For as long as our party’s political publications have existed, our writers have been logging and commenting on the attacks on, and, the undermining of, Britain’s health service, under both Labour and Tory administrations.
We have regularly exhorted defence of the service where possible, as well as pointing out the necessity of a socialist system if we want to ensure the real and permanent growth of the British NHS into the health service that both staff and patients deserve – one which can become a leading saver and enricher of the lives of all.
Even those who don’t use it benefit from a functioning NHS
That the NHS has a tremendous importance to the working class cannot be overstated. But it is also true that the whole of British society, even our class enemies, has a dependency on the service that many of the better-off don’t always understand or appreciate.
Writing in the Financial Times recently, NHS Confederation chief executive Matthew Taylor enlarged on a report his organisation had produced after investigating the impact of healthcare investment – not only on health outcomes directly but also on labour productivity and broader economic activity.
The results, he said, should be taken as seriously by the Treasury and Downing Street as by the health and social care department. In presenting the report, he pointed out:
“The NHS is the fifth-biggest employer globally and by far the biggest in the UK. In most towns and cities, it is the single biggest employer and makes a vital contribution to the local economy through job creation, purchasing of local services and keeping people healthy for work.”
He continued: “The economic activity of a local area, and how productive it is, is heavily influenced by its inhabitants’ health. Unmet health and care needs are among the key reasons for people of working age being out of the labour market. Relatively small reductions in the number of those off for long-term sickness could have a huge impact on labour productivity and economic activity.”
And he then highlighted this with the following common-sense example: “A one percent decrease in the proportion of workers off due to long-term sickness is associated with an additional 180,000 workers joining the workforce. This would be a significant boost to the economy at a time of ongoing challenges in labour market participation, widespread labour and skills shortages, and the rising cost of living.” (The NHS can help cure the UK’s economic malaise, 16 October 2022)
Individual v collective capitalist logic
So why, if the NHS is so important for keeping workers fit for exploitation, are there so many private companies trying to muscle into the health business, extracting its resources and fatally undermining its ability to do what it should be doing?
Why do drug manufacturing giants continue to bleed the NHS of so much of its public funding by forcing it to pay outrageously prices for medicines that have usually been developed in the public sector in the first place? Welcome to the contradictions of capitalism, Matthew Taylor!
The NHS is also needed by capitalist society as an employer, since every NHS worker has a wage with which to purchase the fruits of capitalist production. But! Capitalist business logic demands that the service be run in the same way as any other capitalist enterprise, and so it slashes wages, cuts jobs, sheds hospitals and beds, and puts even greater workloads and stress on the workers who remain.
Result? An extremely poor service for patients, with staff struggling to do their jobs and struggling to help the economy through purchasing power.
This clearly does not make sense for society as a whole. But it is perfectly logical if you are an individual capitalist, making the most of every opportunity to extract profit from the NHS. In fact, you would not be fit to be a capitalist if you didn’t take that chance to enrich yourself at others’ expense!
The NHS is not the only place where we find these crazy contradictions. They are everywhere around us.
For example: capitalism needs the best possible transport systems to get its products to the markets and its workers to their places of work, yet rail services are butchered and split into different companies, while more and more haulage is driven onto clogged roads that are overwhelmed as soon as they are opened. But! There are profits to be made in breaking up the railways, in road haulage, etc.
Similarly, bus services that workers relied on to get to work, school, shops etc, have been privatised – and now they only run on routes that guarantee maximum profits, the costlier (but no less necessary to those who use them) routes having been cut as ‘inefficient’.
Basically, we live in a political system where the greed of the owners of capital is the basis of all activity. Profits always come before people, and maximum profits at that – even if that individual business logic interferes with the successful and common-sense organisation of other sectors of capitalist industry!
Why is the NHS today so desperately understaffed?
At this moment in time, the NHS has a huge number of staff vacancies. The total is not known, but estimates range from 60,000 to over 130,000. We are not in a position to judge which of these figures is more accurate, but suffice it to say that the NHS is desperately short of staff of all types.
What is clear from talking to workers who are clinging on within the service is that the NHS today provides such an unwelcoming and harsh environment in terms of hours, workloads, financial rewards etc, that many people would not even try to apply for work in it.
For those that do, many cannot stick the particularly demoralising combination of low pay, long hours, high stress, miserable conditions and a total inability to deliver what patients palpably need.
So they leave again, joining the stream of workers who are dropping out exhausted after long years of dedicated service, and becoming part of the massive personnel churn which ensures that, no matter how many are recruited one day, the next there continues to be a huge demand for staff across the NHS, and all our vital services continue to be seriously undermanned.
Failing service is failing the patients
With all this going on for the staff, what is happening to the patients?
If you needed to phone for an ambulance in August, the average category one (life-threatening illnesses or injuries) response time was 9min 8s, as compared with the current (low) target time of 7min. The response time for category two calls (burns, epilepsy, strokes) was 42min 44s, despite a target of 18min. The response time for category three calls (late stages of labour, non-severe burns, diabetes) was 2h 16min 23s, as compared to a target of less than 2h.
Since August, these statistics have become far worse.
“Severe NHS ambulance delays are contributing to the avoidable death of 230 heart patients a week, analysis shows.
“The British Heart Foundation (BHF) said there had been 30,000 ‘excess’ deaths involving heart disease in England since the beginning of the pandemic. This is linked to a collapse in ambulance response times and gridlock in A&E units, meaning patients are not getting help until it is too late.
“The latest NHS data shows that heart attack and stroke patients are having to wait 48 minutes on average after calling 999, well above the 18-minute target.” (NHS ambulance chaos blamed for 230 heart patient deaths a week by Eleanor Hayward and Rhys Blakely, The Times, 3 November 2022)
There are more than six million of us at the moment on various healthcare waiting lists; ten percent of the population!
Nearly 380,000 people have been waiting for more than a year, while 2,800 have been stuck in the growing waiting list backlog for at least two years.
If you are unlucky enough to need to go to A&E, you could find yourself among the 30 percent of attendees who wait longer than four hours to be treated, or even among the 1,000 patients every day who wait longer than 12 hours in an A&E department.
More than 250,000 people had been checked for cancer after an urgent GP referral in August this year. This is the highest number since records began, and yet only 75.6 percent of patients in England saw a specialist within two weeks, as against a 93 percent target – the second-worst performance on record.
The NHS has now warned ministers that it may have to make cutbacks to already overloaded cancer care, GP and mental health provision in order to cover a £20bn hole in its budget. We have to wonder what, if anything, new health minister Steve Barclay (the fifth in five months, although he was the third as well), will or can do.
The contradictions outlined above mean that even if Barclay wants to do something to curb the flow of public money out of NHS coffers into private pockets, or to make jobs within the NHS more appealing, he will be pushing against a brick wall of vested interests from some monopoly capitalist high roller at every turn.
And any health minister from a future Labour government will be in exactly the same boat.
Contradictions insoluble while capitalism remains – and it’s the workers who suffer
Many working-class parents in our society are unable to work because they have young children, and the high price of private childcare (where childcare still exists) puts it beyond the reach of those in low-paid work (including many who work or would like to work in childcare).
Meanwhile, many middle-aged to older workers with ailments that could be treated are leaving the workforce because they cannot get the treatment they need and cannot work without it.
A society run along such lines is constantly jarring and smashing its parts into one other. And, for the most part, it is real, living, breathing workers who are battered and bloodied in these daily collisions; this practical ‘realisation’ of capitalism’s inherent contradictions.
Humanity has, after thousands of years, developed forces of production that can produce enough for everyone, so that none should go without. But because those forces are still held in the private hands of a small elite, which uses them to chase maximum profit, we have to watch so much of what we produce go to waste or be destroyed – not because we don’t want or need it, but because we cannot afford to pay for it!
So long as this system survives, there can be no sanity in the provision of healthcare – or of any other service, or in the production of anything at all. ‘Common sense’ and ‘rational’ are not words that can be properly applied to any major activity within a capitalist society.
We have, as a society, everything we need to live peaceful, happy and full lives. It requires us only to reach out and take it from that tiny group of beings who tell us it’s all theirs to do with as they see fit.