First Published: May 1983.
Source: Published by the Workers Socialist League.
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The National Health Service is now fighting for its life. With the deepening crisis of capitalism and the onslaught of the present Tory government’s monetarist policies, the welfare state is an expendable luxury in the eyes of the ruling class. The health of the working class is irrelevant to capitalism in crisis, and the NHS, the state system which attempts to keep people healthy, is under attack.
One of the easiest, and least ‘public’ ways of dismantling the NHS is to make the working conditions and pay so unattractive and unrewarding that it literally becomes impossible to staff it. Closing a ward here and a ward there through staff shortages is like eating the loaf crumb by crumb. No-one notices that it is gone until it is too late. Some people will argue that it is unlikely to be impossible to staff hospitals in a period when unemployment is running between 4 to 5 million and growing. However, low rates of pay, coupled with irregular, unsocial hours, dirty jobs and the rigid hierarchical structure of the NHS offer no incentive for unemployed workers to join the health service workforce.
As we entered the 1982 pay round, the figures were stark. Between 1975 and 1981 average earnings nationally rose by 133%. Nurses pay rose only by 118% and in real terms by 1981 had fallen by 3.5% Ancillary workers, already amongst the lowest paid workers in the country, had an overall percentage rise of only 96.8% between 1975 and 1981. The official government poverty line is a weekly earning of £82 (the point at which Family Income Supplement is available). Half of all full-time nursing staff earned less than that, and an incredible 73% of ancillary workers were on or below the poverty level at the start of the 1982 pay negotiations!
The Tories, fresh from defeating major sections of industrial workers, decided to impose the 4% norm on NHS workers, despite the fact that inflation was running at 12%. At the beginning of the dispute no other major section of workers had settled for the 4 %, the lowest settlement at the time being 7.4 %.
The fight was clearly on from January 1982 when it became clear to activists that the health workers were fed up with getting settlements well below the rate of inflation and were prepared to take strike action for a decent wage. The feeling amongst ancillary workers was particularly strong, but the common settlement date negotiated the year before meant that nurses would also be coming up for a pay increase at the same time, and there was a lot of support for some kind of action even from the reactionary Royal College of Nursing. To the ordinary worker, fighting meant fighting the Tories; to the militants it meant fighting the Tories and the trade union bureaucracy who had no real intention or will to do battle in a year which was clearly a run up to a general election.
The last major industrial action in the NHS had been in 1979 – the ‘winter of discontent’ – when embittered ancillary workers went on strike but were forced back to work following sell-outs at national level and widespread scabbing by other grades at local level. The media had conducted a ruthless smear campaign in 1979 and the aftermath of the strike left bitter and seemingly irreparable rifts both between unions and between different groups of workers.
There was no attempt by the officials to analyse the lessons of that year and to try to build a cohesive and united stewards movement in the NHS. In assessing any dispute it is important to look at the trade unions in the industry and in the NHS it is a very complicated structure.
All negotiations on pay and conditions are on a national basis through Whitley Councils. These councils have a staff side and a management side. The staff side is composed both of TUC affiliates and so-called professional organisations which range from the substantial Royal College of Nursing to the tiny Remedial Gymnasts Association. However, on the nursing and midwives council all the ‘professional groups’ together can outvote the major TUC unions. The two major TUC affiliates are NUPE and the Confederation of Health Service Employees (COHSE).
Following 1979’s strike it was apparent that much more could be achieved through one union, which would in reality mean an amalgamation between NUPE and COHSE. However, COHSE is a traditionally right wing ‘non-political’ union and NUPE is more ‘left’. A large number of COHSE members and most of the national officials would resist very strongly any suggestion of amalgamation. In fact for several years it was more likely that COHSE would join with the RCN and speculation around that reached its height, significantly, in 1980 / 81. So with no attempt towards unity from the top, the task of rebuilding links within the NHS, through stewards committees, after 1979 was left to committed stewards and activists.
The NHS unions were until the mid-seventies way behind other sections of workers in even grasping the importance and the functioning of joint stewards committees. COHSE only introduced the post of steward in 1970.
However, cuts and closures arising since the mid-seventies and the increasing threat of job losses in the NHS meant it was no longer a cushioned and safe place to work. Coupled with growth in trade union membership, this helped to increase the consciousness of NHS workers and shop stewards committees were started in several areas. Their success was patchy, but what became obvious during last year’s dispute was that to build any opposition to both the bosses and the bureaucrats, Joint Shop Stewards Committees are essential.
In the more traditionally militant areas they were comparatively well established and provided a much needed lead for the rest of the country. In Manchester a half day strike was called before any ‘official’ action was taken. In South Wales the JSSC booted out the officials and took control of the Regional TUC committee which was coordinating the dispute. In Edinburgh the workers took indefinite strike action and were only forced back because of the lack of support from the national leadership; and in Sheffield and Leicester the JSSC gave a strong lead in organising action and in launching the initiative for a health stewards conference later in the dispute. It was clear from these areas and their strength in fighting that the way to win the dispute was in mobilising from the areas, through stewards committees and taking the fight and the demand for indefinite strike up to leadership level.
The TUC was also building its own version of unity. Once they realised that there was going to be a fight, their obvious course to take was the one which meant maximum control over the rank and file. This came through the TUC Health Services Committee. It is a committee made up of representatives from all the TUC affiliates which cover the NHS – and that even includes the Prison Officers Association! Its composition is such that the smaller unions representing only a fraction of Health Service workers can outvote the major unions. Immediately then the scene is set for a battle over tactics and strategy which requires a clarity and sharpness from the more politically conscious unions, such as NUPE. What happened however right throughout the 8½ months was a fudging and blurring of the issues, particularly by NUPE, which led the dispute down the long road to the eventual sell-out.The first action
It was COHSE, surprisingly, which initiated the first form of action when it declared official support for a work to rule from April 26. The settlement date was April 1, so already there had been 3½ weeks of waiting for action. It was to be the only real initiative COHSE made nationally throughout the whole period. NUPE, despite the national ‘unity’ propaganda, did not support COHSE in its work to rule until three weeks later.
But NUPE’s real betrayal of the health workers was through the unwillingness of the leadership to push to implement the NUPE conference resolution calling for indefinite strike action. The resolution was worded in such a way as to give Alan Fisher (outgoing general secretary) a chance to make, possibly, one of the best and most militant speeches of his career. He came over as a real fighter – but that was because he knew he would never need to enter the ring and fend off the blows.
The resolution recognised the futility of two-hour stoppages and one-day strikes and resolved “to call for an all-out indefinite stoppage, commencing June 4th involving all health service unions, with accident and emergency cover”. The phrase ‘involving all health service unions’ was the way out. It was clear that some of the NHS unions would not adopt that policy. The contrast between the NUPE and COHSE conferences was remarkable. An emergency resolution went to COHSE conference leaving out the unity phrase – and was viciously attacked by Albert Spanswick, the general secretary. He distorted what the resolution said, called it “totally irresponsible” – and it was lost. Had Fisher been presented with the same resolution he most certainly would have reacted in the same way.
As the dispute wore on and it became clear that one-day strikes and the TUC strategy .was demoralising the workers and getting us nowhere NUPE now under the leadership of Rodney Bickerstaffe, young, ambitious and supposedly ‘left’ (but as unwilling as Fisher to turn words into actions) resolutely and consistently refused even to push for a vote on all-out action on the TUC Health Service Committee. Fisher’s “we’re not looking for an armistice. We’re looking for a victory” statement was being more and more exposed to the membership.
“All out for 12%” became the slogan and the aim of the activists. With each announcement of a new one day strike the officials hoped that the strike would collapse and they could then wheel out the ‘blame the membership’ argument and settle for well below the 12%. But, against the overwhelming odds, the strikes were successful and the workers continued to look for the kind of action which would win. A setback in organising the rank and file was that there was no broad rank and file group crossing union boundaries and bringing together those most committed to building the call for all out action and pressing the national leadership into fighting.
The SWP had initiated Hospital Worker – a broad grouping – in 1972. It had a varied effect during the struggles of the ’70s, but was the only established national grouping. In the ’80s it had increasingly become a SWP vehicle and lost most of its unaligned or non-SWP contacts. However, it did have the potential through its publication called Hospital Worker to be a catalyst for calling together the NHS activists during the crucial period before and at the beginning of the dispute.
It is an indictment of the SWP’s increasing sectarianism and lack of understanding of the methods of organising workers in class struggle that they wound up Hospital Worker, along with all their other broad groupings, in the winter of ’82, at a time when militants were beginning the push to get a fight on low pay.
The WSL took the initiative to organise and at the beginning of May a loose grouping of activists called Health Workers for the Full Claim began to meet. This was the only attempt at any kind of organised coordination of the rank and file during the dispute. The group campaigned around indefinite strike action with emergency cover, as the only way to win the full claim. Health Workers for the Full Claim produced eight bulletins which were well received and had a presence at both the COHSE and NUPE conferences. The NUPE fringe meeting was one of the biggest fringe meetings ever held. There were clearly a lot of people looking for the kind of leadership which could challenge the bureaucracy.
Health Workers for the Full Claim called two lobbies at Congress House to pressurise the leaders into discussing all-out strike. Both times the trade union officials exposed their real feelings about rank and file pressure by calling the police to protect them from their members.
The leaders, unable to break the militancy of the workers through one day strike action, began to float the idea of arbitration as the way to win. The government refused to go to arbitration and the workforce consistently rejected the idea that anything significant could come from such tactics.
The TUC showed themselves to be totally bankrupt in responding to a real call to beat the Tories and quivered at the thought that the conditions for a general strike had never been so imminent since the steel strike at the beginning of the Tory reign. During the course of the NHS dispute, both the NUR and ASLEF took strike action. The water workers had a one-day strike against low pay, and the POEU had a one-day strike against privatisation. Yet incredibly the TUC consistently refused to link the struggles. In fact they clearly went out of their way to make sure that both ASLEF and the NHS workers were not on strike together. When ASLEF were ruthlessly sold out, they were ordered back to work on Sunday night – when the NHS workers were starting a strike on the Monday.
But the links were made despite the treachery. Nurses, domestics and porters went out to the mine workers, steel workers, textile workers and other sections of industry. It was the rank and file who organised the sympathy strike action. The extent of working class solidarity during the 8½ months was overwhelming. The miners were at the forefront but the extensive action by white collar unions, such as NALGO and CPSA was very strong and crucial to areas where industry has all but disappeared. The argument that the working class are in retreat and will not fight was turned on its head.The Geraghty affair
The most significant solidarity action though was that taken by the London Press Branch of the EETPU led by Sean Geraghty. The print unions had announced that they would strike in support of the health workers. The Newspaper Publishers Association, led by Richard Marsh (ex-NUPE full timer and Labour Minister) threatened and then took out an injunction under laws introduced by Prior in 1980 to stop secondary strike action. All the militant speeches and hollow words of the TUC leaders opposing anti-union legislation suddenly evaporated in the face of the need to support Geraghty and stand up to the courts. In a typical betrayal of working class solidarity Albert Spanswick on behalf of the TUC Health Services Committee asked the unions to call off the action. This clearly showed the cowardice of the union leaders. The EETPU picketed all the newspapers and shut them down. Geraghty was taken to court. Health workers from all over the country came to demonstrate in support of him and against the Prior / Tebbit laws. None of the trade union leaders turned out and Frank Chapple, reactionary leader of the EETPU, disowned Geraghty. The courts in the knowledge that strike action in support of Geraghty would be overwhelming were he imprisoned, gave him a derisory fine. Despite the precedent it set, it was a clear victory for the working class against the Tories’ union-busting laws.
Geraghty’s action and the subsequent court proceedings raised the whole question of Tebbit’s proposals in a way which would never have been possible otherwise. Workers saw first hand that the Tories were serious about smashing the power of trade unions, and they saw first hand that when the workers defend their rights they can win. It also raised the whole important question of the power of the closed shop amongst ordinary health workers who had been convinced by propaganda that closed shops somehow eroded individual rights. Workers who had stood day after day on picket duty outside hospitals seething with anger and frustration when scab workers crossed, saw the whole national network of newspapers closed down by a small group of trade union members.
As the dispute went on, stewards’ committees grew stronger but were unable to budge the total intransigence of the TUC – and the Tories, riding high on the “victory” in the Malvinas – grew stronger. The billions spent on the Malvinas war, the 18% salary rise given to judges, the commitment of vast amounts of money to cruise missiles convinced even the most sceptical workers that there wasn’t a shortage of money – but the Tories were only prepared to spend it on things which bolster their priorities, capitalist profit and imperialism.
Under intense pressure to do something the TUC at its annual conference called a national day of action on September 22. They were still not prepared to actually put out the call for a one-day general strike and limited their support to a day of action. The turnout was tremendous. Millions of people took some form of action. A march in London had more than 150,000 participating and took 4½ hours to finish. 15,000 marched in Sheffield and there was similar action in a dozen other cities. Despite the restraint of six months by the TUC, the health workers were absolutely solid and had the massive backing of the working class.
The will and the strength to win was apparent. Fowler was at pains to denounce the day as “irrelevant to working Britain”. Millions of workers knew differently.
A lead from NUPE immediately after the 22nd could have changed the course of the dispute. Instead the TUC announced what turned out to be the death blow – a series of regional “days of action”. Even hardened militants could not believe it. All the strength which had been there on the 22nd was dissipated into regions trying to organise with no enthusiasm, for local action. There was no further strong national action. A planned Transport Day of Action on November 8 was called off at the last minute to please ACAS.
At the end of October the TUC decided to ballot members of each union separately on the question of all-out strike action. Meanwhile ACAS stepped in and on November 9 a ‘new offer’ was produced. It offered only an extra half a percent for nurses and tied the unions to a two year deal. Suddenly the ballot on all-out strike became a consultation on the new offer. The rank and file fought right until the end for a yes vote for indefinite action. The most cutting betrayal came from COHSE. Having opposed the call for action with emergency cover in June, the NEC recommended on the eve of a special conference that members should take indefinite action with no emergency cover. The strike ended on December 15 when the TUC Health Services Committee voted to accept the offer. COHSE and NUPE voted against the two year deal and the differential settlement but were outvoted by the smaller organisations and Fowler won.
The defeat of the health workers was a blow as far as the working class was concerned. It was the latest in a long string of victories for the Tories, aided and abetted by the reformist leaders of the trade unions (the miners are the most recent casualties). Intent on building on that defeat immediately, the government is embarking on a strong bid to privatise whole sections of the NHS as part of its consistent plan to dismantle the health service and replace it with private medicine.
Just two months after the end of the strike the DHSS issued a circular entitled “NHS support services – contracting out”. It singles out domestic, laundry and catering services as prime targets. It is no coincidence that these areas are the most militant and highly unionised sections of the NHS. Many areas were virtually paralysed as a result of strikes in the laundries during the dispute. The government is even prepared to pass a special Bill (1983 Finance Bill) which will make it possible for VAT (which at present makes contracting out less viable) to be refunded to health authorities as an incentive.
Meanwhile they continue to allow brand name drugs to be prescribed when generic prescriptions would allow savings of tens of millions of pounds, enough to keep all the present services operating and to expand the primary health care system. Obviously ‘saving’ money is seen as important; reducing the profit level of the multi-national drug companies is no part of Tory plans.
The issue of contracting out has met with a lot of talk and hot air from the TUC but no action has been taken to oppose it. Yet the NHS dispute was never solely about pay. It was about saving the Health Service. The onslaught was begun by the Wilson / Callaghan Labour government as a condition of an IMF loan. It was increased and sharpened by the Tories. In London alone in the first 4½ months of Tory rule there were 12 hospitals and 2,000 beds lost. Coupled with the proposed closure of 4,000 more beds by 1984, London will have lost over 6,000 beds under the Tory axe.
Nationally since 1970 the number of NHS beds available has dropped by 16%. It must be stressed that this did not involve a transfer of resources to care in the community and preventative medicine. It is a straight loss of services. At the same time private health care is booming. In 1980 alone there was a 27% increase in the number of subscribers. This corresponds with growing waiting lists and shorter hospital stays as well as increased prescription charges as a result of Tory policies.
In October, the government arrogantly announced that any new building or new services will have to be paid for by ‘savings elsewhere’, another name for more cuts. How are the unions responding in the wake of the defeat on pay to these attacks on jobs, services and the health of the working class? The workers, despite the defeat on pay are fighting back. There are major campaigns being organised, using the links made during the pay dispute, to oppose the cuts and closures and the threat of privatisation. The bureaucrats however, are retreating as expected. Any real fight on cuts involving the struggle for all-out strike action, occupations, and the coordination of supporting struggles by other health workers and the wider trade union movement, will bring the unions into head-on clashes with the Tebbit legislation. COHSE has already issued a circular to its full time officials advising them not to support anything remotely in conflict with the legislation.
The importance in building the stewards’ organisation during this period is primary. In other areas, for example, British Leyland, the continuous attacks on jobs and on trade union rights has led to victimisations which the officials have not opposed.
In many areas the stewards movement is in severe crisis and the fight against the bosses is hampered time and time again.
However, in the NHS the stewards movement is growing. Links were made during the dispute and the lessons of the importance of JSSCs have not been lost. Some areas were weakened and demoralised by the defeat on pay, but overall, the move is towards strengthening and building joint stewards committees. Management are fighting this development. They are not allowing time off, giving no facilities and not recognising the committees for negotiating rights. But the trend is there. As the fightback grows there will be more victimisations and attempts to destroy the strength of the NHS unions. In order to fight these there has to be maximum unity and strength amongst all the sections of the NHS workers.
Privatisation and closures cannot be fought and won in isolation and the work force know that. The union leadership will not be keen to see JSSCs growing. They realise full well that such committees can and will fight with much more commitment than the TUC. JSSCs are a real threat to the officials.
NHS workers are relative latecomers to the militancy and wider politics of the labour movement. But, we have learned a lot from the lessons of other workers in struggle and a lot from the 1982 dispute. The groundwork is laid for a strong united initiative to defend the welfare state. The main lesson of the NHS struggle was that reformist bureaucrats do not fight for the interests of the working class. But the rank and file will.
Rosa Luxemburg said that “only the working class, by itself actively, can bring about socialism . . .” The primary organisations of the working class, the unions, have started that fight. Union members need to take control of their unions to make them into democratic, accountable organisations which will back the activities of the working class and win the struggles.