| Measured in numbers employed, health is the largest single industry in Britain. As UNISON prepares for its health conference, NHS workers must face up to the challenge of controlling the country that produced it... |
How healthy is class organisation within the NHS?
WORKERS, APR 2005 ISSUE
April looks as though it will be the month before the general election. It is definitely the month of the UNISON Health Conference. Hopefully, not too much time will be spent by the latter on the former.
But will they leave us alone? No doubt one of Labour's ministers will be haranguing us on some subject or another, no doubt connected to the election, and you just know what it will be: Vote for us; NHS not safe with Howard; slow but steady progress; more yet still to be done; radical third term; flying pigs visit Plymouth.
So what should class-conscious, or even unclass-conscious, health workers be exercised about at this election time? What is the state of the NHS, and the wider healthcare arena? Of our union organisation? Of our prospect for progress?
The fate of that great step forward 50+ years ago must not be mirrored now. We cannot allow this head of steam to be sidetracked into lining up behind Labour, fooling ourselves that the only way to maintain our gains is to vote for them. The only way to maintain these gains is to make new ones. Our conference must pursue these.
Compared with, say, manufacturing industry, health gets a lot of what is usually described as positive government attention. Lots of money, they say, is being spent on health over and above the rate of inflation. True, but how much of it is going straight into the pockets of otherwise struggling private companies, increasingly foreign-owned?
How much is going into bodies established to "regulate" the workings of hospitals, which should just be straightforwardly managed, instead of being floated off into the Neverland of Foundation status?
How much has been spent to prove that the government welcomes independent scrutiny (as opposed to that of the "regulators") of its activity? On this point we know exactly. Community Health Councils, the bodies established in 1974 to provide the means by which patients and other members of the public could keep track of and complain about the NHS, and which were summarily abolished with zero consultation, cost about £13.5 million in their last year of operation. Their notional replacement, the cumbersomely entitled Commission for Patient and Public Involvement in Health, consumed more than £63 million in its setting-up costs alone. Which wouldn't have been so bad except the commission proved so inadequate that plans were announced to wind it up, just before its first (yes, first) anniversary.
Some of those long-suffering souls who have spent most of the past 30 years helping patients complain are up for being sacked twice in the space of as many years. That's what you get for being patient...nearly five times the amount is spent to achieve about a fifth of the result. So what was the point of that extra money being spent? None whatever.
Money is coming into health, but how much is going straight out into private companies' pockets?
PFI
After PFI, the Private Finance Initiative, has bled tens of millions into the hands of the profit-mongers (see previous Workers) now we have Independent Treatment Centres (ITCs). These are surgeries specialising in elective procedures that are relatively easy to plan and carry out, and which are in the main, although not exclusively, run by the private sector. There is no medical or surgical case to be made for the development of these centres, and a lorryload of arguments against.
A squad of foreign-owned companies, usually coming from places that haven't got a healthcare system worth the name, come here to cream off millions of pounds which really could help bring down waiting lists (the stated aim of ITCs). If they're so very good at providing healthcare why don't they try A&E? Actually, hang on a minute, better not give them any ideas....
But surely, the growth in nursing and some other staff — a net increase of about 40-50,000 nurses since 1997, is a great step forward? For whom? For Malawi, which has had most of its newly trained nurses seduced away from their impoverished country and its almost non-existent healthcare system to come and work here? Or are they over-provided with nurses in Africa, as they say they are in the Philippines? Actually, training nurses for export is not proof of over-provision, rather of not giving a damn about the needs of your own people, for which the pro-US Filipino government has long been known. And the words "net increase" hide the fact that the number of British-trained nurses leaving to work in North America doubled last year.
So what we have is a kind of carousel where nurses from one country move to another country for higher wages, to replace nurses from that country who move to yet another country for higher wages. New nurses are being trained, but much of the training is for students from elsewhere coming here who may well move on when they have completed their studies.
The only country that is genuinely exporting nurses, and can do so because it has a sufficiency at home, is Cuba. It is doing the same thing with doctors. It is doing it for the good of the people in the countries where the nurses are sent, countries less developed than Cuba, and not for the benefit of the millionaires who run international nursing agencies. Cuba does not send doctors and nurses to Britain or the US, but to countries that Britain and the US have ignored, abandoned or consciously brought to the brink of ruin: to Mozambique and Venezuela, to Honduras and Haiti. Theirs is internationalism of the highest order.
Peddling people
The kind of people-peddling we are witnessing is the selfishness typical of modern-day colonialism covered up by a smokescreen of blather about free movement of labour. Movement of labour will only be free when labour, that is workers, not the party that has nicked the name, is in charge, in power. When workers run the show then we'll see whom we should invite in and to whom we can afford to offer help abroad. In the meantime, while capitalism has the whip hand, there is nothing free about the movement. It is only happening to make somebody, somewhere, rich.
But good things there are, brought about by the persistence and ingenuity of health workers. Hundreds of millions of pounds is being wrenched from Blair to pay for improved terms and conditions, better wages, of health workers. The new pay system, Agenda for Change, is now being rolled out across Britain, and the difference is being felt. For the first time, perhaps ever, workers in the NHS are fighting to implement something positive, rather than fighting off something negative. Unsurprisingly there are many so used to the negative that they cannot see the positive in front of their eyes.
This shows that taking responsibility is now critical. It is not possible to be class-conscious and sit on the sidelines, without taking steps to exert control. Sometimes that responsibility has to be taken by seeking to stop what is bad. Sometimes it has to be taken to promote what's good, and it is crucial to be able to tell the difference between the two.
The new pay system is not something proposed by the government. It is the brainchild, in detail as well as in conception, of workers. It is so breathtakingly bold that it has left many lagging behind in their understanding of it. The fact that many employers are left behind is an advantage that must not be lost through indecisiveness on our part. We have the opportunity now to embed something so effectively that no successor government, Labour or Tory, could undo it. We also have the chance to use it as a platform for greater progress and class consciousness, including the opportunity for a significant rise in trade union membership.
Who knows what might follow? So we look to the future, confident in our struggle to control the largest single industry in Britain (measured in numbers employed, not in wealth created), and posing ourselves the challenge of controlling the country that produced it.
