The fight to defend Britain’s National Health Service

28 January 2013

Britain’s National Health Service (NHS) is suffering death by a thousand cuts and faces wholesale privatisation.

The Conservative-Liberal Democrat coalition has demanded a £20 billion cut by 2015 from an overall budget of £108 billion—a reduction that is impossible without slashing essential life-saving services.

So far, only £6 billion in cuts have been made—mostly one-off savings. Much worse is to follow. But staff levels are already being cut by as much as 20 percent and new labour contracts are being imposed with lower wages and higher workloads.

Accident and Emergency departments (over 30 nationally), children’s units and other wards and facilities are closing—justified by claims that services and medical procedures can be better provided in specialised units. There are no guarantees that such specialised units will not be swamped by demand, or that lives will not be lost due to the distances involved. Yet the medical director of the NHS, Sir Bruce Keogh, dismisses broad opposition to these changes as pressure to “inhibit excellence” and “perpetuate mediocrity.”

The Health and Social Care Act allows private companies to provide health care under the auspices of the NHS and comes in to effect in April 2013. However, this will only escalate a process already underway. The NHS is being bled dry by innumerable private corporations that are fleecing the taxpayer while care is either rationed or denied outright to the chronically ill and the most vulnerable members of society.

On November 13, 2011, Circle Health became the first private corporation to run an NHS hospital. In October 2012, a Freedom of Information request found that in one week alone contracts were signed taking more than 400 community services out of the NHS, including ambulance services, diagnostic testing, podiatry and adult hearing.

Doctors warned that the NHS was being “atomised”, with over 100 health care firms now providing basic care under Any Qualified Provider rules. Some private companies already earn up to £200 million a year each from NHS-funded work.

Sixty NHS Trusts face being declared bankrupt in the next four years, threatening hospitals with “rationalisation” or closure. To fend off this threat, trusts must cut budgets and ration or deny treatments declared to be “of limited clinical value”. Nearly one in five hip replacements and hernia repairs are already handled by private companies. Soon they will have to be paid for.

Cold hard cash is a major factor in the drive to first gut and then privatise the NHS. It will open up massive revenue streams for private medicine, which previously made up just 8 percent of the health sector and was for decades almost entirely parasitic—a form of glorified queue-jumping for the better-off, using NHS taxpayer-funded facilities and doctors trained at public expense.

The NHS is hated by the ruling class as a symbol of everything they were forced to grant the working class in Britain in the post-war period—the “cradle to grave” welfare reforms—in order to placate demands for social change.

It is even now an object of hatred for the political and business elite in the United States, where bitter denunciations of “socialised medicine” conceal the fact that the NHS is still, thanks to being free at the point of delivery and based on clinical need and not the ability to pay, one of the best in the world for the standard of care provided, while America is one of the worst. This is despite spending nearly £5,000 per capita in the US, compared with just over £2,000 in the UK.

These figures provide some indication of the quality of health care that could be provided under a truly socialist health system, integrated into a socialist economy in which the corporations and banks were publicly owned and democratically controlled.

Working people depend on the NHS for their lives and health and want to fight for it. But, as with all fundamental tasks workers face—the defence of jobs, wages, essential services and benefits—this desire is thwarted at every turn by the trade unions and parties once associated with such struggles.

The Labour Party presided over the creation of the NHS in 1948, but spent 13 years in office from 1997 on undermining it. Privatisation by stealth first began in 1989 with the introduction of the “internal market” by Margaret Thatcher. However, it was the last Labour government that encouraged outsourcing of medical services and used the Private Finance Initiative to build hospitals that cost multiple times their initial outlay, saddling these institutions with massive debts for facilities that often had up to 28 percent fewer beds. Labour is now seeking to pose once again as the friend of the NHS, but this is a worthless fraud.

As for the trade unions, none of them has lifted a finger in defence of jobs and services—confining workers to signing petitions, writing letters to MPs, and participating in campaigns to keep open this or that hospital or unit so that the axe falls somewhere else.

How could it be otherwise? The universal experience of workers the world over is that social democratic parties have become indistinguishable from their conservative counterparts, while the trade unions stifle and betray any and all expressions of resistance to government austerity measures, corporate downsizing and speed-up.

In Greece, the social democratic PASOK and the Democratic Left sit in government with the conservative New Democracy, presiding over austerity measures that include the near-total collapse of public health care.

The Socialist Equality Party in the UK has initiated the NHS FightBack Campaign, based upon the independent political mobilisation of the working class. The SEP campaign insists:

“The defence of health care and every other basic social right can be taken forward only through a break from the unions and the Labour Party. Action committees must be formed by patients, hospital staff and the workers and youth whose lives and health are being jeopardised. The problem is not a lack of funds or resources, but the monopoly of wealth by the super-rich. This monopoly can be broken only by a mass movement of the working class to bring down the coalition government and replace it by a workers’ government based on socialist policies.

“Such a government would carry through a radical redistribution of wealth in favour of working people, which would include ending the obscenity of medicine-for-profit and restoring the health service as a free, high quality state-run facility for all.”

This is the basic perspective upon which every fight by the working class in every country must now proceed.

Chris Marsden