workers.
workforce.
This is why there still exist gravely neglected areas of health care, such as the care of women, the old, and the chronically ill. These groups either have little chance of recovery or are not central as workers in producing capitalist profits. It is also the major reason why the NHS has suffered from a chronic sickness of lack of staff, epuipment and new buildings. In 1948, the Nuffield Trust estimated that the health service urgently needed 30 per cent more hospital beds. Since then, although the demand for treatment has increased every year, the number of beds has steadily declined.
The Labour Government first introduced health charges in 1951. Since then both Labour and Tories have treated the health service with varying doses of cuts in hospital building, increased health charges, and appalling pay and conditions for health workers. Indeed, it took the NHS thirteen years to build its first hospital!
However, by the late 1960s an even more stringent medicine was needed to halt the rise in health costs. From this time on, the state has been developing a clear strategy. Its purpose is to make the NHS work better and more cheaply for the capitalist class.
First, however, it was necessary to reorganise the NHS through the NHS Reorganisation Act 1973, to streamline the administrative structure and make it a more effective tool to carry out the strategy of cuts and changed priorities. Under the 1973 Act it is bodies such as the Regional Health Authorities (RHAs) and Area Health Authorities (AHAs) which are now deciding which hospital to close, which staff to make redundant, and what areas of health care will be made priorities at the expense of others.
MAIN POINTS
As the cuts are carried out, the main points of the Government's strategy are becoming clear: (a) The axing of hospital building programmes. (b) The concentration of facilities and resources into large district hospitals, with the systematic down-grading (closing of wards and departments such as casualty) and closure of small local hospitals. The latter usually serve working class communities, and are often especially concerned with the treatment of women or the old. District hospitals cannot adequately compensate for the loss of such health facilities. (c) The shifting of the burden of care of the chronic sick and of convalescence onto working class families. This is carried out by shortening hospital stays for treatment (so that more patients can be treated in fewer beds) and by changing treatment from in-patient to out-patient regimes. (d)The reduction of the staffing levels in hosMENT OF HEALTR SOCIAL SECURITY It has been t The creation of the National Health Service in 1948 was an important gain for the working class. For the first time, it brought health care within the reach of most Yet the the NHS has never been a beleaguered island of socialism in a sea of capitalism. It has always been dominated by the needs of capital for a healthy pitals and an increase in workloads through bonus schemes and regrading of jobs. (e) The encouragement of private medicine outside the NHS. Castle's latest plan for licensing private practice at one stroke guarantees its future and doubles the number of short stay hospital beds in the private sector. This could only lead to the establishment of a private health industry in direct competition with the NHS.
The effect of these measures is to reassert more nakedly the capitalist nature of the health service. Those who are not directly needed for capitalism's workforce are especially hard-hit in fact, one AHA has already considered plans to give productive workers open prioirty in treatment. care will begin to depend once more on the ability to pay, either via private practice or in increased health charges.
NO DOUBT There is no doubt about the meaning of the Labour Government's policies on health. The cuts are being used as a further way to force down the living standards of the whole working class in order to shore up an ailing British capitalism. ably those with large memberships in the NHS. such as ASTMS, NALGO, and NUPE - and now the Labour Party have all passed resolutions under the pressure of their rank and file against these cuts.
In total, these resolutions outline the immediate demands needed to roll back Wilson's attacks:
• Immediate injection of funds — at least £1000 million - to begin to restore the cuts and restart the hospital and health centre building programmes. • Automatic increases in the NHS budget to protect it against inflation.
• Complete abolition of all private practice, both inside and outside the NHS. All private health facilities to be turned over to • Nationalisation of the drugs industry without compensation to end its profit-mongering and dangerous and cynical exploitation of the sick.
Other important demands for reforms in the service provided by the NIS have also been raised • Free abortion and contraception on demand;
An extensive health education programme;
• A free full occupational health service to protect workers trom the health hazards of work under capitalism.
NUPE es of hospital workers themselves over the past few years, such as the nurses we've got no money."
Moreover, the standard of health And several unions -10L policies.
movement COF socialist policies in practice. they are being carried out.
Such demands, if implemented, would remove some of the most serious gaps in the health care presently provided by the NHS. However, simple calls on the Labour Govern ment to carry out such measures will be met with a simple response: "There's a crisis - our's attacks.
It is clear what the working class's reply this job. should be. The crisis is a capitalist crisis, and its cost must be borne by the capitalist class A crash building programme of hospitals and health centres is needed in every area, as part of a programme of useful public works. Such a programme would not only put to good use the materials being stockpiled by building manufacturers, but would help to soak up a good deal of the unemployment in the building industry. The funds for such a policy could be released by abolishing 'defence' expenditure and by a tax on the capitalist class How can the labour movement best fight for these alternative policies? Resolutions are of course an essential part of any campaign, but on their own they are completely insufficient. No amount of resolution passing will stop Wilson and Co, from carrying out the cuts. These policies go hand in hand with the incomes policy, and any fight against them must therefore be part of the struggle vice. to smash all of Wilson's anti-working class That is why attempts to democratise the bodies of the NHS (such as the AHAs) are useless. They do nothing to mobilise the labour on the contrary, trade unionists on such bodies will soon find themselves taking part in the implementation of the cuts. These bodies were designed for exactly that purpose. WORKERS' INQUIRY Much better is to start by fighting to prevent the cuts that are already taking place in the NHS. In this way we can begin to win the workers' movement to fighting for the above Look at the way the cuts take place. A hospital is closed here, a ward is cut back there. Many more cuts take place behind the backs of the workers' movement - such as the cuts in the ambulance services, or the understatting of Hospitals through 'natural wastage. What is never revealed to the working class is the full extent of the cuts and the systematic way If we are to mobilise in the class against Labour's attacks, we not only have to point the blame where it belongs, but also expose the extent of the cuts and the implications of to do both these things. Charged with finding out the effects of the cuts, how they are being carried out, and what the socialist alternative would be, such an inquiry could arm the workers' movement to expose and fight LabNo inquiry carried out by the state can do There have been a series of such inquiries carried out — all with the aim of making the health service work better, and cheaper, for the capitalist class. The classic example is that of the McKinsey report, which resulted in the change in structure of the NHS and gave birth to the AHAs. This report was carried out by a team of management consultants!
The inquiries conducted by the state have only contributed to the present crisis in the NHS. The job of a workers' inquiry would be to work out how to make the health service meet the needs of the working class.
The state and the capitalist class would not make this easy, of course. In particular they would say: 'You should leave it to the medical profession who know about these things. Anyway, there is simply no money available.
The workers, movement would have to demand that they OPEN THE BUOKS - let the workers see the plans for the health serA workers' inquiry could not be conducted in the backrooms of Transport House, but only by waging a fight for such demands This would mean campaigning to throw the whole weight of the workers movement behind such an inquiry. Only by doing this would it be possible to bring the full extent of the cuts in the NHS before the gaze of the whole of the working class.
There must be a similar response to the role of the drug companies, exposing the anarchy of research and the way drugs are marketed. The best way of winning the workers' movement to fighting for the nationalisation of the drug companies, so as to plan the research and production of drugs, is by fighting to open their books. This again will be strenuously resisted by the capitalist class under the guise of maintaining commercial secrecy "so as to be able to compete with other firms' It will require working class action to win such demands, including the workers in the drug companies themselves taking hold of the books and submitting them to the workers movement for examination. This would do far more to win the whole of the working class to the need to take control of these companies than any number of paper resolutions.
But the crisis in the NIS is not simply a matter of more money being needed, nor simply a matter of making some reforms. It is not possible to talk about 'putting a bit of
ctober 1975 those reforms that the NHS provided for the