Hospital workers in Bradford, England, facing the backdoor privatisation of their jobs have voted to take indefinite strike action from August 26.
This is the latest in a series of disputes that have hit the National Health Service (NHS) in the last four months—in Merseyside, Cornwall, Blackpool, South London, Birmingham and Doncaster, involving workers in pharmacy, catering, cleaning, domestic services, porters, building services and security.
Many are seeking to avoid being hived off into wholly owned subsidiaries (WOSs), commercial operations owned and controlled by their parent NHS trust.
According to NHS Providers, such an operation enables “trusts to create pay scales that are more flexible and…reflect market conditions.” Trusts have been actively setting up WOSs since 2010, but there has been an increase “in recent months” because the “new strategic direction in the NHS requiring trusts to support new models of service delivery, pursue system collaboration and integration, and deliver operational productivity improvements.” This is code for implementing cuts, speed-ups and other “efficiency measures” at the expense of the workforce.
Part of the “strategic direction” is the Conservative government-imposed diktat to enforce year-on-year “savings” of 4 percent, as well as improving productivity. The Kings Fund health charity notes that the expected 1.1 percent productivity increases over each of the next five years do not include the 4 percent savings targets being imposed on hospitals and other front-line services.
Gains already achieved have been almost entirely at the cost of staff wages, which were frozen for seven years between 2010 and 2017. The “pay cap” cost the average health worker a wage cut of £2,000 in real terms. Even when it was lifted, increases have barely matched inflation. The government and employers are now looking more intently at other areas to achieve their “savings” targets. According to Keep Our NHS Public, at least 30 NHS trusts have set up a WOS in recent months.
NHS trusts were introduced by the 1997 Labour government under Tony Blair, as part of moves to “marketise” health care. This provided the basis for Tory administrations to break up the NHS into smaller and smaller units, each having a “market relationship” with the others.
The Regional Health Authorities and the succeeding Regional Offices were abolished, while the 2012 Health and Social Care Act further atomised the health system in England, introducing Clinical Commissioning Groups (CCGs) of GP surgeries as the fundamental financial unit of the NHS. The NHS now comprises more than 150 nominally “independent” NHS Trusts, responsible for running hospitals and other critical services, and 191 CCGs providing local GP services.
The salami slicing of the NHS and the introduction of an internal market, where CCGs bid for contracts, mean almost half of all NHS trusts were in deficit in 2018/2019, with over two-thirds of acute hospital trusts in the red.
Justifying the introduction of a WOS covering estates, facilities and clinical engineering services, Bradford Teaching Hospitals NHS Foundation Trust points to the 4 percent “efficiency savings” it must make—a cut of £16 million a year. The Trust promises to “protect” the employment terms and conditions for existing staff, who will have “access” to the NHS pension scheme for a period of 25 years. But trade union solicitors say the new company would be able to legally change workers’ terms and conditions after just 12 months. Staff turnover means it would not take long for the existing workforce in the WOS to be replaced with one on considerably worse pay and conditions.
As a separate business entity, the WOS will be able to bid for other contracts, leading to mergers and job and pay cuts. They are prime candidates for takeover by major transnational companies such as Interserve, the Compass Group and Sodexo.
When UNISON head of health Sara Gorton told Bradford strikers, “your jobs are important. Your union is behind you,” her words should be measured against the record of betrayal and inaction by the trade unions.
The trade unions have done nothing over the last decades to oppose the assault on pay, conditions and jobs. More than 1 million jobs have been destroyed in the public sector since 2009—where union density is at over 50 percent compared with 13.5 percent in the private sector.
In 2017, 13 of the 14 health unions—including the Royal College of Nursing (RCN)—agreed to a sell-out contract that failed to compensate workers for the loss of pay suffered during the “pay cap” and did not even cover inflation. Protests by RCN members led to the resignation of General Secretary Janet Davies and a vote of no confidence in the RCN leadership.
The previous year saw the British Medical Association sell out a strike by 50,000 junior doctors. For more than a year, the doctors had fought to oppose a new contract that considerably worsened their conditions, striking on five occasions and taking the first all-out strike, without emergency cover, in the nearly 70-year history of the NHS.
Even now, UNISON proposes to combat WOSs by “raising the issue with political parties and MPs to get them involved in local campaigns” to “attract media coverage,” and “maybe even force a parliamentary debate.”
When workers have pushed for action locally, like Bradford, UNISON has offered minimum support to ensure it retains control of the dispute protecting its role as the negotiating partners of management. UNISON boasts of providing £30,000 towards the local strike fund—a pittance when compared to a dues income of more than £174 million, with the bureaucracy taking in £70 million in wages and expenses.
On the picket line in Bradford, UNISON representatives have sought to prevent strikers from reading the critical analysis of the role of the trade unions made by the Socialist Equality Party (SEP) and the World Socialist Web Site. One representative lyingly accused the SEP of being “scabs…on the management payroll.” The record shows who are the real scabs and strike breakers raking in their fat salaries.
In 2013, the SEP launched NHS FightBack to oppose privatisation and the unprecedented attacks on pay and conditions of health workers. NHS FightBack warned that no faith should be placed in the trade unions. A statement issued by NHS FightBack and circulated at the mass demonstration to defend the NHS on March 4, 2017, warned that Labour leader Jeremy Corbyn, who had been given pride of place at the protest, “has done nothing to oppose the Blairites, or the Tory government with which they are in a de facto alliance—without which there can be no defence of the NHS.”
This warning has been confirmed. The unions are telling health workers to pin all their hopes on the election of a Corbyn-led Labour government, a line repeated by the Socialist Workers Party and Socialist Party. But Corbyn’s record is of constant retreats in face of the Blairite right wing. Does anyone believe that someone who will not oppose a few detested MPs who should all have been expelled from the party will stand up against big business when in government, or rather if he ever gets into government?
The defence of health care and every other basic social right can only be taken forward through a break with the unions and the Labour Party.
Health workers in Bradford should understand their fight within the international context, which has seen a growing struggle by workers all over the world. They must act independently and with determination and confidence knowing they have powerful allies.
Action Committees must be formed by patients, hospital staff and the workers and youth whose lives and health are being jeopardised. A key task of such Action Committees would be to link up and coordinate struggles by workers within the same industry, across different sectors and internationally. The monopoly of wealth by the super-rich must be broken by a mass movement of the working class to bring down the Tory government and replace it with a workers’ government based on socialist policies.