Editorial from the April 2017 issue of the Socialist Standard
On 4th March 2017, tens of thousands of people marched through London in support of the National Health Service. This winter, hospital waiting times had grown and in the Accident and Emergency (A&E) wards, patients were stranded on trolleys while waiting for beds to become available. This has been exacerbated by the crisis in social care, where elderly people have had to be cared for in NHS hospitals, because of a shortage of places in care homes. Last year, there was a dispute with the junior doctors, who objected to new contracts, which would worsen their working conditions. This is against the backdrop of a squeeze in government funding made in response to the economic downturn in 2008-2009.
The NHS was established in 1948, ostensibly with the principle that health care would be provided free to all regardless of their ability to pay. Although hailed as a great ‘socialist’ achievement at the time, it arose out of the recommendations of the Beveridge report. During the Second World War, many in the ruling class believed that the working class should receive some payback for their sacrifices. However, they were not entirely driven by altruism, as they hoped that the workers would become healthier and more productive. Around this time, there was the beginning of the post war economic boom based on the reconstruction of industry, which made commitments, like this one, affordable.
However, like every product or service in capitalism, health care has to be paid for, which is funded mainly from general taxation and national insurance, the burden of which falls ultimately on profits. Charges for prescriptions were introduced by the Conservative government in 1952. These were abolished by the Labour government in February 1965, only for them to be reintroduced at a higher rate in June 1968 by the same government, albeit with a wider range of exemptions.
In 1990, the Conservative government attempted to control costs by introducing an internal market into the NHS in England, with the establishment of NHS trusts. In 1992, the Private Finance Initiative (PFI) was introduced, in which private firms would be contracted to provide funding for public sector projects. The Labour government supported its use for the NHS and it also established NHS Foundation trusts, which provided more scope for the involvement of private companies. Under the Health and Social Care Act 2012, NHS primary care trusts and strategic health authorities were abolished and more control of NHS funds given over to GPs, who have the freedom to engage private contractors.
Many campaigners blame the Conservative government for the woes of the NHS. However, as experience has shown, Labour have no more solutions to the problems of the NHS than have the Tories. The problems lie not with the Tories, but with the capitalist system itself. The quality of health care depends entirely on the vagaries of the market. If profits are running high, then extra crumbs can be thrown at it, but if profits are falling, then the health service will be squeezed. Only under socialism can the best health care be guaranteed.