Issue 238 of SOCIALIST REVIEW Published February 2000 Copyright © Socialist Review
It makes you sick
Peadar O'Grady is a consultant who works at a community health clinic in St Helens
'People expected that things were going to get better under Labour, but things are getting worse in the NHS generally and there seems no chance of improvement. We experience all the same stresses that are appearing in the health service generally--the lack of nursing staff, lack of qualified therapists and psychiatrists. It seems stupid to say the NHS is underfunded but it is.
You often see managers quoted in the press saying that "the NHS staff are doing a marvellous job given the circumstances". But a lot of health workers are getting increasingly annoyed when they say this--we know we are doing a good job, but we also know that it is not good enough. It encourages people to see that any criticism of the health service is also a criticism of the health workers. This is not true--we are saying to people if you are not happy with the NHS then complain.
In my job I rely on other elements of the public sector such as social services and education. The effects of the cuts on these services are also absolutely devastating. Under Labour there seems to be a coordinated deterioration of health, education and social services. This is part of the Blair project. The reforms that Blair is planning--such as PFI--will destroy the public sector. The underfunding that New Labour has continued to preside over seems directly in line with privatising the NHS. We are seeing health insurance companies such as BUPA and PPP try to take advantage of the problems of the NHS--if you don't want to wait months for surgery then take out private funding.
Labour claims it has got rid of the internal market, but there is still a division between purchasers and providers. Certain aspects of the internal market have gone but in terms of structural changes that happened under the Tories--most importantly the break up of the NHS into trusts--this still exists. If Labour was serious about getting rid of the internal market it would get rid of the structural changes. Labour is still making funding available for certain areas and then everyone has to bid for it. I never heard of bidding for staff before until I came to work in the NHS in Britain. You have to bid for what is available and then fit this in to the staffing needs of the hospital.
People often say that the demands for the NHS are infinite--especially with new technology. Therefore, the argument goes, no government could ever meet all the health needs of its people. But this is absolute nonsense--people don't just walk into a casualty unit when they are fit and healthy simply because it is free. Also, if you look at the wider picture you can actually bring down the level of pain, suffering and illness in society by taking certain measures--better housing, community facilities and so on. The other obvious thing is that the allocation of funding to health is ridiculous--even other capitalist countries such as France and Germany are spending one and a half times more on health. The result is that health standards are falling in this country. For example since 1982 there has been a 40 percent cut in acute beds. In the last ten years there has been an increase in bed occupancy from 75 percent to 95 percent. These are dangerous figures--especially when you have the situation we have this winter.
In terms of mental health, trying to get an inpatient bed is very difficult--there are not enough. Children often end up being looked after in adult mental health settings--completely inappropriately. In terms of the so called "flu epidemic"--in Liverpool the rate of flu is lower than last year, and the flu this year has not hit any more people than it would normally--it is certainly and utterly predictable. Yet it has caused massive bed shortages, cancellations of operations both in Liverpool and elsewhere. People are dying unnecessarily because of the flu.
Health workers have become cynical about New Labour. I do not know anyone who believes that New Labour is in any way serious about bringing up the level of funding to the European level. People simply don't believe that it is going to happen--they actually think that New Labour is lying. I was surprised when I arrived about how run down the NHS was in terms of the buildings, the staff levels and the level of morale in hospitals, and the level of service that was being offered by the NHS. I was brought up and studied medicine in Ireland and everything we read about the NHS argued that it was one of the best in the world--although not the best that we could possibly have. Nothing short of a massive strike through the health service is going to save the NHS--not improve it but actually save it. The NHS is going to be destroyed and healthcare is going to be privatised, although whether it is in line with the American model of private insurance or the German model with a social insurance scheme I don't know. If people don't want to lose the principle of free healthcare then it is going to have to be fought for.
A health service should operate as a system where every measure is taken not only to prevent disease, but also to promote health. The key thing in terms of health would be control--workers' power will give people not just power over production and economic issues, but control over their own lives. When people have an interaction with their environment which they find unfavourable or noxious then they will be able to act on it and make sure that they don't suffer ill health. That is going to be the most important difference about the NHS we have now and where it fits in society. Healthcare will be central in a socialist society, whereas now it's profit that is central. Today healthcare will always be secondary to profit, and it is geared so that workers are just about healthy enough to do the job which is required from them--that is about as much as the bosses are prepared to pay for, and no more. Old people are dying unnecessarily at the moment, not because of the lack of care by health workers but because of the system.
The priority under socialism would be addressing issues of control over healthcare. Health workers should stop feeling shy about their own terms and conditions and they should be confident that they are not acting against the development of the service. If health workers improved their own terms and conditions then this would improve the health service generally.'
Jacqui Pointon is a nurse specialising in child mental health at St Helens
'For the staff the NHS has become a sick service. The non-nursing staff are still negotiating to get a rise for last year. The nursing recruitment and retention has not really been resolved by the pay rises last year--some of the money has gone into recruitment but certainly not into retention. And the new pay rise is going to do nothing to redress that because it is targeting one particular group of nurses. The so called NHS crisis exists because there is a bigger crisis. If we look at social services for example, they no longer provide services socially. The elderly are one of the groups who are likely to get ill in the winter and they are a group of people who have very real physical needs. If they are not met they end up on long waiting lists--they end up getting ill and using the NHS even more. So that is why the NHS is just part of a larger jigsaw.
In terms of the pay rise announced by the government, people have been quick to realise that yet again it is targeting small groups--only 6,000 nurses nationally get the highest pay rise. I have spoken to a few people about Blair's pledge for increased spending on the NHS and their attitude is, we'll believe it when we see it. They also think it probably means they will rob it from somewhere else. There is a real sense that privatisation is coming in through the back door in the NHS.
When Labour was elected there was a feeling that, as the phrase went, it can only get better. Now people are saying it is no different, things haven't changed, if anything things are still getting worse in the NHS--at least under the Tories we knew they were going to cheat on us and privatise us. Labour has let us down.
In the last 12 months we have taken a petition around work which asked how willing people would be to strike if they didn't get a decent pay rise. We got something like 84 percent of people saying of course we would strike if we didn't get a decent pay rise and we'd want the union to ballot for strike action. There is caution about actually taking action but if people within the union actually talked to people in the NHS and argued why it is the right thing to do then they can be won round. People are angry enough to do it although they are a bit cautious, but they could be won to striking. It would be the quickest strike in history if we got everybody in the NHS to walk out.
The problem is that people are getting worn out and exhausted--and so the government will just try and sit this crisis out. But at the same time people are getting really furious and angry. If we can combine this anger with an understanding of what's happening we may shift things--we can't let this happen again.'