted on the basis of defending all public health services right across the board.

The privateers are only too happy to use divide and rule tactics, splitting hospitals into ‘centres of excellence’ versus ‘basket cases’, with privatisation presented as a reward for the former and a rescue for the latter.

Genesis of the NHS

In order to resist those who are stealing the NHS from under our feet, we need to understand clearly how we came by such a health service in the first place.

When a campaign leaflet handed out in Brighton outside September’s Labour party conference tells us that “The Lewisham campaign has successfully challenged the status quo”, we can only applaud. It is, indeed, one more cheering proof of the courage and initiative that workers are capable of displaying given half a chance.

But then the leaflet goes on to shoot itself in the foot by heralding the NHS as “the iconic achievement of the 1945 Labour government”, concluding that “Labour’s victory in 2015 is essential to saving the NHS”. Labour? The party that brought you PFI and Foundation hospitals? You might as well put the fox in charge of the chickens!

The real genesis of Labour’s supposed ‘iconic achievement’ was somewhat different from the nostalgic fairy story told by Labour apologists – as we spelt out in an article in this newspaper back in August 2006.

The NHS was born in 1948. On superficial examination, it was delivered by Aneurin Bevan and the Labour Party, which has ironically (even as Labour demolishes the NHS) been identified with this ‘pro-working class’ institution and policy ever since.

In fact, with the international prestige of the USSR riding high, and workers of the whole world looking to communism to deliver them from the bloody barbarism of capitalist exploitation and war, concessions were being made to workers of ‘developed’ capitalist nations throughout Europe and North America.

Even Franco granted similar concessions to the Spanish workers, notwithstanding the repressive fascist nature of his regime, and these conciliatory benefits of the Keynesian consensus were soon enjoyed even by defeated Germany, Italy and Japan as well.

This was a calculated bribe by the ruling classes of these nations to put ‘their’ proletarians off the revolutionary path. A conscious decision was taken to buy social peace at home at the expense of increased superexploitation of the remaining colonies and neo-colonies.

Churchill and Attlee: joint architects of the welfare state

Furthermore, through the Beveridge Report of 1942, the preceding wartime coalition government, presided over by that great ‘socialist’ Churchill, had already started to lay some of the groundwork for Labour’s subsequent health policy.

The founding of the NHS was no more the unique ‘iconic achievement’ of the Labour party than has its demolition been the unique crime of the Tories. Capitalism post war needed to, and could afford to, make concessions to the working class; capitalism in the current period of renewed crisis needs to, and cannot afford not to, claw those concessions back again.

An openly reactionary Tory-led government is currently an appropriate choice to lead the demolition, just as a pretended ‘socialist’ Labour government was an appropriate choice to deliver the ‘welfare state’ to the working class.

Whilst some Tory backwoodsmen doubtless spluttered, harder capitalist heads understood well enough that, behind the New Jerusalem mood music of the Attlee government, a crucial devil’s bargain was being sold to an unsuspecting working class – a bargain which Labour’s phony ‘socialist’ credentials made it uniquely qualified to market.

The subliminal message that Labour relayed to the working class, in essence, was this: “Forget about your proletarian internationalist duty to your brothers and sisters in Ireland, India, Kenya, Malaya and Greece. Forget all about class struggle and revolution. Turn a blind eye to the colonial butchery and looting indulged in by your masters, the sweating of superprofits from the superexploited millions of colonial slaves.

“In exchange for this collective amnesia, a ‘socialist’ government will, with the help of crumbs from the imperialist table, magic up for you a ‘welfare state’ that will look after you from cradle to grave.”

The Labour leadership, anti-communist to the core and reflecting the interests of that top stratum of better-off workers that Lenin liked to call the “labour aristocracy”, was only too ready to oblige its imperialist masters.

The Lewisham leaflet referred to above includes a ringing declaration from Nye Bevan, telling us that the NHS “will last as long as there are folk left with the faith to fight for it”. The welfare state was indeed conceded by a capitalism that felt threatened by the militant mood of workers in the immediate aftermath of the war against fascism. There were more than enough folk around with enough faith in a socialist future to cause concern in Whitehall.

But what inspired that faith more than anything else was not the tub-thumping phrasemongering of Nye Bevan, but the revolutionary example being set by the socialist Soviet Union – both in terms of its own unprecedented welfare provision for the masses and in terms of the stupendous sacrifices and achievements of the Red Army in the cause of freedom and socialism.

Stalin and the Red Army had a lot more to do with the arrival of the welfare state in Britain than did Bevan and the Labour party. It was the revolutionary example set by the Soviet Union that electrified the working class and terrified the capitalist establishment – terrified it so much that the imperialists were prepared to forgo a fraction of their vast profits to pay the rent on the welfare state.

And before we get too misty-eyed about Nye Bevan, let’s remember the other Bevin in the Attlee Cabinet, Ernest Bevin. Whilst Nye Bevan was posing as the people’s champion, handing out crumbs from the imperialist table to the masses, Attlee’s foreign secretary, Ernest Bevin, was busy helping found Nato, inveighing against communism and promoting Britain’s development of nuclear weapons.

When Labour’s reactionary colonial policy came under fire, it was Bevin who candidly justified it on the grounds that loss of the colonies would mean falling living standards for the British. Nye Bevan and Ernest Bevin – this was a package deal; you couldn’t take one without the other.

Tory and Labour: fellow assassins of the NHS

Wind the clock forward to the eighties and nineties, and the picture changes. The tragic loss of the Soviet Union, weakened by years of Khrushchevite revisionist mismanagement, gave cheer to capitalists everywhere, now that Russia no longer posed the threat of a good example.

At around the same time, imperialism was challenged by the beginnings of a new overproduction crisis – one that would incubate over many years, before finally breaking out in 2008 in the form of the present banking crisis. The onset of crisis sounded the death knell for the post-war Keynesian consensus, experienced politically in Britain as the arrival of Thatcherism and subsequently the shedding of the Labour Party’s joke ‘socialist’ Clause 4 fig leaf.

It is only to be expected then that, with capitalism plunged back into overproduction crisis and desperate to drive down the social wage, Tories and Labour should over the past three decades have taken turns at the demolition of these temporary concessions to the working class.

By the time Thatcher came to her third win in 1987,” notes an article in the journal Lalkar, “serious long-term plans had been put in place for profiteers to leech off the NHS. These included:

The idea of establishing the NHS as an independent statutory body with decentralised financial accountability and an end to national wage bargaining for NHS staff.

Bringing the NHS and private care together in an integrated market.

The plan to devolve all responsibility for patient care to directly-funded district health authorities while dismantling the regional health authorities and, of course, their planning function. It was also part of these plans to encourage individual hospitals to compete for patients.

Also on this list was the plan to create a national health insurance scheme jointly with private companies to promote the use of the private sector and eventually support the practice of paying for all treatment.

The article goes on to conclude that “It is very helpful to ponder on this list when trying to understand how we got to where we are, and how all governments, of whatever hue, have basically followed this 1987 programme to privatise the health service in order to divert taxpayer cash away from patient care and into corporate profit.” (‘NHS: continuing bourgeois attempts at dismantling’, September 2013)

In 1987/8, competitive tendering was introduced for catering, cleaning and laundry. Efforts by the unions to resist this were given lukewarm support from the TUC. In 1989, the internal market came in, dividing the NHS up into ‘purchasers’ and ‘providers’ – a familiar prelude to privatisation in all public services.

With the advent of the Blair Labour government in 1997, it was time to hang the PFI millstone round the neck of the NHS, as privateers knocked down hospitals, rebuilt them as privately-owned facilities, then leased them back to the NHS on extortionate long-term contracts. This disastrous scheme, entirely Labour’s brainchild, drained resources from the NHS at the expense of patient care.

In 2003, Foundation Trusts were brought into being. “This scheme gave semi-independent status to ‘deserving’ hospitals. Basically, a Foundation Trust is free to provide services as its directors see fit, as well as being free to borrow money on the private financial market, to enter into joint ventures with private companies, set its own terms of service for staff and, like all good private ventures, to go ‘bust’ and to be taken over by a private enterprise.” (Lalkar, op cit)

Again, it was Labour that pioneered this wheeze, entirely in line with Thatcher’s 1987 wish-list. The main cause of the Mid Staffs hospital disaster, resulting in hundreds of fatalities, was the devil-take-the-hindmost scramble to meet the targets that would secure Foundation status.

In 2004, a new GP contract was introduced allowing corporate provision of GP services and turning the local doctor’s practice into just another company whose main business is the realisation of maximum profit.

2007 saw a set of private-sector providers identified to support the commissioning of services by the Primary Care Trusts.

Labour handed over the axe to the ConDems in 2010, but not before spelling out in its election manifesto exactly what it planned to do if returned to office, promising to “continue to press ahead with bold NHS reforms”, “turn all hospitals into Foundation Trusts” and free them up “to increase their private services”!

As it was, it fell to the ConDems to push through the infamous Health and Social Care Act, coming into effect in April 2013. Under this act, the state relinquishes its former duty to provide a comprehensive health service. It replaces Primary Care Trusts with clinical commissioning groups (CCGs), which will choose which medical services to buy and from whom. Under this arrangement, the majority of treatments will be put out to tender, pushing NHS ‘providers’ into competition with wage-cutting and corner-cutting private cowboys.

Thatcher would chortle to see how her 1987 privatisation wish-list has been carried out almost to the letter, with maximum assistance from Labour and with minimum practical resistance from the Labour-controlled TUC.

So what is to be done?

So given that this is the state of our NHS, what do we do? It doesn’t matter who we vote for in a general election does it? They have all done their bit in setting up the NHS for milking by the multi-nationals who want to get into this very lucrative business, haven’t they? So what do we need then – some kind of revolution?

Well yes, that is exactly what is needed, all rhetoric aside. The above-quoted Lalkar article concludes with this thought:

Why, when talking about saving the National Health Service as a wholly publicly-owned and free-at-the-point-of-use institution, do we arrive at revolution as the answer?

Quite simply, the NHS does not exist in a bubble: it is part and parcel of our society, where working-class people are coming under growing oppression.

The ruling class manages all too often to divide us along lines of colour, of employment, of sex, age and a host of other things, but people are starting to see beyond that and understand that if we want an NHS that is always accessible, publicly-owned and free; if we want all our children to get a decent education; if we want decent homes and jobs for everyone and a quality retirement at the end of a working life, then we are going to have to change from a system that says ‘Protect the profits of the rich before all else’!

That doesn’t come easily or without struggle, but it can be done.

This starts with the working class uniting to physically protect our NHS from demolition, kicking out the profiteers by any means necessary. Communities need to join with hard-pressed NHS staff to put effective pressure behind our demand for an end to PFI and the contracting out of services.

But these necessary defensive measures cannot succeed so long as we continue to be bamboozled into defending the NHS as the ‘iconic achievement of Labour’. It was illusions on this score that gave Blair licence to press on with PFI in the first place. No, in order to unify and mobilise the working class, our measures of practical defence must be complemented by an offensive strategy.

Defending our local hospital services is an important start, but it’s not enough. Victories on this score, whilst vitally important in developing the organisational strength of the working class, won’t of themselves change the fact that capitalism is spiralling ever further into crisis at home and conflict abroad.

If we want to give our children a future with top-quality health care; a future free from debt, homelessness, poverty, unemployment, hunger and war, we need to get rid of the parasites who are bleeding us all dry and take not just a hospital or two, but the whole British economy and society into our own hands.

Socialist planning is the only alternative to capitalist anarchy – and the only way to ensure a decent future for all working people. It is time we forged a movement, organisation and leadership that is bold enough to put the concrete demands of workers back on the agenda.