The question of health and access to necessary health care is of primary concern to the working class. The crumbling provision of state healthcare in Britain is having a dramatic impact on the living conditions of the working class. There are 7.48 million active and retired workers waiting for treatment. 2.84 million workers are long-term sick. The ability to access family doctors is becoming increasingly difficult due to a shortage of General Practitioners. Overworked ambulance crews can take hours to respond to emergency calls, because too many ambulances are waiting for hours to unload patients into Emergency Departments. Patients are unable to be discharged from hospital because of collapsing social care.

The visceral depth of this situation is made clear by an RCN (Royal College of Nurses) Report on Corridor Care in Emergency Departments. The 450 pages of the report are composed of profoundly shocking testimony by health workers.

“A group of patients (6 patients) were cared for in an escalation bay. This space is not suitable for hospital beds, only for trolleys. Patients were elderly - 80+ years old - and frail with multiple co-morbidities, had no chairs, bedside table or lockers, no call bells in place. The room escalation bay was used to be for patients who goes for surgical procedures therefore this room had air conditioning and unable to turn up the heat. The room is freezing cold and blowing cold air to the patients. No nurse in charge present, run by bank or agency nursing staff. In this escalation area, multiple priority calls happened, falls and other incidents. Absolutely unsafe and poor quality of care to patients”.

A paramedic summed up just how desperate the situation is becoming, “As a nurse it is heartbreaking to provide care in corridors and storage rooms where there is no humanity for anyone involved. Families are being given sad news in corridors and also sometimes not even being allowed into see their families due to lack of space in departments. I worked throughout Covid-19 and although it was a horrendous experience this lack of care in the broken system is worse. People are dying as a result of ambulances being held at hospitals and calls are eventually being responded to almost 2 days after 999 has been called.

This has to end, now!”

This situation is causing many deaths. The Royal College of Emergency Medicine estimated that patients having to wait for more than 12 hours in the Emergency Department before being admitted to a ward for continuation of care caused about 14,000 extra deaths in 2023. This is 21 times more deaths in a year than the 645 deaths of British soldiers during the Iraq and Afghan wars.

These figures do not include those deaths caused by delayed ambulances or by waiting to be seen in Emergency Departments. Nor the long-term impact on health caused by delayed treatment for strokes, heart attacks, and other illnesses.

Workers, and the majority of the population are starting to fear becoming ill, particularly if there is an emergency, because they know that they may not get the necessary treatment in time or not at all.

The class division in health

This class division of health care is part of the social war and murder Engels denounced in 1844:

“When one individual inflicts bodily injury upon another such injury that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual; disguised, malicious murder, murder against which none can defend himself, which does not seem what it is, because no man sees the murderer, because the death of the victim seems a natural one, since the offence is more one of omission than of commission. But murder it remains”[1].

The same capitalist laws of accumulation are still driving capitalism’s social war. There may not be starving so many people on the streets, but the drive to maintain profits is still murdering large numbers of workers.

Engels demonstrated that the law of accumulation demands that the proletariat is forced deeper into relative poverty in order for the ruling class to accumulate capital. The levels of poverty amongst the working class are ruining workers’ health. In 2023 1 in 5 adults lived in poverty -14.3 million people. Of these, 8.1 were adults of working age, 4.3 million children and 1.9 million pensioners. Of these 14.3 million 3.8 are classified as destitute, including one million children[2].

The level of social murder inflicted by this social war is astonishing. The public health expert Michael Marmot has calculated that between 2011 and 2019 more than 1 million people died prematurely because they did not have the same life expectancy as the top 10% of society. The vast majority of them were from the working class. Marmot also estimated that 148,000 were socially murdered by the austerity measures of the 2010s[3].

The difference in life expectancy between the least and most deprived areas in Britain is 19 years. 3 times more people will die before the age of 60-64 in the most deprived areas than in those in the most affluent. The people in the most deprived areas have 1.5 times more long-term health conditions such as COPD, diabetes, etc[4].

5000 workers a year are dying from asbestos-related deaths a year in the UK[5]. These deaths arose because the “widespread use of asbestos containing products in the past – particularly in the post WWII building industry – led to a large increase in asbestos-related disease in Great Britain over the last few decades” [6]. The ruling class knew that asbestos caused asbestosis before WW2, but this didn’t stop workers from dying a horrible death.

The attack on healthcare

The rapidly deteriorating state of health care is caused by decades of lack of sufficient funds for NHS, the increasing ill-health caused by growing levels of poverty, murderous rates of exploitation for those at work and the lack of a proper community care. The local authorities that fund social care have had their funding cut by about 60% since 2010. This means less care workers to look after those in need of care in the community. Many care and residential homes are closing due to lack of funding. The result is that 2 out of 3 delayed hospital discharges are due to lack of social care.

The ruling class is aware of the deep crisis in health care: the RCN report is just one of a long stream of reports about the untenable situation in health care and points to one of the manifestations of the profound contradictions of the capitalist system.

In December 2023 over 1.4 million active job postings remained unfilled nationwide and several sectors of the UK economy were in need of workers. To solve this problem the bourgeoisie, even though its priority is to drastically reduce immigration after Brexit, gave the employers permission to recruit tens of thousands of foreign workers to fill the vacancies. At the same time 2.84 million long-term sick workers, most of whom certainly want to return to work, are denied appropriate treatment.

There is nothing they can do about it. It is not a question of moving funding from defence spending or other spending to pay for health. The state has to cut back its spending in order to try and reduce state deficits. It has to prioritise arms spending because the capitalist state is an imperialist state. The ruling class has to defend its national interest by seeking to make the economy more competitive economically and militarily.

The Elective Reform Plan, presented by the Labour government on 6 January this year, demands a stronger competition and an increase in productivity of the NHS which is already facing deep financial deficits and must cut services with another £7 billion. Such a plan expresses more a concern for figures and statistics than for the provision of proper health care. This government is as uninterested in the quality of healthcare as the Tories or any other faction of the ruling class. Those who still might have illusions in the Labour Party may be cured of this belief by its wholehearted commitment to ramping up the war economy. 

The capitalist state is the commander-in-chief of the social war, not a neutral body that has the best interests of the working class at heart. Its purpose is to ensure the most rigorous exploitation of the proletariat and to repress any resistance against the effects of exploitation. As for those too old, too ill or not able to find work, its aim is to drive them back to work, more or less by starving them. Social Security payments are just enough to avoid starvation. The NHS is part of this system of exploitation.

Defence of workers’ health

This pitiless war on the working class’s health and lives is going to get much worse. This deterioration is being driven by the worsening crisis of the world economy, by raging trade wars, with the necessity for British imperialism to significantly step up arms spending. The ruling class is already starting to talk about the working class having to accept attacks on health, education, and social security to pay for more arms.

The struggles of workers in Britain, France, the US and Belgium, since 2022, have shown that the proletariat is not ready to lie down and accept sacrifices. In 2022 the strikes in Britain took place during the first year of the war in Ukraine, and amid talk of the need for more military spending. Today the media hysteria about Trump’s whims and defending Europe against Russia is even louder. The only way to hold back these attacks is for the working class to demonstrate its strength and determination to defend its interests and for all workers, including those working in the health sector and those enduring the deterioration of health provision, to come together in a common struggle against capital and its state.

 

Ernie, April 2025

We publish here a contribution of a sympathiser of the ICC about the discussion at the online contact meeting of Sunday 2 March.

We fully agree with the contribution of the comrade as he emphasises for instance that today the depth in the political crisis of the bourgeoisie in in the USA is unprecedented. After the election of Trump, as he writes, “USA and its upper elements resemble a rogue state with elements of a regime like North Korea”

Just one point we want to clarify.

The comrade writes that, in the current situation in the US, any form of a political choice seems to be absent, since the bourgeoisie has to “submit itself to the dynamic of the tendencies laid down by the decomposition of its system”. However, we think that the American bourgeoisie is not merely a victim of  decomposition. Even if the response of the Trump clan with “America First”, “Make America Great Again”, etc. is completely irrational, it is and remains an attempt to defend its interests as a faction of the American ruling class against the decline of US leadership in the world. And there will be reactions within the US ruling class to the Trump faction’s policies as their disastrous implications become more and more evident. For example, we are now seeing big anti-Trump rallies being organised by Bernie Sanders, Alexandria Ocasio-Cortez and others on the left wing of the Democratic party

.

Meeting on Sunday March 2.

1.

In order to understand Trump 2’s consequences on the world we have to be clear why Trump has been elected as President of the United States.

The reason is that the bourgeoisie have no alternative, no choice in the matter overall – it has to follow, submit itself to the dynamic of the tendencies laid down by the decomposition of its system. It cannot escape from them no matter what or whatever elements exist among itself including the so-called “grown-ups”. The bourgeoisie is in thrall to its system and thus its system’s decay and decomposition is a reflection of a class with no future. The consequences, if it’s not clear how this will pan out, are profound. The post-45 consensus is, as the ICC has laid out for some time now, finished. What takes its place is more chaos and even more centrifugal tendencies. Agreements, pact and protocols are increasingly worthless as chaos and irrationality takes hold.

There’s no Machiavellianism here, no strategy or plan from the bourgeoisie as has been suggested in previous meetings and particularly by MH[1]. Machiavelli is out of the window and instead of the strengthening of the state (state capitalism is the direct descendent of Machiavelli), we see the disembowelment of the most powerful state, its pillaging, as the mighty USA and its upper elements resemble a rogue state with elements of a regime like North Korea (with whom the US voted  last week against Europe!). And one of the great strengths of Machiavelli was his giant nail in the coffin of feudalism with his separation of religion from bourgeois politics. Look at the USA today in this respect (along with India, the Middle East, etc).

The depth of this political crisis is underestimated by the clockwork analysis of the CWO/ICT[2]. It was initially wary to mention Trump’s election and when it did. In “Trump and the New Golden Age”, it emphasises the continuity between Trump, the only difference being “the character of Trump”. That position of continuity was defended by MH in his intervention at the meeting on Sunday where he welcomed the ICC’s position which he suggested supported the continuity of Trump’s election rather than the disaster that it was.  In a further article of the ICT, “As regimes fall...”, dated mid-February, it states: “imperialist camps are re-aligning and ironing out some creases” – yes, that what it says, “ironing out some creases”! The march to world war is ticking away for the ICT. The war between the USA and Russia has long been heralded by the ICT; in Trump’s first term, his hit on the Iranian general Soleimani was seen by the ICT as a precursor to war with Russia when in fact Trump had done Russia a favour (which it later acknowledged).

The rigid and mistaken analysis of the ICT and the position of MH underestimate the enormous upheaval in international relations, the political weakness of the bourgeoisie (that the working class cannot exploit – on the contrary) that has happened with Trump 2. While banging the drum about WW3, the ICT underestimates the real dangers to the class struggle.

2.

Since the rupture the working class has continued to fight with examples from Belgium and the USA where anti-Trumpism is a particular danger to the working class. But nowhere in the western metropoles of capitalism is the working class ready to be mobilised for war. After the betrayal of Social Democracy[3], the class was hoodwinked into war and marched off willingly from towns, cities and villages. In a situation of a profound defeat for the working class, we saw workers mobilised and volunteering to fight for democracy and against fascism in WW2. Not today. Populism is not the expression of a deliberate policy of the bourgeoisie, a ploy to contain the working class as some have suggested. It is instead an expression of the loss of control by the bourgeoisie. It is also an expression of the continuing stand-off of the two major classes and by no means a strategy for containing the working class and mobilising it for war. The British government, as mentioned by the ICC during the meeting, has taken an intelligent approach to its confrontation with the working class by not adopting a frontal attack – as in Belgium – but allowing above inflation pay rises, sick pay rises for lower paid workers and various “workers’ rights” programmes. But this can’t last as inflation rises everywhere with the majority of workers living from paycheque to paycheque.

The ICT position of a march to WW3 underestimates the unbeaten nature of the working class alongside the real dangers coming from decomposition that threaten it.

In previous discussions there were some elements that said the working class should fight this or that element of decomposition (war, ecology, etc.) but the class needs to fight on its own terrain which brings it directly against the needs of the war economy. Therein lays the basis for an offensive from an undefeated working class.

Baboon. 3.3.25