The National Health Service at 75: Defending free healthcare demands a struggle for socialism

On July 5, 1948, the National Health Service (NHS) was founded in Britain. Established by Clement Atlee’s post-war Labour government, the NHS promised a “comprehensive health service for England and Wales”.

The NHS was the jewel in the crown of a post-war welfare state model including social housing, comprehensive education and a range of social security benefits and has been cherished by millions of workers ever since. But seventy-five years later, the NHS has been brought to the brink of collapse by systematic under-funding and the principle of care “free at the point of use” is in severe peril.

A survey by the Health Foundation Sunday found that 71 percent of people believe charges for NHS care will be implemented over the next decade. And the sentiment is echoed among healthcare professionals.

On Tuesday, Professor Philip Banfield, the British Medical Association’s chair of council, said “a very common comment that I hear, from both doctors and patients, [is] that this government is consciously running the NHS down. [And] if you run it down far enough, it’s going to lead to destruction… I would be very surprised if the NHS in its current form survives the next five or 10 years, at the rate that it’s declining.”

The ruling class did not agree to free health care and other vital social reforms as a gift. It saw them as necessary concessions in order to stave off social revolution by a working class radicalised by the horrors of war and demanding “a land fit for heroes” amid mass movements by workers in Europe, China and internationally. The reforms were paid for through increased taxation, without fundamentally challenging the profit system.

Forced into these measures, the ruling class was never reconciled to the continued existence of the NHS and its ethos of free universal healthcare. Following the major defeats inflicted on the working class in the 1980s, it has been under a continual, ferocious assault by Tory and Labour governments alike. Underfunded by hundreds of billions of pounds, the NHS was brought to its knees during the pandemic and has been left incapable of providing adequate treatment for millions in need.

The waiting list for NHS care is now at 7.4 million people, with some waiting as long as seven years. This week, the King’s Fund published research showing that the NHS produces “below average” health outcomes because it spends a “below average” amount for every person on healthcare, including higher levels of deaths from treatable diseases than most similar countries, and below-average survival rates for many cancers. Thousands are dying as a direct result of government healthcare cuts in an act of social mass murder.

If it were not for the dedication of its 1.4 million-strong workforce, the NHS would have collapsed long ago with terrible consequences for a poverty-stricken population.

The Thatcherite fanatics running Rishi Sunak’s government hate the very idea of the NHS. None of these assorted multi-millionaires (Sunak and his wife are worth £730 million) ever use it or would ever want to, having access to the best private medicine money can buy. They are among the 12 percent of the population, the ruling and affluent middle class, covered by private medical insurance.

This week Sunak announced his NHS Long Term Plan, declaring it “will secure the future of our NHS for years to come.” A sick joke. The government says it aims to hire an additional 230,000 doctors by 2037—more than two parliamentary terms away—by which time the NHS will need another 360,000 posts filled. It has a current staffing shortage of 150,000.

Prime Minister Rishi Sunak holds a press conference and unveils the NHS Long-Term Workforce Plan in 10 Downing Street, June 30, 2023 [Photo by Simon Walker/No 10 Downing Street / CC BY-NC-ND 2.0]

Moreover, Sunak is allocating just £480 million a year over the next five years, set against an annual overall NHS budget of £150 billion. Whatever pittance is ultimately handed to the NHS will only be robbed from other vitally needed public services, with Sunak stating, “By prioritizing the NHS there will be other things we can’t afford.”

Existing NHS workers will be forced to ramp up productivity and there will be no taking “an easy route” by agreeing above-inflation pay with health workers, said the prime minister.

The Tories operate as one half of the Thatcherite consensus they maintain jointly with the Labour Party, which together with the trade unions bears its own heavy share of responsibility for the NHS’s death by a thousand cuts.

It was Tony Blair’s New Labour government, proudly pointed to by Thatcher as her greatest achievement, which opened wide the doors to privatisation with the internal market and ruinous Private Finance Initiatives. To this day, PFI schemes are costing the NHS over £2 billion a year in payments to private companies, with roughly £50 billion left to pay by 2050.

Gordon Brown’s 2007-2010 Labour government demanded £20 billion in NHS efficiency savings. Hundreds of thousands of health workers fought back after the Tories began implementing the “age of austerity” planned by Labour following the financial crash, but strikes were derailed by the trade unions in 2011-12, with David Cameron’s government able to pass its brutal Health and Social Care Bill.

This tripartite alliance between the Conservatives, Labour and the trade unions continued in the years that followed, to devastating effect: the run-down of the NHS estate, outdating of medical equipment, burnout and resignation of staff and their worsening impoverishment—matched by declining patient health.

The betrayals of the health unions culminated this year with the betrayal of a mass strike movement of NHS staff demanding above-inflation wage increases and more funding for the NHS. Union leaderships have sabotaged strikes by hundreds of thousands of nurses, ambulance crews and other front-line staff, allowing the Tories to impose another rock bottom pay deal.

NHS nurses on the picket line in Bournemouth during the national nurses strike

After last week’s sell-out by the Royal College of Nursing, the only NHS staff remaining in dispute are junior and senior doctors, who are striking separately later this month. These are also at risk, as the British Medical Association pleads with the health secretary to offer a few crumbs as a justification to end the struggle entirely.

The Labour Party is now overtly hostile to the NHS it founded. Leader Sir Keir Starmer decries strikes by health workers, as every other section of the working class, banning any shadow cabinet minister from attending picket lines. Shadow Health Secretary Wes Streeting denounces health workers in the pro-Tory Telegraph and Times for being “obstacles” to the “unsentimental reform” of the NHS required.

In an interview with the pro-Tory Sunday Telegraph, Streeting said, “We are not going to have a something-for-nothing culture in the NHS with Labour… I’m not prepared to pour money into a black hole.” [Photo: screenshot of Sunday Telegraph print edition, December 11, 2022]

This week, Streeting repeated his mantra that the NHS is “not a shrine”, after telling his admirers in the Telegraph in January, “We are not going to have a something-for-nothing culture in the NHS with Labour… I’m not prepared to pour money into a black hole.”

With a general election to be held no later than January 2025, Labour has not pledged a single penny in extra NHS funding while openly discussing further privatisation. In Starmer’s New Year’s message he declared that a Labour government would not be “getting its big government chequebook out.”

The assault on the NHS is part of the decades-long global assault on all social programmes by governments internationally, that was rapidly accelerated by the COVID-19 pandemic. The 226,000 lives lost in the UK due to the criminal actions of government included over 1,500 front-line NHS workers, with tens of thousands made seriously ill and many still suffering from the debilitating impact of Long COVID. The refusal to protect healthcare workers with high-quality FFP3/N95 masks and other protections against an airborne virus led to vast suffering and death concentrated in this section of the working class. According to the World Health Organization (WHO), an estimated 115,000 healthcare workers internationally died from COVID-19 January 2020 to May 2021.

Clinical staff care for a patient with coronavirus in the intensive care unit at the Royal Papworth Hospital in Cambridge, England, May 5, 2020 [AP Photo/Neil Hall Pool via AP]

Besides savaging the NHS workforce, the pandemic served as a test bed for the ruling class’s plans for a sharp reduction in the health and life expectancy of the entire working class.

The final destruction of the NHS by the Tories and Labour is the death knell for the last remnants of the social reformist project. With the development of globalised production over the last four decades, setting the benchmark for pay and conditions at the level of the most heavily exploited sections of the international working class, class antagonisms have been drastically intensified, undermining any basis for reforms.

With NATO’s de facto war against Russia war in Ukraine, this process is to be accelerated rapidly. Ruling classes all over the world are declaring the end of the post-WWII “peace dividend”. The imperialist powers are planning war on a massive scale, with major powers Russia and China. This requires the looting of workers’ wages and a wholesale transfer of resources out of social spending and into arms factories and the military.

Health budgets have already been marked for sacrifice. Analysing Tory plans to spend £150 billion more on the military in the next eight years, the Royal United Services Institute (RUSI) think-tank complained last year that “Since the mid-1950s, the UK has been able to fund the growing share of its national income devoted to the NHS and state pensions through cuts in the GDP share spent on defence.” Institute for Fiscal Studies Senior Research Economist Ben Zaranko writing in The Conversation last year commented, “Defence cuts effectively paid for UK welfare state for 60 years—but that looks impossible after Ukraine”.

None of this can be accomplished without massive social struggles, which is why the state is being tooled up with new repressive laws targeting industrial action and democratic rights. Making use of the trade unions’ demobilisation of workers’ struggles, the Tories are legislating anti-strike laws that effectively ban industrial action in “essential services”, including the NHS. They anticipate the eruption of mass struggles like those in France.

Today the defence of the most elementary social rights, including access to healthcare, housing and education, is bound up with an international offensive of the working class against capitalism. This requires a socialist programme enabling workers to act independently of the trade union bureaucracies which restrain them and against a hostile Labour Party.

NHS FightBack, established by the Socialist Equality Party and affiliated to the International Workers Alliance of Rank-and-File Committees, seeks to organise workers throughout the healthcare sector for this urgent struggle. Get involved today.