Opposing the ‘liberation’ of the NHS

Lesley Mercer of the Chartered Society of Physiotherapy told the TUC Congress in September that “the future of the NHS is less clear than at any time since 1948” (our emphasis). Moving a composite motion which was seconded by Unison and adopted unanimously by Congress, Lesley said that it was important to maintain a “service which is publicly provided, publicly funded and publicly accountable … the [government] proposals represent the biggest gamble with the nation’s health and the taxpayers’ money that we have seen”.

Whilst Proletarian is happy to see the beginnings of what it hopes will become a determined counter-offensive against the government’s proposals to privatise the NHS, we would put the case somewhat differently. The government White Paper Liberating the NHS makes the future of the NHS plainly clear; this government, like the last, seeks to carve up the NHS with a butchering knife and then take the pieces to market, where they can be haggled and paraded before the profiteers, swindlers, fat cats and speculators.

The White Paper is quite clearly a programme to fragment and privatise the health service. To make the swill more enticing to the city pigs, the ConDems propose £20bn of spending cuts by 2014; that’s the government’s garnish to make the cheque books come out. The latest edition of campaigning newspaper Health Emergency carried the following observations in its lead article:

“The cost of implementing the White Paper (upwards of £1.7bn) seems like a classic waste of money much better spent on patient care. But from the point of view of Andrew Lansley and his Tory colleagues, if it resulted in denationalising the NHS, reversing the great legacy of Nye Bevan, and [u]opening up a new £100bn market to private companies, it would be seen as money well spent[/u].” (‘Say NO to the ConDem rationing boards’, Autumn 2010, our emphasis)

The final comment from the authors of Health Emergency is what lies at the heart of this matter. Tories are no more opposed to the ‘legacy of Nye Bevan’ than Tony Blair, Gordon Brown, the brothers Miliband or even good-old ‘comrade’ Abbott and the rest of their Labour cronies. What the ruling class (and whichever of their parliamentary stooges are currently representing them in government) is interested in, is an avenue of profitable investment; a chance to make cash.

It certainly isn’t the case that they want to get rid of the NHS out of some urge for revenge upon poor old long-deceased Nye Bevan. And it most definitely isn’t the case that this wouldn’t have happened under Nye’s inheritors in the Labour party!

Just two years ago, Proletarian covered an eerily similar set of proposals contained in the 2008 Darzi Report, which was all about coded privatisation. As we observed at the time:

“The focus of Darzi’s vision for the NHS is ostensibly the quality of care over the quantity. In real terms, this means a steady erosion of the treatments that can be expected to be provided free of charge at the point of delivery.

“Already, certain drugs are deemed too expensive for the NHS, no matter how much the patient may need them. This is just the tip of the treatment iceberg.

“Unsurprisingly, the report is essentially a gateway for privatisation. Further use of ‘market forces’ will serve as evidence for the ‘need’ for greater private investment and the withering away of free health care as a right …

“Lord Darzi believes that the time has come to address the issue of ‘quality’ in health care because the Labour government has now ‘done the investment’. Darzi tells us that there are now enough doctors and nurses, that waiting lists are being removed, and that it is now time to focus on the quality of their work.

“The investment has indeed been huge. Unfortunately, the money spent has done almost nothing to remedy years of underinvestment, but has instead flowed directly into the pockets of the drug companies and the multitude of private profiteers who are making fortunes by providing extortionately-priced (and often poor-quality) ‘services’ to the NHS, whether they be cleaning wards, sterilising surgical instruments or building new hospitals …

“The reality of Labour’s investment in the NHS is the pouring of millions of pounds into capitalist pockets, especially through the notorious PFIs (see Proletarian 23), certainly not an investment in the quality or quantity of the health care provided to the end user.” (‘Labour sharpens the privatisation knife’, August 2008)

Liberating the NHS is nothing more than a continuation of the policy of the previous administration. It’s about liberating capital. Liberating the currently restricted potential for private finance to pick and choose which members of our society will receive the care they need, based on their ability to pay. The government (of whichever hue) can dress it up as ‘liberation’, ‘choice’ and ‘freedom’, or make it an issue about the ‘quality of care’, but in the final analysis it’s all about the profit motive.

Health Emergency provided a succinct few paragraphs detailing some of the proposed changes in the White paper: “It aims to abolish the existing commissioning organisations – 152 Primary Care Trusts and 10 Strategic Health Authorities – and hand the main responsibility for commissioning services with a combined budget of £80bn to GPs. GPs will be required by their contract to be members of around 500 local ‘consortiums’, which will be statutory bodies to carry out the responsibilities of commissioning. They will receive a management allowance to allow them to buy in support, which may be from former NHS employees or from the private sector.”

So all those salaried unionised workers currently fulfilling this vital work will be given the heave-ho and transferred to new companies appointed by GPs and their ‘consortiums’. The pensions, rates of pay, terms and conditions will be gone, and in their place will come a pack of extremely aggressive capitalists, ready to mop up the cash.

The paper continued: “A new NHS Commissioning Board will be established to commission primary care services, specialist care and maternity services. It will oversee the GP consortiums, and have powers to assign GPs to a consortium if they have not already joined one [some ‘freedom’! – Ed]. It will have regional offices, and will employ NHS managers – but it is not known how many. The 90 plus NHS Trusts which are not yet Foundation Trusts will have to achieve Foundation status, or become part of a larger Foundation Trust by 2013, when the legal status of NHS Trust will be abolished. The ‘cap’ that limits the proportion of Foundation Trust income that can be derived from private medicine or contracts with the private sector will be removed.”

Therefore it seems quite clear that those medicines that the patient may need will make way for those that make most economic ‘sense’, ‘consortiums’ like the fat cats who’ll run them will be engrossed by margins and revenues instead of patient need and ‘quality of care’. Furthermore, “Foundation Trusts … will be encouraged to negotiate local variations on national pay and terms and conditions.”

GP consortia and the NHS Commissioning Board will buy in health care from “any willing provider” – Foundation Trusts, social enterprises or the for-profit private sector. Competition law will apply. Patients must be given free choice of GP (not restricted to where they live), choice of any provider, choice of named consultant team, and choices in maternity care, mental health, diagnostic testing, long-term conditions and end-of-life care, which all sounds perfectly lovely until one considers the effect that ‘parental choice’ has had on our schools! In the doublespeak of the capitalist class, ‘choice’ is a veiled term for rationing – a way to gradually focus the ever-diminishing public resources on those practices and services frequented by the middle classes, while the ‘choice’ by default of the majority of working-class people will be the crumbling, overstretched and under-resourced leftovers.

Performance targets including waiting times are to be scrapped. The public health and health promotion functions of Primary Care Trusts are to be taken over by local government through new ‘health and wellbeing boards’, which will also take over the role of councils’ oversight and scrutiny of local health services. The patient voice is also to be changed again: Local Involvement Networks (LINks) are to be replaced by new Healthwatch groups funded by local government, which will take on additional roles to make them “more like a ‘citizen’s advice bureau’ for health and social care”. (DH)

The White Paper is out to consultation until October. Most of its proposals are for swift implementation, and all of the proposals are to be carried through before 2014.

If we truly want to find a way of fighting back then we have to challenge the link that ties our movement to the whims of the Labour party, the very people who did everything they could to bring us to this calamitous moment. The results of this attack will be tremendous, not only for the terms and conditions of a million plus workers, but for the future health of our nation.

These are not ‘efficiency savings’ and the situation we face is not ambiguous. This is all about a sacrifice at the altar of finance capital, and the British proletariat, bound by Labour and Tory anti-union legislation, is the sacrificial lamb. These cuts are just the beginning; they’re just the first fumbling efforts of our ruling class to make ordinary people pay for the crisis of capitalism.

Proletarian urges all its readers and supporters to get behind the various local campaigns and resistance movements, take a Marxist analysis to these movements, build a vanguard revolutionary party and turn our attentions to an all out attack on those who would impoverish the workers.

‘Fair’ cuts? NO cuts! Take the fight to capitalism!

Break the link with Labour!