The crisis in the NHS is getting worse. It’s forecast to be in deficit by between £600 million and over a billion. A survey of NHS acute Trust chief executives by the Health Service Journal found that; 75% had frozen recruitment, 25% had made staff redundant, 63% had closed wards and 37% were in deficit. The survey also showed that Trusts were using very dubious methods to protect their finances: 26% were withholding National Insurance payments, 21% were deliberately slow in paying suppliers. The crisis affecting the NHS has reached such a point that the East Suffolk Primary Care Trust, for example, does not have the money to pay March 2006 wages.
The impact of crisis on health workers is very hard. The freezing of jobs is the same as cutting jobs, because effectively that post is no longer there. The impact of such a freeze can be clearly seen in the 50,000 nurses that left the NHS in 2004 a number that certainly did not decrease in 2005. This leaves the remaining health workers to try and maintain some form of service with thousands fewer workers and increasing demands. It is no surprise that 78% of the members of the Royal College of Nurses surveyed in 2005 (Nursing Times 11.10.2005) felt they were working under too much pressure and 49% of those who had left nursing in the previous year had done so because of the workload.
These attacks follow the complete restructuring of pay for health workers. Jobs have been ‘restructured and assessed’ which means that for thousands of workers their jobs are no longer consider to be worth as much as they were, and, once a period of pay protection ends, wage levels go down. To this needs to be added the ‘restructuring’ of pay for unsocial hours worked from April 2006. Instead of being paid by the hour, there will be a complex scaled set of payments based on the proportion of unsocial hours worked over 13 weeks: in other words, a substantial reduction in pay, given the number of such hours worked by health workers.
Also, as with many workers in both the public and private sector, health workers are faced with the loss of the final salary pension scheme.
According to the government the cause of the crisis is bad financial management by the NHS Trusts. For the Tories it is the government’s fault for not being rigorous enough in its ‘reforms’. For the leftists, it is Blair and New Labour’s love affair with private capital that is to blame. What none of them say is that the cause of this crisis is the crisis of capitalism. These attacks are part of a long-term strategy to reduce the burden of the NHS on British state capital that has been underway since the 1980s.
The Labour government has continued the policies set in motion under the Tories…
The constant stream of NHS ‘reforms’, which have increased the use of private capital to fund hospital building, the implementation of strict and draconian targets for health services, the meeting of which determine funding, the introduction of set payments for different operations or other medical procedures, and the most recent proposals to transfer many services now in hospitals into ‘the community’ - a community where private capital, charities and others will be able to bid to run services - are not the aberration of Blair and New Labour. They are the more systematic and brutal continuation of a process of NHS restructuring that started under the Tories in the 80s. It is a strategy based on the state introducing ever greater competition and financial rigor into the NHS. It aims to increase rates of exploitation for health workers and hold down costs.
Health workers do not produce surplus value, through the production of commodities, but they do treat workers whose labour power is the basis for all value creation in capitalist society. Health workers cannot produce more commodities in less time and for less money, but they can be forced to work harder, longer and for less pay, as the NHS tries to save money and increase output.
To this end we have seen a careful acceleration of attacks on health workers and services.
In the 1980s health workers faced a two pronged attack. On the one hand, ancillary services, cleaning etc, were put out to tender which meant tens of thousands of workers saw their wages and conditions reduced. On the other hand, the introduction of local NHS trusts allowed the introduction of new and constantly altered terms and conditions for workers.
In the 1990s this process accelerated with the introduction of different pay scales within trusts. Efforts were made to pitch worker against worker with the introduction of competition between Trusts for the gaining of contracts from the NHS. The tendency for ‘private’ capital to be introduced into the funding of the building of hospitals began under the Tories and was continued and strengthened by Labour. The Private Finance Initiative means that companies pay for building hospitals and directly employ all but clinical workers. This means that clinical and ancillary staff are on different contracts with different employers. It also means that the costs for the state can be spread over 30 to 50 years, which is the usual period of debt repayment to companies involved.
Under Labour this process has been accelerated. Labour has extolled the virtues of ‘local autonomy’ and ‘community’ control of health services, while introducing the most brutal financial and clinical controls. Every level of the health service has been placed under the most harsh regime of payment by results. There are 700 targets an acute hospital has to meet in order to get its full funding. Labour has introduced the direct financial incentives for senior managers to attack workers’ working conditions and pay, because chief executives’ pay is dependent upon the meeting of targets. This means that at every level of management there is the utmost pressure to meet targets, that is, to make workers work even harder.
…Along with its own innovations
The recent proposal to put all community health services out to tender so that businesses, charities etc can run these services, means that tens of thousands of nurses and other health workers are faced with a whole new series of attacks on their pay and conditions if they want to keep their jobs - either with the present employer or a new one.
The proposal to put more funds into community care, and to force many services out of general hospitals, is going to mean even greater attacks as acute Trusts will lose funding at the same time as they have to maintain services for the very ill patients that cost the most to care for. In the case of new hospitals, they will have to service the debt to the companies that built the hospital in the first place, but with less patients and therefore less money. This can only mean more job losses, recruitment freezes, ward closures and calls for workers to accept worse conditions and to work harder in order to attract work to the hospitals.
This strategy has not been confined to British state capitalism: all the major capitalist countries have been carrying out similar ‘reforms’ since the 1980s, as a report by the International Labour Organisation in the late 1990s made clear: “The need to contain expenditure has dominated health policy debate in European countries, despite the very different patterns of expenditure between countries. This has led to major restructuring and privatization initiatives which, as health services are highly labour intensive, impact directly on workers within the health sector. Reforms to the structure and financing of health services, frequently with a competitive element, have placed new pressures on workers”.
The growing attacks expose the reality that hospitals and other health services are basically factories where as many patients are ‘processed’ as quickly and cheaply as possible. The patient is nothing but a sum of money, an illness is a set price and an operation another. If there is not the money to meet the price then the ‘job’ is not done. This logic has always underpinned the NHS but now it is becoming increasingly obvious.
The attacks on NHS workers are going to worsen substantially as the
weight of health spending becomes increasingly intolerable with the deepening
of the economic crisis. Faced with this, health workers cannot fall for the
lies of the unions and the Left that these attacks are the fault of Blair and
privatisation. These attacks are the result of the crisis of the whole
capitalist system. British capitalism cannot do anything else but seek to
reduce spending on health and attack health workers’ working conditions and pay.