From the March 1988 issue of the Socialist Standard
In a society where goods are produced solely for profit, the fact that social needs are subordinate to the demands of profitability can be demonstrated quite simply by the fact that coal mines are closed, the elderly die of cold each winter; food production is curtailed despite widespread starvation in "underdeveloped" countries and malnutrition among the poor in "developed" countries; houses stand empty and building workers are unemployed while people are homeless or live in substandard dwellings.
Services are provided, at a price, to ensure a profit, or are state-funded to facilitate profitability or avoid social disorder (which also affects profitability). It was in this spirit that the Public Health Acts of the last century were passed to eradicate the cholera epidemics, which threatened rich and poor alike, and to combat Chartism and civil disorder. The National Health Service of 1948 was formed in accordance with these same economic rules; the workers' health needed to be conserved because of a shortage of labour and the social unrest of the 1930s had to be averted in the post-war reconstruction of industry.
In recent years capitalism has undergone one of its periodic slumps and state-funded services have been reduced as profitability has been adversely affected. And, in terms of profitability, it is unnecessary and uneconomical to conserve workers' health when there is a reserve army of over three million unemployed.
Concern about the National Health Service and industrial unrest among nurses has reached unprecedented levels. A national survey carried out by the Association of Community Health Councils of England and Wales showed that 50 per cent of health authorities are cutting services to patients by closing beds, wards or specialist units and that: "Parts of the NHS are on the brink of collapse and will fall apart this year unless immediate action is taken" (Guardian, 4 January. 1988). A study by the Incomes Data Services stated that nurses receive the worst compensation in British industry for working a continuous three-shift system and that "A flood of nurses may leave the health service because of proposals by the Government to alter their pay structure" (ibid.).
These reports are to some extent confirmed by the strike of 38 night nurses at North Manchester General Hospital on the 7 January 1988 and the news, a few days later, that the Manchester Royal Infirmary is on the verge of bankruptcy unless more funds are provided in the near future to offset debts incurred by the cuts in their income for the current financial year. In the short term, over 140 redundancies have taken place in a desperate attempt to balance the books.
The Manchester nurses' decision to strike was provoked by the government's intention to reduce the extra pay for night and weekend work and, at the same time, alter nurses' working hours, making the shifts more unpleasant, to provide greater flexibility and economy of labour at the expense of nurses' wages and free time. Enhanced rates for nurses working nights and weekends have been paid only since the mid-1960s and took several years to reach the level of time and one-third for Saturday and night work and time and two-thirds for Sundays and bank holidays. As poor as these rates are, compared with industry, they have been pegged at the 1984 level of pay for trained nurses and. consequently, have lagged behind still further. It is not surprising that the British Medical Journal stated that one in five qualified nurses do one or more extra jobs to supplement their low pay.
It is in keeping with the government's plan to run the health service as cheaply as possible that general managers have been bribed with the offer of bigger bonuses if they can make further savings in the budget of their district health authorities. Further redundancies; closures of more beds and specialist units; the extension of "flexible" hours of working for health service staff will be attempted as the general managers boost their earnings at the expense of their fellow workers and turn a blind eye to the distress of patients as waiting lists for hospital treatment increase.
Although increased productivity and harder work are almost tenets of faith of capitalist government, pay cuts and redundancies are the rewards for an increased patient turnover of nearly forty per cent in the last two years in many British hospitals. To add to the problems of providing an adequate health service there is a shortage of school-leavers which has led to a fall in the number of nurses starting their training. The last time there was a shortage was in the 1950s when Enoch Powell. Minister of Health at that time, launched a recruitment drive in the West Indies and saved the National Health Service from collapse by the exploitation of black, female labour. The ready availability of recruits from the West Indies throughout the 1950s and 1960s also managed to suppress the level of nurses' pay. But Britain's immigration laws have stopped the supply of labour from the Caribbean to help this time.
Up to a point, the present shortage of trainee nurses will not disturb the government as much as it did in the 1950s because the health service is contracting in response to the recession and some ward closures can be blamed on the difficulty of recruitment. But the situation is quite serious — the Royal Manchester Children's Hospital has closed wards recently because of a shortage of trainee nurses (Manchester Evening News, 8 January, 1988) — and the government knows that closing children's wards causes emotions to run high, which can pose problems at election times.
The difficulty of recruiting nurses in London because of the high rents and prohibitive house prices has forced the government to abandon the sale of nurses' homes in the capital and consider providing £20 million to improve nurses' accommodation in the Oxfordshire and Metropolitan regions (Independent, 22 August. 1987). And the Manchester strike forced the government to abandon cutting the rates for nurses' night and weekend work, although the attempt to alter their working hours is still going ahead despite widespread opposition from the health service unions.
The increased turnover of patients and poorer laundering, catering and domestic services has led to increasing stress levels for staff; junior doctors work excessively long hours trying to cope with the rising numbers of admissions. The government's attempt to "privatise'' hospital laundering, catering and domestic services has led to a poorer quality of service due to cuts in the workforce and the use of more part-time, temporary staff. Even where hospital "in-house" tenders were sufficiently low to prevent these services being contracted out to private firms they were still at the expense of staff redundancies. Either way, fewer workers were expected to try to provide the same services as before.
Nurses are also manipulated in this way. Bank nurses, particularly the less expensive enrolled nurses, are employed to cover shortages of staff due to sickness. Thus a trained nurse may languish at home for a week or two and then be asked to work a day or night shift at short notice. These nurses receive no holiday or sick pay and demonstrate how "flexible" labour is merely an euphemism for further exploitation.
As much as the National Health Service is unnecessary from capital's viewpoint in a recession — and John Moore. Secretary of State for Social Services is trying to get a Bill through Parliament to allow hospitals to make a profit, to shift the burden for health care back to the individual — it is also recognised that health services provide a safety valve by "patching-up" the problems created by poverty, poor housing, pollution and stressful, alienating work.
It is unlikely that nurses will leave in the large numbers predicted by Incomes Data Services because there are few alternative jobs to go to. And although the private health sector is expanding it cannot provide employment for all the nurses currently employed by the National Health Service. Even the emigration of nurses has slowed because of contracting health services abroad.
Although there will be further cuts in health provision with an extension of charges for prescriptions, dentistry and other treatments, the government realises that it cannot afford the unpopularity of dismantling the National Health Service with the risk of a return to the political unrest seen in the 1930s. But above all it cannot risk people questioning what makes them ill; for if the workers realise that they suffer from unnecessary illness and early deaths because capitalism makes them poor, and that it is preventable, then they might want more than a reformed health service.
Carl Pinel
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