The organisation of health services has become a chaotic battleground, with the government seeking to set hospital trust against hospital trust, locality against locality. It is up to the working class to ensure that the NHS remains not just public and free, but national as well...

Our NHS – we need more planning and integration, not chaos

WORKERS, MAR 2013 ISSUE

Across Britain the National Health Service is now centre stage for chaos and deadly systemic failures. We have the Francis Report into the Mid-Staffordshire NHS Trust disaster, cuts, closures, reprieves of closures, disruption of long-term clinically supported reconfigurations, takeovers, mergers, de-mergers, disastrous and lethal failed staffing levels, political intervention on an unprecedented scale, and mind-boggling uninformed localism never seen before in the “National” Health Service.

On the march in Lewisham, February 2013.
Photo: Workers

Campaigns to “save’” hospitals are growing apace; one North London hospital (The Whittington) has four separate campaigns to save it. To save it from what? It is of course right to look at the suitability of hospital buildings, but the possibility of professional decision-making is marred by the push to sell off assets as part of the drive for Foundation Status. The crucial question should be what are the best centres for healthcare for local people?

In South East London, health care provision across Greenwich, Woolwich, Bexley, Bromley and related areas, an estimated 4.5 million patient base, has been blighted by political interference by MPs and local politicians promoting themselves. Add to this poor planning, bad management, Public Finance Initiative deals – which border on the insane, incompetent or corrupt – all of which have damaged the integrity of the NHS for over 30 years. Bankruptcy and political dogma are now driving yet another restructuring of the Trusts involved in this health care provision. All aspects of planning and retention of an integrated NHS are being destroyed as the Strategic Health Authority for London nears its extinction under the Health and Social Care Act on 1 April.

The concept of the capital of Britain having no strategic coordinating and planning body for health is unbelievable. But this is exactly what is happening, a move mirrored across Britain. The impact in London is that without planning, without integration, without longterm provision, Trusts are set against Trusts.

In his short tenure of office, Health Secretary Jeremy Hunt has not issued one statement supporting the NHS. He has seized upon every failing, every bad press report, every local campaign, to justify further dismantling of the NHS. Every protest brought to his attention justifies his mindset that the ‘national’ health service has to go.

Thin end of the wedge?

225,000 workers marching to save Lewisham A+E demonstrate a fear that this is the thin end of the wedge we have been expecting. That so many have come on to the streets does show the depth of that fear.

Workers in one part of London, in this case Lewisham, can perhaps be forgiven for seeing their part of the whole, but not the overall. The only way they see to fight the attack on the NHS we all know to be real is to resist every single local change. Local change is frequently needed, but against a background of imminent threat it feels necessary to resist all change. Yet strategic thinking is vital, to ensure that patients receive the best possible care in an integrated service, however that is delivered.

And there's the rub. If workers were truly in power then far more widespread change would need to be undertaken than anything being proposed in London at present. Hospitals, ambulance stations and GP surgeries have all been randomly plonked in various places over the last century and would need to be relocated by a rational health service.

Medical developments mean that less stress needs be placed on quantitative, and more stress placed on qualitative, resourcing. In other words we don't need everything we've currently got, but we need better. It therefore means we have got to close down wasteful buildings and services in order to concentrate larger numbers of higher skilled workers in better and more modern facilities.

An example of how this can work well, and where professionals took charge of change, is the reconfiguration of stroke services in London in 2010. Stroke wards in local hospitals were closed (often to local opposition), while a new network of more concentrated stroke centres was opened, with highly skilled specialist teams and up-to-date diagnostic equipment. In just five months of the new centres opening, the number of stroke patients receiving clot-busting drugs trebled. It is estimated that this change will save over 400 lives each year across London, as long as the level of quality is maintained.

This kind of change is difficult to manage in the current climate of fierce attack on the NHS – it is hard to have an honest, open debate about what needs to go and what needs to develop and grow.

Workers have to view healthcare provision differently. We need centres of excellence, geared to the highest clinical standards. If the infrastructure or logistics of getting people to such centres is lacking or inadequate at present then we should demand they are built or renewed. Workers must demand more, not less, NHS planning, more integration not disintegration, more patient-centred healthcare rather than profit or managerially driven tick-box exercises. And such demands can only be led by health professionals inside the service, not by campaigners on the outside.

Health trade unions and professional organisations must together demand the removal of the market from healthcare provision, the cessation of the £20 billion efficiency savings tax to the Treasury, the re-establishment of strategic planning and the rescinding of not only the Health and Social Care Act 2012 but all the previous Labour government legislation which paves the way for the possible privatisation and hence destruction of our National Health Service.

And we must say to the Oppose Everything Brigade, your indignation and suspicion are a welcome basis of progress, but they are not enough, and can be counterproductive. We must become the Take Responsibility Brigade and learn that in order to really defend the NHS we need political power. We need to sweep away insidious anti-NHS anti-planning and the Parliament that voted for it.

A path forward

Workers and in particular their unions must develop a way of articulating the real need beneath the surface anger (anger is always an emotion to be avoided in determining political line) which will enable ten times 25,000 to see a clear path forward, not of saving one small facility in one local hospital, but a path to a safe and developing health service where local provision is integral to a national system of healthcare.

It is a sign of how far progress has been retarded that any real national defence of the NHS raises revolutionary implications. Whether we like it or not, no A+E department, no hospital and no healthcare system will ever be safe as long as capitalism rules. This is the lesson we must learn, and quickly. ■