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Ian Burge

Health Workers Defend NHS

(November 1976)


From Militant, No. 330, 12 November 1976, p. 5.
Transcribed by Iain Dalton.
Marked up by Einde O’Callaghan for the Encyclopaedia of Trotskyism On-Line (ETOL).



Health workers have shown in recent weeks their readiness to defend the health service against the cuts carried through on behalf of big business. They have brought to the attention of all workers the seriousness of the situation. In the coming months they are going to be faced with the problem of how to actually prevent hospitals being closed down.

Up to now they have succeeded, by their actions, in winning a stay of execution while the management consider alternatives, but very soon now will come the first major closures. The health workers will need all the support they can get from the labour movement. Within the NHS itself, the developing campaign is forging new links between the unions, and making many sections of workers in the health service far more conscious as shop floor meetings are being held everywhere to discuss how the cuts can be fought.

On the first day of strikes in London on the 23rd September a meeting for all stewards in the East End was hastily arranged to maintain the impetus and discuss further action. Calls were made for open ended strike action to force the Area Health Authority to change its plans.

Meetings of shop stewards have been continuing, with the aim of thrashing out a joint policy on which to campaign. These meetings have not been without disagreement, and it would be foolish to expect otherwise, but this does mark the beginning of the breakdown of barriers between the various unions, and the development of a health workers organisation capable of challenging the rule of the managements.

There is confusion among the workers as to whom they are fighting. The Area Health Authority gave the go-ahead for cuts. Local management has to implement them. The Area Authority claims to be bound by Regional Authority policies. Regional policies are largely determined by financial restrictions and DHSS and government policy.

A serious financial crisis is looming in the health service as the local managements are finding it impossible to implement the full sweeping cuts necessary to avoid massive overspending. If nothing is done, East London Areas will be several million in the red by next April. New budgetary policies have been introduced this year to force managements to remain within ‘cash limits’. In the past, due to increasing costs, the authorities have been allowed to over-spend. Now any money overspent at the end of the year will be taken from next year’s allocation.

The main factors in reducing the allocations being made for health spending are: (a) effects of national cuts in the Health Service allocation; (b) re-allocation of funds between Regions to provide more for deprived Regions; (c) re-distribution between the Areas within Regions; (d) inflation; (e) and a policy of cuts in some services to pay for the improvements in others.

The only way that spending in grossly deficient services can be increased is by cutting down on others. The invention of ‘norms’ gives management the justification for the cuts. These norms are not based on any assessment or measurement of actual health needs, or existing utilisation of resources, but are more aimed at spreading out the shortages and deficiencies more widely.

The big stick being waved is that if the books do not balance, if the overspending is excessive, then the auditors will be sent in, as they were at Clay Cross.

The reason that managements are finding it impossible to implement the full cuts are firstly because they are so sweeping and cannot be done without risk to the patients, and secondly because of the growing resistance of the health workers. Thousands of jobs have already been lost over the past year. As one management has put it, “any ‘fat’ which has existed has, for the most part been taken up.”

The message is now getting through to the workers that the un-filled jobs, the extra workloads, are now permanent. Overtime working has been slashed, and this, together with other losses of earnings followed ‘reviews’ of bonus schemes, added to continued inflation of prices, fares, and rents, is severely reducing health workers’ living standards.

The problems of the health service cannot be solved whilst the government is pre-occupied with meeting the demands of the CBI for more and more profits before companies will invest. Profits can only be increased at the workers’ expense. The ‘social contract’ has kept wages down whilst prices have soared. The cuts in public spending represent a further erosion of living standards through reduction of the social wage. The great National Health Service and Welfare State, set up in response to the near revolutionary mood of the working class, and to its demands for change at the end of the war, cannot now be supported by the system.

The present policies of the government are doomed to failure. The Tories, the CBI and international finance are clamouring for more huge cuts. They will not be happy until our welfare state is completely dismantled and we have returned to the days of pauperism.

On the question of the NHS, the Labour Party Conference has: 1. demanded ‘the implementation of a massive building programme particularly in view of the proposed closure of National Health Service Hospitals in London. 2. demanded ‘a minimum wage for 35 hours (tied to the cost of living index) for all National Health Service workers’ and ‘a halt in the systematic reduction of staff who are vital to the service at all levels’. 3. called on the government ‘to take urgent steps to totally abolish private medicine in this country’. 4. concluded that ‘exploitation by private industry of the sick in our society can only be ended by the nationalisation of the pharmaceutical industry with compensation to be paid on the basis of proven need...’ 5. demanded ‘an end to undemocratic control of hospital boards, running the National Health Service to be in the hands of elected boards comprising of Health Service workers, trade unionists and the general public’.

This is the way forward.


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