Gerry Dawson (David Widgery), The Battle of Bethnal Green, Socialist Review, No.5, september 1978, pp.20-22.
Transcribed & marked up by Einde O’Callaghan for the Marxists’ Internet Archive.
In issue 99 of International Socialism, June 1977, the predecessor to this journal, Gerry Dawson reviewed the impact of the health service cuts and the strategies for resistance. Here he makes a progress report on the battle of Bethnal Green Hospital and the fight to stop the cuts.
The Green is a medium sized general hospital in a part of East London with notoriouly high incidence of illness and a community health service which is only now emerging from decades of neglect. It has about 280 in-patient beds and sees nearly 48,000 cases each year in its casualty and outpatient clinics.
It is no medical derelict; from the specialist hip replacement unit, its patients’ kitchens, reputed to be the best in East London to its excellent postgraduate Medical Centre it’s a busy working hospital with high medical standards and unusually good relations with general practitioners.
But, Enter The Cuts. The Tower Hamlets District not only have the national nil-growth ceiling now strictly enforced by the cash limit which was introduced as part of the IMF’s loan terms. It also has the RAWP (Regional Allocation Working Party) tax to pay.
RAWP is a classical social-democratic cock-up; designed to level up the regionally uneven levels of medical spending noted by socialist critics in the 1960s. Now in the 1970s it has become a formula for rationalising cuts. RAWP shifts still more money out of the Thames regions, long overdue fireproofing and internally financed pay increases for junior doctors further reduce the Tower Hamlets District coffers already ravaged by the rocketing supply costs, especially of drugs.
It’s a national story but East London is feeling the full impact first and hardest. The Tower Hamlests Health District are attempting to ‘save’ £2 million or 300 beds (beds aren’t strictly the things with mattresses on but a unit of medical currency). This abolishes at a stroke, 1 in every 3 acute bed in the district although last winter the existing beds were frequently chock-a-bloc.
The scheme was to smother the Green quietly, under the guise of a conversion, labelled temporary but likely to be permanent, to an all geriatric ghetto. This would achieve the rquired acute beds cut without involving the other better organised hospitals and care.
But the plan blew up in their face and the battle to save the Green has achieved the widest working class action against the cuts so far in London this year.
An increasingly vicious management succeeded in smashing the 24-hour casualty work-in which had run throughout July on 1 August by withdrawing staff and threatening senior medical staff involved with legal action. But it has proved a Pyrrhic victory and at the Council, the Community Health Council, the hospital and general unions against them and the East London public in angry mood.
There is now no chance of conversion to the all-geriatric unit unless at least some of the demands of the Campaign – retention of medical beds, open X-ray services, the Postgraduate Centre, a 9-5 Casualty Station – are met.
What is important to realise is the very slender basis from which the campaign was nursed. The Green has an unhappy trade union past and was clearly seen by management as a push over, especially since the all-geriatric future gave the impression that jobs would be safe.
For months a tiny committee of staff who wanted to make a stand, and local people, did careful groundwork, sat through visiting know-alls who would monopolise a meeting and not be seen again, petitioned GPs, tried to change the pessimistic mood inside the hospital. Only two years ago when the Metropolitan, a Hackney hospital opened in 1886, was closed, its secretary said, ‘The staff have been incredibly loyal and have steadfastly refused to strike and now it is us who face the chop’. The Green could easily have had the same obituary.
Carefully argued critiques of the plans were put into the complicated ritual of paper shifting called ‘consultation’ but at the same time Green campaigners knocked, wrote, and implored the entire local trade union movement to rise to the issue.
After two highly successful public meetings, the biggest the York Hall could recall, the Campaign called its first two hours stoppage on 10 March and in much trepidation. Myrna Shaw, NALGO shop steward remembers:
‘We stepped out of this hospital yesterday to give two hours to the community and in the true spirit of the East End we found the community waiting for us.
‘Anyone who could not be stirred by the sight must be dead. There were the massed banners of the trades councils and the trade unions. The Ambulance men were there and the Tenants’ Associations. St. Bartholomew’s turned up and St. Leonards, St. Mathew’s and St. Clement’s.
‘We picked up contingents from Mile End Hospital and The London on the way. Hospital chaplains marched – so did doctors, nurses, social workers, town hall staff, GLC staff, people from the breweries, local industries and teachers. Apologies to anyone left out.
‘If you lost your place in the procession it was hard to find anyone you knew when you went back. Best of all our own staff marched – from every Department in the Hospital’.
Behind that unity lay careful groundwork. 103 local GPs had been canvassed and stated that the closure was ‘a disastrous mistake’. The local community nurses stated ‘it would be difficult for us to cope with a large increase in our work load even if our staffing levels were increased’.
The social workers stated ‘The hospital has greatly enhanced the service we are able to give, its loss would greatly diminish it’. But the 1974 re-organisation scheme has established a pattern of medical autocracy which is virtually impossible to dent with reason and damned hard to affect with force.
After a three month reprieve which was clearly designed to defuse rather than encourage the supporters, instructions were issued for closure of the Casualty, the first step in the change of use, on 1 August at 8.00 p.m.
Once a closure date had been stated, down to the hour the phoney war was over. A Joint Trade Union Co-ordinating Committee elected by the East London Health Shop Stewards had been arguing out the implications of the Green’s closure for the general patterns of cuts in East London and tightening up its own organisation and communications.
When it called strike action, even at notice of days rather than weeks, the response was splendid. The day before the attempted closure nine local hospitals stopped simultaneous, St Barts and The London were solid for 24 hours, and many industrial supporters came out spontaneously too. 300 locals were outside the hospital gates as 8.00 p.m. arrived and at 8.01 a sign went up ‘Casualty OPEN under staff control’. Withing minutes, long planned agreements with the ambulance and emergency bed service unions went into action.
Over the next few weeks, the Casualty, which the administration still insisted was closed, saw and treated more patients than in the same month the previous year. And the pickets outside the hospital now really had something to defend. The six point motion moved by Mrs Henrietta Cox of NUPE had done its work in each respect:
The staff of Bethnal Green Hospital declare that the Casualty Department will stay open. We declare we have no confidence in the DMT. We resolve to elect a committee representing all the staff to make sure casualty runs as usual. We call on ambulance staff, the BBS and local GPs to support us. We call on workers in other London hospitals to take any action necessary to support us. We call on our unions to organise supportative action. We ask the people of East London to support us!
It took the management a full month to break the Casualty work in. After early attempts to withdraw staff and victimise the other hospitals and ambulance men who defied their official instruction that the Green was closed, direct and legal pressure was put on the rebel consultants and nursing staff forcibly transferred within the district.
It is important to realise that a work-in is not a universal panacea. Its remarkable success at the EGA depends on the special cases of consultants in the very specialised women-treating-women field, for which no real equivalent alternative can be offered. But in most hospitals, consultants can be only too easily bought off with promises of new, perhaps better, facilities in other hospitals in the districts.
And such is the independent power of the consultant in the NHS structure that medical work simply cannot continue without their approval, even though they are are only on the premises for a small part of the time. Management, too, are learning from the EGA, especially in finding ways to pressurise nursing staff who are most vulnerable to hospital discipline.
The Bethnal Green work-in could never have worked without the very remarkable devotion of a consultant physician John Thomason and the hospital’s casualty officer, Kutty Divakaran.
But the Health Authority still hold the trump card: the ability to transfer staff. Short of running an alternative private health service, paid for by collection, within the hospital there was little to do but protest when an ‘Invisible Hounslow’ took place.
There was further strike and public protest on the day of the final forced closure. But the battle has now moved into a second phase, to prevent the conversion to the all-geriatric dumping ground so many staff and locals oppose because its notorious effect on morale and nursing and medical standards by insisting the remaining medical, postgraduate, X-ray, ECG and outpatient services stay put.
This time round it will be that much more simple to convince the Community Health Council, the Council and the statutory bodies who found the initial package plausible, of the real intent of the management; quite savage cuts in a area which is crying out for more resources. And to prevent the destruction of an excellent community-based hospital with no planned alternative.
Already there are ‘lessons’ galore. DMPs all over the country are finding increasing resistance to their attempts to enforce cuts. Not only are older community hospitals like St Nicks and The Green (which do need change but, with imagination, could find an important inner city role) being forced into closure, but completed new hospitals are unstaffed, and long promised and long needed facilities, such at Hemel Hempstead are postponed. 30 threatened hospitals joined a torchlit vigil on the 30th Birthday of the NHS in London alone.
Despite the BMA and Ennals, medical staff and unions are finding common cause and using sophisticated types of industrial action to force their case – at a time when the rest of the labour movement has its fists firmly in the pocket. Occupations live, it seems, in the NHS, if they have been forgotten in Clydeside. For the Bethnal Green battle and that of the EGA and Hounslow before it, will have to be repeated all over Britain as we descend further, further down the course established by Ennals, who is to British hospitals what Henry the Eighth was to British monasteries.
Here in East London the particular emotional significance of the hospital, and the genuine gratitude felt to the NHS, has given the campaign a moral pungency and unity which have done something to revive the flagging fortunes of East London labour whose greatest days seemed all to be in the Museum. With the steadfastness of the young Bengalis in Brick Lane, the limbering up of the docks unofficial committee and the fightback on the hospital cuts, the sleeping lion of East London labour is stirring.
If hospital workers just plead for passive support, it’s simply a case of wishing them well. But once the hospital unions take strike action or mount a work-in, the question becomes active. We are doing something, what are you going to do? Suddenly the all powerful authorities can look extremely isolated.
As for the politics of the situation, the weakness of the Communist Party is quite startling. Even ten years ago they would have delivered a formidable industrial punch but now their support is well-meaning, inexperienced and a bit airy fairy.
The left of the Labour Party, especially ousted councillors, have been excellent but must face the fact that it is a Labour minister, Roland Moyle who gave the Green the Ministerial Kick in the teeth. Even Mikardo, who has taken up The Green like the fighter he is, may oppose cuts in his constituency but voted for the package nationally. On the ground it has been independent trade union activists, local socialist feminist groups and the SWP who have run the campaign.
The lack of response from the hospital unions at a London level or nationally has been truly scandalous. Reviewing the annual conferences this year, it’s clear that the bureacracy considers cuts were last year’s thing. It seems even possible that NUPE and the DHSS have an agreement, off the record, to let certain hospitals go without a fight.
Fisher has made not one visit to a hospital where his members are putting their necks on the block against the very cuts that he used to establish his own credibility as a campaigning union leader. The informal networks, Hospital Worker, and now the excellent Fightback co-ordinating committee based on the shell of Hounslow Hospital have been worth 100 times more than another Alan Fisher TV appearance.
The success of the cuts is not just a financial saving and a worse service. It is a code word for a social counter-revolution, a crueller, harsher Britain. The hospital service planned for us will consist of highly centralised (and incidentally absurdly expensive) units run more and more like factories to achieve maximum efficiency in ‘through-put’ and a few sub-hospitals for geriatrics and sub-normality practicing third world third-class custodial medicine. The sick who fall between those two stools will have to trust its luck to something called the community’ which is itself busy being destroyed.
It is this Dismal New World every cuts battles faces head on. And because of the degree to which the Labour Party has become the agent of financial capitalist orthodoxy, that even the most minor closure has to be fought up to cabinet level. The battle against the cuts, like the battle for the right to work, are part of a bigger battle to reshape the priorities of modern Britain. If it seems at times unrewarding, it is where real socialists should be building.
Last updated on 31.12.2004