Victory to the junior doctors!

NHS on the chopping block

This slightly adapted article first appeared in Workers Vanguard no 1084, 26 February. Since then junior doctors staged a 48-hour strike on 9-11 March.

February 18 — Junior-ranking doctors at the National Health Service (NHS) in England are resisting government attacks on their wages and working conditions. The enormous popularity of their struggle speaks to the discontent and frustration among Britain’s working people and minorities. Fully two-thirds of those surveyed supported the 24-hour strikes staged by junior doctors in January and February. Millions lust to see that public schoolboy smirk wiped from the face of Conservative prime minister David Cameron. Since the Tory government’s re-election last May, an incessant flood of attacks has targeted everything from elementary trade union rights to council housing to education. Now the Cameron government is intent on smashing its boot into what remains of the nationalised health system. That most revered — and rightly so — of the gains of Britain’s working people in the past century has already been crippled by decades of attacks under both Labour and Tory governments.

Beginning in 2012, the previous Conservative/Liberal Democrat coalition government under Cameron moved to tear up the junior doctors’ contract under the pretext of improving weekend hospital coverage and providing 24/7 care. Under the new contract the government unveiled last summer, these doctors would no longer receive extra pay for working evenings and daytime Saturday shifts. With a miserly base salary beginning at less than £23,000 per year, these doctors — who may remain “junior” for a decade or more — rely on overtime for much of their income.

While the government has trumpeted its offer of an eleven per cent increase in base salary, it is estimated that the new contract would slash junior doctors’ overall pay by some 26 per cent. Moreover, the end to extra pay for most overtime work would encourage desperate NHS hospitals to impose even longer shifts. There are severe staff shortages across the NHS, and there are no plans for more hiring to cover extra shifts. Instead, they propose to work doctors and other staff into the ground. “Tired doctors make mistakes”, reads a common junior doctors’ placard that resonates with all those who rely on their care.

On 11 February, the morning after the second 24-hour walkout, health secretary Jeremy Hunt detonated his “nuclear option”, unilaterally imposing the new contract. With the arrogance and ham-fistedness characteristic of this government, Hunt touted the “support” of 20 NHS executives, many of whom immediately denied any advance knowledge of or agreement with his move. An online petition demanding that Parliament consider a motion of no confidence in the health secretary garnered more than 100,000 signatures in one day. Even Tory MPs voiced consternation over the government’s handling of the issue. Dr Hannah Mitchell, the daughter of a sitting Tory MP, described Hunt as “either dishonest or stupid” in a letter to the Guardian (12 February).

Vowing to consider further strike action, a spokesman for the British Medical Association (BMA), which represents the doctors, declared of the government: “If it succeeds with its bullying approach of imposing a contract on junior doctors that has been roundly rejected by the profession it will no doubt seek to do the same for other NHS staff.” No doubt, indeed. But a few 24-hour walkouts by junior doctors, who constitute a handful of the more than one million NHS employees, cannot by themselves reverse the capitalist government’s vicious onslaught on the NHS. Meanwhile, many demoralised junior doctors are talking of leaving medicine altogether, or moving to Wales or Scotland (which have different contracts) or abroad.

Three of the country’s biggest unions — Unite, Unison and the GMB — which represent hundreds of thousands of NHS workers, have the clout to bring the NHS, and much of Britain’s economy, to a standstill. But the union tops have not lifted a finger to mobilise their members in solidarity with the junior doctors. Their response to Hunt’s provocation was worse than pathetic. Unison general secretary Dave Prentis bemoaned the fact that unions will lose “faith” in the government’s intentions “if ministers just choose to impose what they want”. The Unite union, headed by Len McCluskey, offered to look “into the legal consequences of imposition” and, predicting a “mass exodus” from the NHS, to “assist junior doctors in the weeks and months to come as their employment circumstances change”.

The government’s vendetta against the junior doctors — and their determined resistance — has placed the future of the NHS at centre stage. A new study by the King’s Fund think tank states, “This is shaping up to be a make or break year for the NHS” (Guardian, 18 February). It could not be clearer that piecemeal privatisation and massive underfunding are wrecking the health service. The Tories are determined to escalate that process until nothing remains of the NHS but a logo. Scarcely a day goes by without some newly reported catastrophe — from the failure to meet the most minimal targets for accident and emergency care to a mental health system that can leave children waiting more than four months for an appointment.

A solid strike throughout the healthcare system — private as well as public — in defence of the junior doctors and of free medical care for all would electrify the proletariat and galvanise the many millions who are fed up with having their housing, healthcare, education and livelihoods hang by a thread. It is necessary to fight for a new leadership of the unions — one which does not sacrifice its members’ wages and jobs in a futile attempt to patch up a bankrupt system but instead pursues a class-struggle fight against capitalist misery. Tied to this is the forging of a revolutionary workers party that will champion the cause of all the oppressed.

The war against the NHS

Following the passage of the 2012 Health and Social Care Act, which signalled a fundamental shift towards private-sector healthcare, the Spartacist League/Britain noted:

“For the British bourgeoisie, the NHS presents an unwelcome overhead — not to mention the easy profits privatisation offers the financial speculators in the City. The interest of the capitalist class in the health of the population comes down to maintaining a workforce fit enough to exploit and soldiers to fight their wars and imperialist adventures. In times of social upheaval, the capitalists may shell out enough to placate the population, but they will always attempt to take those concessions back.”

—“Mobilise union power to defend the NHS”, Workers Hammer no 222, Spring 2013

Labour Party leader Jeremy Corbyn and others on the left lionise the postwar Labour government headed by Clement Attlee as “socialist” because of the nationalisations it carried out. Most of these amounted to giant bailouts of bankrupt industries, for which the state assumed direct responsibility after generously compensating the former owners. But the establishment of the NHS in 1948 was a genuine and far-reaching gain. No longer did working-class families have to worry about paying for the doctor to treat a sick child, or to fear for the needless death of a mother due to infection after childbirth. Many received dental care and glasses for the first time in their lives. This reform was not the result of the kind hearts of the British ruling class. Rather, it was a byproduct of their fear of revolution, as the Soviet workers state, albeit bureaucratically degenerated under Stalinist rule, emerged triumphant from World War II and a wave of working-class militancy swept Europe.

So long as capitalist rule remains, even the most profound reform is reversible under the dictates of the profit system. As the postwar peace turned into a Cold War against the Soviet Union, the capitalists’ priorities shifted. Inroads into the NHS began only four years after its founding, as charges for prescriptions and glasses were introduced to help finance Britain’s involvement in the counterrevolutionary US-led war against the North Korean deformed workers state and the insurgent workers and peasants of South Korea.

In 1990, “Iron Lady” Margaret Thatcher, whose hatred for the Soviet Union was rivalled only by her hatred for the trade unions, introduced an “internal market” into the NHS, planting the seeds of disintegration. A few years later, the New Labour government of Tony Blair vastly expanded the role of “private finance initiatives” (PFIs), supposedly to provide funds for building new hospitals and schools. The NHS trusts, which manage healthcare provision, were gradually transformed into “foundation trusts”, which borrowed on the financial market, entered joint enterprises with private companies and set their own terms of employment. Blair also created the “Extended Choice Network”, allowing handsomely remunerated private centres to treat NHS patients. Then came Cameron’s Health and Social Care Act, which created the clinical commissioning groups that control the lion’s share of the NHS budget, “a gateway for the outflow of billions in NHS funds to private firms”, as we wrote in our 2013 article.

Now the NHS is fragmented into a plethora of different organisations, some public and some private. As Neena Modi, president of the Royal College of Paediatrics and Child Health, noted in an article in the Guardian (9 February), “The private sector is said to have received 70% of contracts awarded over 2013-14, estimated at £20bn of the total NHS budget of £113bn.” Another £10 billion a year goes towards PFI repayments, and administrative costs of the “internal market” swallow up a further £5-10 billion of NHS funds. Among the private firms currently gouging the NHS are Richard Branson’s Virgin operation as well as the Hospital Corporation of America and Optum, a subsidiary of another US healthcare giant, UnitedHealth Group. The CEO of NHS England is in fact a former executive of UnitedHealth.

The quality of care provided by these profit-hungry outfits can be gleaned from the experience of Circle, the pioneer in private sector involvement in the NHS. Last year, Circle pulled out of a £1 billion contract to run Hinchingbrooke Hospital in Cambridgeshire after a Care Quality Commission inspection gave the facility an “inadequate” rating. The hospital’s privatisation had been upheld as a model for the whole NHS. Circle was only three years into its ten-year contract.

At seven per cent, Britain’s healthcare budget is a lower percentage of GDP than that of almost any other West European country. To match the average rate of spending of other European countries, the annual NHS budget would have to rise by £43 billion. Yet the government demands billions in “efficiency” cuts while insisting that NHS trusts will be further penalised if they refuse to implement the new contract for junior doctors.

According to the Guardian (13 February), one in five general practice surgeries in London, covering nearly one million people, may close in the next three years because they cannot find replacements for retiring doctors. Meanwhile, the NHS is short of some 15,000 hospital nurses. Coincidentally, that is just about the number of nurses who would have been recruited from outside Europe in the last few years if tighter immigration controls had not been applied. Now the government is also slashing the domestic supply of new nurses by abolishing the NHS bursaries which currently allow student nurses to pay no university fees and to receive means-tested subsidies ranging between £1000 and £4000 a year. To make up for the lack of available nurses, the NHS pays parasitic private agencies to provide contract workers.

Defence of the NHS cannot be divorced from other social questions. It is tied to the fight against all racial, sexual and national discrimination and for full citizenship rights for all immigrants, who are heavily represented in the workforce; for an end to university tuition fees and a full living stipend for all students; for cancellation of the PFI debt and the return of privatised hospitals and other health facilities to the public sector; to shut down the parasitic private agencies.

Instead of the division of the workforce among 13 different unions and professional associations, which sows disunity and is used to justify scabbing and passivity, what is needed is a single union made up of all healthcare workers, including agency workers — from doctors and nurses to lab technicians and cleaners. Such a union could lead a struggle for a massive infusion of funds into the public health service. This includes the fight to expand education and training and increase hiring, under union control, with special programmes to reach out to minorities and immigrants, so that there would be enough doctors, nurses, technicians and other medical staff to care for the whole population. A revolutionary workers party would fight for the expropriation of the private healthcare, insurance and drug companies and for quality healthcare for all free at the point of use, as part of the struggle for socialist revolution.

Workers need revolutionary leadership

It speaks to the spinelessness of the don’t-rock-the-boat apparatchiks who currently head the trade unions that they have left it to a layer of petty-bourgeois professionals to play a vanguard role in defence of the NHS. The union misleaders are driven by a desire not to defend the workers who pay their salaries but to police the working class and maintain class peace. They hide behind a respectful veneration of the bourgeoisie’s laws (and profits!), avoiding any infringement of the anti-union laws, which proscribe spontaneous or solidarity strike action. The capitalists and City speculators are certainly not so concerned about flouting the laws that supposedly regulate their activities! The union tops’ obeisance to the capitalist order goes a fair way to explain why working people find themselves in their current, parlous state — saddled with declining incomes and zero-hour contracts, working two or more jobs to make ends meet, etc.

In the absence of union struggle, the capitalists have gorged themselves on huge profits derived from the sweat and blood of the workers they exploit while reducing a large and growing part of the populace to penury. The “bedroom tax” on allegedly unoccupied bedrooms of people on housing benefits penalises especially those who can’t or won’t move out of the homes they’ve lived in for decades, eg, the elderly and disabled. Now, the government proposes that families with a joint income of more than £30,000 (£40,000 in London) be forced to pay exorbitant market rents for council housing. This means that a London family could be penalised an estimated average of £12,000 per year!

Suicides, the leading cause of death among men aged 15-49, are steadily increasing. The lack of mental health facilities plays a role here. But so, surely, must the fact that many people — young and not-so-young — can no longer afford to set up their own households, that college-leavers are saddled with unbearable debts for much of their working lives, that young workers — and older workers who have been thrown out of work — can never expect a well-paid, full-time job.

Health means more than jabs, pills and surgical knives: it means a decent place to live, plenty of good food to eat, safe working conditions, the promise of a future that is not just instability and despair. The inequities and manifold oppressions in capitalist society have their roots in a system based on production for bourgeois profit rather than for human need. To guarantee not only quality healthcare for all but all the other fundamental requirements of life demands the construction of a planned, collectivised economy in which those who labour rule. The only future that will allow the all-sided development of humanity, no longer haunted by material want, is one based on an enormous leap in the productive capacity of society — a global classless, communist society guided by the principle: from each according to his abilities, to each according to his needs. Advances in science and technology beginning with the Industrial Revolution made it possible for Marx and Engels to envisage such a future; the prospect of deepening immiseration and bloody wars underlines how necessary it is to fight for it.

The counterrevolutionary destruction of the Soviet Union, undermined by decades of Stalinist misrule, was seized on by capitalist ideologues to proclaim that socialism was contrary to human nature. Yet today Jeremy Corbyn, the first Labour leader in decades to speak positively of socialism, enjoys the support of millions of working people in this country who are fed up with how the profiteers have wrecked their lives. However, Corbyn’s “parliamentary socialism” is truly a pipe dream, a contradiction in terms. Parliament is a capitalist institution, a cover for the class dictatorship of the bourgeoisie. It is no more possible to achieve workers rule through Parliament than it is to defend the workers interests against the bosses while adhering to the bosses’ rules.

Workers need a revolutionary vanguard party, based on the teachings of Marx and Engels and on the experience of the Russian October Revolution of 1917. Led by the Bolshevik party of Lenin and Trotsky, the Revolution demonstrated that it is necessary for the workers to replace the capitalist state with a workers state based on elected workers councils (soviets) in order to open the road to socialism. Although isolated and burdened by the backwardness of an overwhelmingly rural and peasant society and years of economic devastation and social dislocation caused by war and imperialist rampage, the workers state nevertheless used such resources as were available to begin to provide free healthcare and education for all. The Spartacist League is dedicated to building a party of the Bolshevik type, composed of the most conscious and dedicated workers and pro-socialist intellectuals, as part of a reforged Trotskyist Fourth International. The victory of the Fourth International on a global scale will bring about a truly humane epoch.