SPGB Meetings (1994)

Party News from the November 1994 issue of the Socialist Standard

Never trust a Trust (1993)

 

From the November 1993 issue of the Socialist Standard

The government has recently announced that thirty more district health authorities are to become self-governing in the fourth wave of trusts, and that the remainder will follow suit within two years.

The National Health Service enjoys considerable public support and attempts to return to private medicine have to be carried out cautiously whilst protesting vociferously that there is no such intention. But despite this cautious approach at least three-fifths of all self-governing trusts have run into financial difficulties. And in August, four London hospitals announced that they were going to cancel routine operations for the rest of this financial year. With seven months to go, from the date of these cancellations, to the next financial year, the waiting list for treatment will continue to grow, with pain and discomfort for patients.

The financial difficulties experienced by the health service trusts is only to be expected as an internal market does not put any more money into the system but costs considerably more to administer it. Whilst administrative costs have risen sharply to cope with the extra paperwork many newly-qualified nurses have been unable to obtain jobs and others have been given temporary contracts, only to find themselves unemployed three or six months later.

Despite the greater technological expertise required for modem nursing, the number of qualified nursing staff fell by 5.2 percent between September 1990 and September 1991 according to the Department of Health. But unqualified staff have increased by 17 percent. (Nursing Times. 1993, no.7)

The increase in total staff has been necessary to compensate for the removal of student nurses from the wards into colleges for the Project 2000 training courses. This change from traditional training methods has been introduced to improve academic standards and technical knowledge but also to pay students less by giving them grants instead of employing them as salaried workers.

Despite the dearth of jobs, financial hardship and the prospect of unemployment at the completion of training has led to a 5.5 percent wastage rate for Project 2000 students compared with 4.7 percent for students undertaking traditional training (Nursing Times). While the government juggles with the figures and nurses find out the hard way that professional status counts for little in the job market, the waiting list for treatment has increased by 60,000. A number of hospital trusts have changed nurses’ patterns of shift work, worsening their conditions of service and reversing some of the hard-won gains of the last thirty years. The Bradford Hospital Trust announced up to 300 redundancies shortly after it became a trust.

During recessions the bargaining power of workers is weakened and they are vulnerable to attacks upon their living standards. This will always be the case while capitalism lasts because trade unions tackle effects and not causes. Thus, any gains made during booms will be attacked by employers when there is a surplus of labour during a slump.

The government has repeatedly stated that it wishes to reduce public expenditure. Indeed, public health service employees have been held to a 1.5 percent pay increase this year (equivalent to a pay cut after allowing for inflation), and a proposed wage freeze for next year.

At first glance it seems curious and inconsistent to try to reduce expenditure on the one hand and to increase it on the other by opting for a system of management which is much more expensive. But a consideration of the ideological and political motives underlying the formation of the National Health Service and the reasons for the attempts to dismantle it show that both courses of action are consistent with capitalism’s priorities. When Henry Willink, Conservative Minister of Health in the wartime Churchill coalition government presented the 1944 White Paper setting out the proposals for a unified national health service, free at the point of use, centrally funded and administered by Local Authorities it was because it was recognized that after the sacrifices made by the working class in fighting a lengthy war to protect the capitalists’ interests they were not prepared to accept a return to the heartbreak conditions of the 1930s. It was also recognized that, with an acute shortage of labour, a reliable health service would be needed to conserve workers’ health in the critical postwar years of reconstructing industry. It was also necessary to provide concessions to blunt working-class militancy as strikes would have placed British capitalists at a disadvantage with their competitors.

A centrally-administered health service was more efficient and cost effective than the fragmented, piecemeal provision of health care which had hitherto been available in the 1930s. But by the 1980s, capitalism’s priorities had changed. A worldwide recession had reduced the capitalists’ profits making less money available for social programmes; a large pool of unemployed labour had weakened the power of the trade unions and made it no longer necessary to conserve the health of all the workers. The National Health Service now represents a cost against production that the capitalists would prefer to see drastically reduced if not abolished.

The NHS is an institution welcomed by the working class and its abolition, however desirable from capital’s point of view, is politically damaging, therefore, the moves towards replacing it with private services have been gradual. Laundering, catering and Portering services have been contracted out private companies in the last few years with reduction of staff, lower wages and poorer working conditions in the majority of cases.

Once all district health authorities become self-governing trusts it will be possible to break the power of the trade unions by dismantling the Whitley Council which negotiates health service employees’ pay. The trusts will be able to set their own pay and conditions which will lead to further downward pressure on wages. And with each trust being independent and no longer part of a nationally administered service then a national strike by health service employees over a dispute in an individual trust would be considered to be an illegal "sympathy" strike. Also with an internal market in place it will be possible for a hospital trust to break a strike by sending patients to other hospitals.

It has been claimed that the internal market, with buying and selling of health care on business lines, can make the most efficient use of resources and expertise by sending patients to other hospitals for services which may be in short supply in their own areas, but the 60,000 increase in the waiting list for treatment shows this not to be the case. There is a consultation process between health districts, regional health authorities and the public at each trust application but the public’s response is not disclosed by the Department of Health. We can be certain that if the public’s response to hospital trusts was enthusiastic then this would be widely publicised and trumpeted as a vindication of the government's policies. The secrecy surrounding this information is an attempt to conceal the lack of support for their plans. The announcement by the Government that it intends all health districts to become trusts within the next two years makes a mockery of the so-called consultation process and makes the public meetings little more than a declaration of intent.

In addition to the plans for NHS trusts, the 1989 White Paper Working for Patients (sic) provides for a range of optional extras such as single rooms, television and a choice of meals for those who wish to pay for them which will create a two-tier system with only basic amenities being provided for the poor and better services being provided for the not-so-poor.

A visit to any of the older district general hospitals will provide evidence of expensive refurbishment having been carried out on some of the surgical wards whilst, in many cases, even basic repairs are not carried out on the geriatric wards, reflecting capitalism's attitude to non-producers. Obviously, the majority of elderly patients will be unable to pay for "extras’' out of their pensions. A return to Victorian values, particularly the Victorian workhouse, is beginning to look an unpleasant reality for the poor and needy.

The government’s policies have caused problems for the mentally handicapped. Dr David Tod, President of the National Association of Fundholding Practitioners, told the Conservative Party conference in October that he cannot accept any more mentally handicapped patients in his practice without extra funding (Independent, 9 October).

The proportion of pay which general practitioners earn from the number of patients that they have on their books has been increased from 46 percent to at least 60 percent and this has, predictably, led to a reluctance to treat patients requiring a lot of medical care. There is no doubt that further attacks will be made on the NHS and that the present cumbersome structure is being set up with a view to selling it off to private speculators in due course. For the poor, only the most basic provision will be retained, and the mentally ill will continue to swell the ranks of the homeless as long-stay hospitals continue to be closed without adequate alternative care being allocated.

But the attacks on the NHS provide an object lesson to those who wish to reform capitalism. The reforms were gained only after years of struggle, implemented when it was no longer in capital’s interests to obstruct them, and are being reversed when it was no longer expedient for capital to accede to workers' demands and a recession makes it difficult for workers to resist the encroachment upon their living standards. Nothing less than the complete overthrow of capitalism and its replacement by socialism can prevent this happening to reforms over and over again.

Carl Pinel

SPGB Meetings (1993)

Party News from the November 1993 issue of the Socialist Standard

Socialist Party Meetings (2001)

Party News from the November 2001 issue of the Socialist Standard

Edinburgh Branch Day School

Against all war!

Public Meeting and discussion, Saturday 10th November,

Quaker Meeting House, Victoria Terrace, Grassmarket, Edinburgh.

Afghanistan - Another War For Oil? Speaker: Brian Gardner (Edinburgh), 4pm.

From Hitler to bin Laden - how do you defeat terrorism? Speaker: Richard Donnelly (Glasgow), 5pm.

Questions and Discussion.

Capital study group

The next meeting will be held on Saturday, 1 December 2001 4pm, Head Office, 52 Clapham High Street London (nearest tube: Clapham North). For more details, or if you would like to receive minutes or discussion papers,  please write to stuart_commie@yahoo.co.uk, Stuart Watkins, 173 Archway Road, London, N6 5BL. Tbel: 07785 106 XXX.

Rambles

Walk 1: Hampton Court and Bushey parks. Distance 5 miles. Pub stop for lunch. Meeting place: Hampton Court station, Sunday 4 November, 11am.

Walk 2: Cassiobury park, near Watford. Distance 7 miles. Pub stop for lunch. Meeting place: Watford Underground station (Metropolitan line), Sunday 9 December, 11am.

Enfield and Haringey Branch

Real democracy — local to global

Informal discussion. Thursday, 22 November at 8pm. Angel Community Centre, Raynham Road, Edmonton, N18.

Manchester Branch

Peter Kropotkin: Anarchist and Explorer

Monday, 26 November at 8pm, Hare and Hounds, Shadehill, City Centre. 

Speaker: Carl Pinel

London Sunday evening meetings

Lessons of the German Revolution 1918

Sunday, 25 November at 6.30pm, at Head Office, 52 Clapham High Street, nearest tube Clapham North.

Speaker: Bill Martin

London Day School

Revolutionary socialism versus left-wing reformism - an historical account

Saturday, 17 November at Friends House, Euston (just over the road from Euston mainline station), from 10.30 to 4.30, with break for refreshments.

10.30-11 am: Welcome and tea or coffee

11-12.15: Labouring in vain  — a brief history of Labour Party reformism. Speaker: Darren O'Neil.

12.15-1.15: Lunch

1.15-2.30: Leninism in practice — the Russian Revolution. Speaker: Robert Worden.

2.45-4.30: The Socialist Party — a history of no compromise. Speaker: Richard Donnelly.

Blogger's Note:

Bill Martin's talk on the Lessons of the German Revolution 1918 is available as an audio recording on the SPGB's website.

Knock-out drops (1988)

From the October 1988 issue of the Socialist Standard

Nearly two million people in Britain are addicted to drugs prescribed for them by their doctors. But. unlike the 80,000 heroin addicts who are mostly young and male, most tranquilliser addicts are women and predominantly elderly. Pain, misery, addiction or even death have frequently been associated with legitimately prescribed drugs. In the United States 130,000 deaths occur each year from drugs prescribed by medical practitioners; in Britain nearly one in thirty hospital admissions are due to prescribed drugs and about 2,500 people each year approach the charity Action for Victims of Medical Accidents for help.

With hindsight, some of the mistakes with addictive drugs seem incredible; when heroine was extracted from morphine in 1874 it was hailed as the new "miracle drug" for the safe treatment of morphine and opium addiction because it was considered safe and non-addictive. And it was to take over fifty years before the Rolleston Report identified heroin addiction in 1926. More recently, methadone was used extensively between 1971-1978 to treat morphine addiction and as an analgaesic substitute for morphine but, being itself highly addictive, led to a further spread of addiction.

Psychotropic drugs, prescribed for anxiety and depression, alter the patient's moods or mental processes. These drugs are much more likely to be prescribed for women; and extensive study in Oxfordshire found that psychotropic drugs accounted for one-fifth of all prescriptions and that women received more than twice as many tranquillisers and anti-depressant drugs as men. (Skegg et al British Medical Journal, 1977). The frequency of tranquilliser prescriptions increases with age; women over 75 years of age receive more of these than any other group.

In part, the larger quantities of mood altering drugs prescribed for elderly women can be attributed to the higher incidence of dementia in old age and the fact that most of the more common causes of dementia affect women more than men. But the excessive numbers of prescriptions for tranquillisers are not entirely justified on medical grounds alone. In recent years the closure of substantial numbers of hospital beds has led to increasing numbers of mentally and physically infirm elderly people being "cared for" in the community.

Providing safe care for mentally infirm old people in their own homes causes considerable problems for relatives. All too often tranquillisers have to be used to control the old person's behaviour and. even if the drugs are not addictive, the quality of life for the person is impaired. Caring for a demented person in a family home can prove to be a nightmare. Family life disintegrates due to disturbed nights, incontinence, noisy, aggressive behaviour and the need for somebody to be in attendance at all times. For such families there is no respite: holidays and nights out cannot be taken together and friends are deterred from visiting.

For middle aged women, in particular, caring for an elderly mother causes considerable anxiety because the traditional caring role is reversed and the awareness of the possibility of helplessness and insecurity for themselves in the future becomes all to evident. In such situations the temptation to resort to the use (and often the abuse) of tranquillisers is difficult to resist. Indeed, members of the family providing care may take tranquillisers themselves to cope with the difficult social circumstances forced on them by the lack of provision for care of the elderly. But for both the dependent elderly and their, mainly, female carers, tranquillisers are used as substitutes for social remedies which are not forthcoming under capitalism because workers are viewed as economic units.

The Royal Commission on Population put into perspective the disadvantageous position of the elderly under capitalism:

The burden of maintaining the old does not consist in the money paid out as Old Age Pensions. It consists in the excess of the consumption by the old over their production. It is the fact that (with some exceptions) the old consume without producing which differentiates them from the active population which makes them a factor reducing the average standard of living in the community, (pi 13)

This view of the elderly as redundant economic units has led to inferior standards of accommodation in the majority of hospitals for the long-stay elderly and the mentally ill.

The difficulty of attracting staff-in adequate numbers to work in poor conditions and inadequate facilities can lead to over-reliance on tranquillisers to control the patients as too few staff try to cope with relentlessly increasing numbers of admissions in the drive to make hospitals more "efficient" regardless of the social costs. And in private hospitals and nursing homes there is a greater temptation to resort to the use of tranquillisers to control disturbed elderly residents as trained nursing staff are reduced to a minimum in the drive to make profits.

Capitalist governments operate double standards when confronted with problems of drug abuse. In the past dangerous, addictive drugs have been sold abroad: human misery being an acceptable price to pay as long as profits are made. Drugs of doubtful therapeutic value but which have undesirable or even serious side-effects are produced and, where legislation prevents their use in this country, sold in countries which permit their use. Thus the addiction to tranquillisers and the misery that they cause, like addiction to tobacco and alcohol, only become the concern of the state when the efficiency of the workforce, and consequently profits, is threatened.

In 1987 only £500.000 was allocated to help tranquilliser addicts compared with £24.5 million for the much smaller group of heroin addicts. But. unlike heroin addiction, the use of tranquillisers is legitimate, respectable and widespread, with 14 million prescriptions being dispensed in Britain last year. The enormous profits which the drug industry makes has led to general practitioners being the targets of aggressive advertising campaigns to promote tranquillisers as a panacea for their patients' problems. But for patients who are prescribed benzodiazepine tranquillisers (Lorazepam; Oxazepam; Diazepam. Chlordiazepoxide) for periods of longer than four months physical dependency occurs even at therapeutic dose levels.

Withdrawal symptoms include anxiety, apprehension, tremor, insomnia, nausea and vomiting; in fact, many of the problems for which these drugs were prescribed in the first place.

Sexual dysfunction may be caused by both the phenothiazine group of drugs and the benzodiazepines. The phenothiazines, especially Phenergan, have been associated with cot deaths in infancy. The problems of toxicity and unpleasant side-effects of drugs arise because of the hasty and incomplete research carried out by pharmaceutical companies in their attempts to market their products ahead of their rivals. The continued demand for drugs to relieve anxiety is assured because competitiveness causes fear and insecurity. Capitalism's booms and slumps, wars, alienation at work and impoverishment in old age all generate anxiety for workers. And for women, the problems of isolation within the home for housewives or the stress of the "double shift" for working mothers leads to them consulting their doctors for the relief of tension more often than men.

Women's economic dependence on men (who themselves are economically insecure) has served capitalism's interests by providing future generations of workers within the conventional framework of the family.

Patrick Jenkin when he was Secretary of State for Social Services, stated.

I don't think that mothers have the same right to work as fathers. If the good Lord had intended us to have equal rights to go out to work, he wouldn't have created men and women. (Man Alive, October 1979)

The barriers placed in the way of working mothers by such attitudes; relegation to mostly part-time, unskilled, alienating work; low pay — women earned less than three-quarters of the average wages paid to men in 1982 — have all combined to place a greater emotional strain on women. The operation of factories around the clock to maximise profits leads to shift workers being forced to adopt unnatural life-styles. Insomnia causes some workers to resort to taking sleeping tablets to cope with this. Doctors are helpless to remedy the political causes of all these problems and offer tranquillisers to help patients cope with intolerable social circumstances.

Further abuses of tranquillisers occur in prisons where drugs are used to control prisoners who fail to "adjust" to their environment.

Undeniably, tranquillisers can be of value. Used carefully they can help to relieve distress. But it is the application of drugs under capitalism, which fails to heed the lessons of the past while the present is profitable, which is at fault. Medical advances, in common with all forms of technological advances, will be abused until the workers decide to place human needs before profits.

Carl Pinel

SPGB Meetings (1993)

Party News from the October 1993 issue of the Socialist Standard

NHS dispute: In place of life (1982)

From the October 1982 issue of the Socialist Standard

In May the long-awaited and greatly feared industrial action by workers in the National Health Service began in South London. Hundreds of ward orderlies, cleaners, catering staff and hospital porters declared a one-day strike. Similar action was taken in Manchester, where three people were arrested after nurses clashed with NUPE pickets outside Oldham and District General Hospital. On May 19 over 600,000 NHS employees took the day off in various parts of the country; and on May 27 and subsequent Thursdays for several weeks two-hour stoppages by selected groups were staged. The action was stepped up in June.

In the months since the beginning of the dispute, hospital waiting lists have soared, admissions have plummeted and tempers have frayed. Rumours are rife that the strikes may be extended to accident and emergency services within the near future.

The aim behind this action is to improve the pay offer for 1982-3 made to nurses, midwives and ancillary staffs by the Department of Health and Social Security. Initially, the offer proposed an increase of 4 per cent on basic income for most ancillary workers, and an average increase of 6.4 per cent for most nursing and midwifery grades, “in recognition of their special skills”, with veiled promises from the Secretary of State for Social Services, Norman Fowler, of future additional payments to nurses “to be drawn from government contingency funds”. Ambulance workers, doctors and dentists and hospital electricians and maintenance staff, whose pay settlements are made separately, were offered average pay rises of 5, 6 and 8 per cent respectively.

In June, the offer to nurses and midwives was increased to 7.5 per cent; ambulance workers and hospital pharmacists were to receive 6.5 per cent and other ancillary workers 6 per cent. These offers were immediately rejected by all except nurses in the Royal College of Nursing, who have now also voted to turn down the offer.

The nurses' and ancillary workers’ claim was. and continues to be, for increases averaging 12 per cent on basic rates, with a reduction in hours of work and more annual leave, and future index-linked pay increases. For the first time, the ten TUC-affiliated unions representing health service workers were to co-ordinate the campaign for these increases through their membership of the TUC’s Health Services Committee. Of the ten, the most important would be the National Union of Public Employees (NUPE) with 300,000 technical, ancillary and nursing staff members in the NHS, the National Association of Local Government Officers (NALGO) with 100,000 NHS members and the Confederation of Health Service Employees (COHSE) with 150,000 members employed mainly in psychiatric and mental subnormality hospitals. The Royal College of Nursing, which is not affiliated to the TUC but has for some years flirted with the idea of limited industrial action by its 195,000 nursing and midwifery members, declared its support for the campaign in June, though without any change in its "no strike” policy. As it represents more nurses than any other union, the RCN’s support was of crucial importance to the success of the campaign.

Official union plans were to reduce the health service to an emergency service within a few weeks, beginning as early as possible after April 26, organisation being initially by local union branches. TUC policy prevented the withdrawal of emergency cover and there has been no change in this at the lime of writing, although spokesmen for individual branches have asserted that the policy is not sacrosanct.

Since the strike began to bite, with a lull at the height of the Falklands escapade (a propitious exercise for the government from more than one point of view), the propaganda war between unions and DHSS has been vigorous and almost unbroken. The government has naturally gone to great lengths to sugar the pill which its workers are expected to swallow, promising “new arrangements" (unspecified) for nurses' and midwives’ pay in the future, based perhaps on a "comparability scale” of the sort mooted on August 18, and talks on new arrangements for ancillary staff. It has also descended to the unusual tactic of publishing blatantly misleading advertisements to NHS staff in national newspapers (of which more below). But the DHSS campaign has concentrated on the message that, owing to the nature of their work, health workers are morally not entitled to strike or take other action which. in the words of Norman Fowler, "must damage patient services and lengthen waiting lists”.

This judgment has posed a considerable dilemma for health service workers. Indeed, it was thought at first that public outrage against the withdrawal of one of the most vital services — outrage assiduously stimulated by the national newspapers — might seriously weaken the strikers' resolve. In fact, unexpected support for the 12 per cent claim received initially from hospital employees in the National Association of Health Authorities of England and Wales, and from doctors of the usually very conservative British Medical Association and in Scotland and Yorkshire, have greatly improved the NHS workers’ public image. (The Lancet, one of the two most respected medical journals, on August 13 1982. actually called for Fowler’s resignation over the matter. But doubts remain among the strikers about the "justice" and efficacy of their action.

The NHS is the largest employer in Britain, with nearly 800,000 workers, and is the tenth largest employer in the world. NHS pay policy, while it is in the end controlled by the government, is influenced, for some groups of workers, by "independent assessors" like the Doctors' and Dentists’ Pay Review Board. (Senior hospital doctors also retain the archaic right to confer “merit awards" upon one another, which may add around £18,000 to an annual income of £21,000 at top consultant rates, without any party to the exercise being accountable to Parliament or the DHSS.) No independent bodies exist to assess the pay of nurses, midwives and the majority of ancillary workers; the nurses’ and midwives' Whitley Councils are merely negotiating forums. Pay increases in the NHS have not been index-linked and are consequently subject to the vicissitudes of government policy, and have tended to be very low.

The 1974-9 Labour government, pledged to rectify this situation, increased NHS wages and salaries in their first year of office. By October 1975 wage rates were approaching those in other industries, but in subsequent years they again fell behind. The present rate for an unskilled male worker in the NHS is about £65 a wreck. After a 12 per cent increase, the basic rate would still be below the net family income at which supplementary benefit becomes payable (currently £82 a week). So a high level of overtime working is necessary for ancillary workers with families — if it can be had. But there are still workers like the laundry attendant interviewed in the Observer of August 15, who earns £71 take-home pay for a 40-hour week plus 18 hours overtime, and who must support families on that. A first year nurse working full-time on the wards receives £63 (gross) a week, after working frequent night shifts and “unsocial hours" as part of the job contract. Board and lodging costs for nurses in hospitals have risen by between 18 and 33 per cent in the past year. According to COHSE, many of these people would be better off on the dole.

On August 6, the DHSS paid about £85.000 for an advertisement in the main national newspapers “to ensure that all NHS staff are aware of the facts". It stated that a ward sister’s “estimated weekly gross average earnings” would be raised by the current pay offer to between £132 and £170 a week. For a staff nurse, the increase would bring in from £107 to £131 a week; for a male ancillary worker (position unspecified) £91-£146 a week, and for a female ancillary worker, £82-£139.

The following day, health workers staged protest strikes in several Scottish hospitals, and COHSE announced that it would report the DHSS to the Advertising Standards Authority. For, as a NUPE official commented, the higher figure mentioned in relation to ancillary staff would apply to no more than 160 top-grade employees, and then only after working up to 20 hours overtime. All the other figures similarly assumed maximum rates of overtime and additional earnings. In fact, most ancillary workers in cleaning, catering and other general service fields are women working part-time, who would be quite unable to earn such amounts.

The DHSS has since admitted that surplus payments were included in its calculations, but insisted they were “statistically valid". Union statistics clearly show that this was not true, whatever “estimated weekly gross average earnings” may be taken to mean. Need we be surprised? Lies and distortions are constantly fed to us to try to persuade people to smoke cigarettes, to insure for private health care, to support the armed forces, so why should the government not use the same tactics in wage-bargaining?

The way in which the health workers’ scruples about striking have been used by successive governments to hold down wages is demonstrated by the recent awards of between 14.3 and 18.6 per cent to top civil servants, the judiciary and senior officers in the armed forces, of 9 per cent to gas workers and 7.5 per cent to public sector manual workers outside the NHS. For the health workers, according to Norman Fowler, 6 per cent should suffice and 12 per cent is "unrealistic" — as if 12 per cent on a pittance made for anything other than a slightly larger pittance.

The question of pay is not the only one to trouble NHS staff. In recent years the loss of small hospitals and the concentration of beds and ancillary services in large district general hospitals, the reduction in patient turnover time and the cut-back in recruitment have greatly increased the work-load on existing staff. In Brent Health District in London, it has been calculated that earlier discharge of patients (five days earlier, in some cases) and a reduction in the time for which a bed is left empty between successive patients have allowed a 25 per cent reduction in beds without affecting waiting lists. As there has been no increase in the number of staff employed in Brent, either in the hospitals or in the community where patients now do most of their convalescing, this has imposed a heavy extra burden on hospital workers. The day-to-day running of a hospital is very labour-intensive; it is difficult to reduce this by introducing machinery. And it must be remembered that 75 per cent of NHS employees are women who, besides their traditionally lower earnings, tend to have pressing commitments and a full job of unpaid work at home.

Women's average earnings now are 37 per cent lower than men’s; 87 per cent of part-time workers and 75 per cent of lower-paid workers are women. Promotion prospects for women in the NHS are poor, and many are forced to take on agency (private) nursing — a notoriously unreliable source of income — in their off- duty hours. On those precious days when they are not working unsocial hours and night shifts for the NHS, they may be doing so for the agency. In truth, they are a peculiarly exploited group of workers.

The long hours are made even more intolerable by the conditions in which they have to be spent. Many hospitals are still situated in old and wholly inappropriate buildings, particularly geriatric, psychiatric and mental subnormality hospitals and small general hospitals in underfinanced and inner city districts. Less than a quarter of existing hospitals have been built since 1948, as against half of the existing schools and houses; 40 per cent of hospitals in England and Wales were built before 1918. and 6.5 per cent before 1850 (In Sickness and in Health — David Owen). The task of caring for sick human beings in such decayed surroundings may be a particularly frustrating and at times a revolting one, and not without risks. Occupational accidents are by no means uncommon: orthopaedic injuries constitute a particularly grave risk for nurses, through proper lifting aids not being installed.

Even in the best-run hospitals workers may be exposed to infections, air-borne drugs, chemical toxins and radiation at a high level. Among the identified effects of this exposure are miscarriages, which occur twice as commonly among women with an occupational risk of inhaling low levels of anaesthetic gases than among others. Occurrence of tuberculosis is five times as common among microbiological laboratory staff in hospitals as in the general population (Hospital Hazards —leaflet produced by the British Society for Social Responsibility in Science, 1981). It is true that the NHS commonly gives its staff priority over other patients when they are in need of medical advice or treatment; but that can hardly be regarded as a perk. People clearly do not join the health service for the sake of their own health.

In an attempt to play down the penalties of employment in the NHS, Fowler referred to it in Parliament as a “service which enjoys secure and growing employment”. This hackneyed argument no longer holds water. It is true that the number of people employed by the service is expected to rise by around 10,000 in 1982-3 but it certainly is not true that individual employees arc secure in their jobs. In such a labour- intensive industry, the tightening of belts demanded by successive governments over the last two decades has meant lay-offs, either through hospital closures or as a result of the policy of reducing staffing levels by “natural wastage”. The resulting increase in work loads for remaining staff has been partially offset, at least in the short term, by the conscription of student nurses and police cadets, who can be made to work hard for little pay, and by steadily increasing numbers of voluntary workers. These people effectively mask the effects of job losses, and even of strikes; the fear that voluntary labour may be used for strikebreaking has often inhibited workers from taking industrial action in the past. This is not to deny the useful work performed by voluntary workers, particularly in geriatric and psychiatric care, and care of the mentally handicapped. But the extent to which voluntary labour has replaced paid labour in hospitals of all kinds puts in doubt both the future standard of care in these hospitals and the good-will extended to voluntary workers by employees whose livelihoods they threaten.

It seems likely that the government will take advantage of the present chaos in the public service to urge increased openings for private contractors in NHS ancillary services and for medical insurance schemes. Even before the dispute, the growing proportion of the NHS workforce hired from private companies was a source of concern to workers who feared it would divide and weaken the unions at times of industrial action, as well as masking the effects of redundancies in the regular workforce. In Sweden. 70 per cent of ancillary services are contracted out to private operators; and such an arrangement would be favoured by the present government, since contract workers are easily hired and fired, and are often more flexible than permanent workers.

Perhaps the most notable feature of the dispute is the distinctive attitude of the nurses and midwives. Until now, these workers have been well known for their willingness to perform an exceptionally demanding and highly responsible job, often under totally inadequate conditions and for the most punishing hours, in return for very low rates of pay. They have been eulogised on paper and on the screen as earthly angels with unshakeable traditions of discipline and dedication. It has often been assumed, both by governments and by the public at large, that in keeping with their singularly “feminine” (because caring) role, nurses should also be politically weak, and should do the feminine thing by obeying the (predominantly male) authorities, just as they are expected to obey the (predominantly male) doctors. Nurses have tended to accept this and have therefore become among the most conspicuously exploited of all workers. Offers of sympathetic strike action from non-nursing trade unions often reflect this all too clearly. Such support may come across as tactless or patronising and may actually reinforce the popular prejudice that a "caring profession" must inherently be vulnerable to exploitation. Even when their union colleagues can turn this prejudice to their own advantage — as during this dispute, when health ministers confessed that only popular sympathy for the nurses prevents them from taking a tougher line with the other health service staffs many nurses feel like weak and therefore second-class union members.

PC

Blogger's Note:

I'm not 100% sure who 'PC' was. My initial thought was that it could have been an early pen-name for Carl Pinel, but I've since been told that it could have been (Doctor) Peter Cook. Fingers crossed that one of them reads the blog, and clears the matter up for me.

SPGB Meetings (1992)

Party News from the September 1992 issue of the Socialist Standard

Business methods undermine health service (1994)

From the August 1994 issue of the Socialist Standard

In recent years there have been a number of sinister changes in the National Health Service. The use of deliberately deceptive rhetoric employed in the 1989 White Paper Working for Patients has tried to disguise the fact that the NHS is becoming increasingly subjected to market forces to the detriment of patient care and is becoming increasingly undemocratic. Expressions of dissent are stifled by getting rid of medical and nursing staff who protest at the deterioration in health care.

With a record 1.07 million people on the waiting list for treatment and an estimated two million people waiting for their first appointment before they can even join an official waiting list (Guardian, 7 May), it is clear that there is something seriously wrong with the health service.

Of more serious concern is the fact that so many people are ill. Poverty is the main contributory factor of ill-health and the increase in morbidity rates in recent years reflects the attacks on the living standards of the workers and the continued high rates of unemployment caused by capitalism’s slump.

Almost half the health trusts are failing to reach their financial targets and in 1992-93, £265 million had to be borrowed from the government or from banks and underwritten from taxes (Observer, 22 May).

To try to save money the Mancunian Community Trust is sending letters to its staff asking them if they want to take breaks to start families, take up courses or work overseas. All of these options are cheaper than redundancies, but the Trust’s chief executive Elizabeth Law has warned that if the workforce cannot be reduced by voluntary means then people may have to be forced out (Manchester Metro News, 27 May).

More bureaucrats

Administrative costs in the internal market have risen from four percent in the mid-1980s to eleven percent of NHS spending by 1993, and there are now half as many administrators and clerical staff as there are nurses in British hospitals.

In fact, when one considers that nurses work a three-shift system to cover 24 hours a day, seven days a week, there are actually more clerical and administrative staff working in hospitals on weekdays than there are nurses.

The Health Secretary has the power to appoint the general managers of large hospitals and the chairpersons of trusts are political appointees: Ann Parkinson, Sheila Taylor, Sarah Biffen and Mary Archer, all wives of well-known Conservatives, are on the boards of trust hospitals. The government has succeeded in pushing through unpopular measures by political appointments and patronage. Thus, lacking control of local councils in many areas, Conservative ideology can be imposed on the electorate which would have been opposed by councillors on the old boards.

The NHS has never been particularly democratic. Nurses have been subjected to a para-military, hierarchical management which has placed them in a subordinate position to medical staff. A questioning attitude has been discouraged; speaking out considered "unprofessional". Consequently, very few nurses have spoken out about shortcomings in the service or their terms of employment. In the past, large numbers of immigrant nurses were dependent on hospital employment for a place to live and continued stay in this country. And this made criticism extremely difficult because of the risks of speaking out.

Doctors have always been in a privileged position in terms of pay, status and power in the NHS and have been able to speak up for their patients. But in the last fifteen years this has begun to change. Doctors who speak out about shortcomings in their hospitals now risk disciplinary action being taken against them.

Disciplinary action

Early in 1990 Dr Helen Zeitlin, a consultant haematologist at Alexandra Hospital, Redditch spoke at a public meeting against the hospital becoming a self-governing trust. She also criticised the shortage of nursing staff at the hospital (Guardian, 10 May 1991). In November 1990 Dr Zeitlin was told that disciplinary action would be taken against her for misuse of a nursing report on staffing levels. Redundancy was then proposed, only to be changed for a different set of disciplinary charges. These charges were then dropped and Dr Zeitlin was made redundant with 24 hours notice instead of the usual three months.

Hospital bosses sometimes go to extreme lengths to silence critics. Dr Bridget O'Connell worked as a consultant paediatrician at the King George Hospital, Ilford from 1977 until the end of 1982 when she was suspended because of her alleged "inability to relate effectively with clinical colleagues". Significantly, this occurred after she had complained to management of her concern about the standard of care within the paediatric service. For the next eleven-and-a-half years Dr O’Connell remained suspended on full pay of about £50,000 a year before the North Thames Regional Board withdrew all allegations, apologised and paid damages believed to be a six-figure sum (Guardian, 7 May).

A doctor was dismissed in 1993 in Cornwall for misconduct. Nurses had pressure put on them to keep secret diaries of her activities to provide evidence which could be used against her (Nursing Tunes, 13 April).

The row caused by the disclosure that a consultant in Luton, known to be opposed to trusts, had his telephone bugged by the chief executive forced junior minister, Tom Sackville to intervene. He stated that anyone "bugging" a telephone will be sacked but that individual employers have to decide whether to include confidentiality clauses in their contract of employment (Manchester Evening News, 24 May).

Most nurses have not seen the NHS executive Duncan Nichol’s guidelines on reporting incidents which give rise to concern over treatment or staffing levels, and some NHS trusts have introduced catch-all gagging clauses into nurses’ contracts to prevent them from speaking out, although barrister Michael Douglas has stated that some of them are so broad as to be meaningless (Nursing Times, vol.90, 1994).

Spying, illegal telephone tapping and the use of disciplinary action to silence critics all add to the climate of fear and mistrust pervading the health service. For health workers the message is clear: to speak out against the undemocratic, anti-working-class measures is to risk the sack.

Business methods can never operate in the interests of the workers; the whole history of capitalism has shown that misery always follows in its wake. The NHS, in its slow but inexorable move towards private health care, is showing all the ugly features of capitalism. Only by workers uniting to get rid of capitalism can we stop the misery that the system imposes on our lives.

Carl Pinel

SPGB Meetings (1995)

Party News from the February 1995 issue of the Socialist Standard

The nurses' dilemma (1982)

From the November 1982 issue of the Socialist Standard

In any dispute over their pay, nurses are in an extremely difficult position. The desire to care for other human beings and to accept responsibility for them when they are in need is a compelling desire for most, if not all of us. The gratification of this desire is intensely rewarding and the great majority of working people, their lives eclipsed by a nine-to-five routine, may speak with envy of the nurses' privileged role. It is true that nurses may in some instances be moved to acts of gross inhumanity. whether by occupational stress or shortcomings in their private lives; this is amply demonstrated by recent well-publicised reports of sustained brutality towards patients at the Rampton Hospital. But for the overwhelming majority of nurses, and for all workers with a direct involvement in patient care, the patients' needs command immediate concern and attention.

Thus it is only in the last few years that nurses in this country have even threatened industrial action. In their ballot on the initial 6.4 per cent pay offer. RCN nurses refused an offer for the first time ever. Even while some nurses are striking in defence of that refusal a few creep back, conscience-stricken, through picket lines, to bring fish and chips to the patients or reassure themselves that the remaining staff can cope. After the IRA bomb attack in Hyde Park, large numbers of local health workers called off their strike in order to look after the victims; and the TUC Health Services Committee still insists upon its code of conduct, according to which emergency services must be maintained throughout the strikes. In effect, all health workers (but above all the nurses) are morally blackmailed not to strike.

Can anyone doubt their desperation, when people accustomed to such selfless actions can bring themselves to dismantle beds (at the West Cheshire Hospital) to prevent further non-emergency admissions? Can anyone believe that they watch the waiting list for surgical operations at St. Thomas’s Hospital in London mounting to the 8,000 mark, and hear a district health administrator in Doncaster announcing that "it may be the case that some patients are dying" with equanimity? Some health workers even called for a one-day suspension of the accident and emergency services. These people are not murderers, whatever the newspapers may say.

The tragic fact is that there can be no progress towards their simple quest as they do their gruelling work for the benefit of others, unless they are also ready at times to endanger the lives of their patients and dependants by industrial blackmail. All workers are mercenaries, who must sell their abilities to an employer or else go hungry; and just as the buyer must learn those highly-valued attributes of the successful businessman — hard bargaining and ruthless persistence — so also must the worker, if he or she is not to be degraded to the barest minimum of subsistence. Mercenaries learn quickly that conscience and devotion to "duty" are luxuries which, at times, they cannot afford.

Any illusions about the NHS being a service created with the humane motive of free care for all, are dispelled if we consider why health services in a rudimentary form were available to workers as early as the mid-nineteenth century. Is it credible that tyrannical employers, bleeding their workers for every last drop of profit, should have subsidised medical attention for their sick and injured wage-slaves, solely for the latter's benefit? The major improvements in sanitation, the building of many early hospitals and workhouses and the proliferation of doctors in Britain during the nineteenth century, were generally limited to those areas where industry needed a fit and healthy workforce, rather than those parts where people's needs were greatest. London and the major English conurbations had well-established systems of relief for the sick, the disabled and the most impoverished males, long before the centuries-starved and diseased peasants of Ireland (then part of the Empire) received any succour. And when conditions at last began to improve in Ireland, as in underdeveloped parts of all nations, they did so first in industrial centres (in the North), only benefiting people in the populous but economically backward country districts as they gave up their ties with the land and put themselves at the service of their new industrial overlords.

The myth of the NHS as an island of welfare in the sea of capitalism is fast waning as the recession puts increasing pressure on the provision of services. The taxes levied to finance these services are a burden ultimately on employers, who are prepared to provide maintenance services to their workers for reasons of efficiency; but in a recession even this is threatened. Workers cannot withhold taxes or channel them as they might wish. If someone earns £4,000 a year "after tax", that is all he or she earns. Taxes are only what the boss is prepared to give his government, in order that we may be fed and watered, trained and controlled, and mended when we are broken. "Our"national income tax has been a confidence trick from the first, to make us seem better off than we are, and to encourage in us a spurious pride in "public" projects — be they hospitals or wars — over which we have no control.

The NHS did not represent a departure from the economic imperative of capitalism, although this is not to say that some politicians and reformists might not, in 1944 as in previous years, have had humane motives. But the important point is that only while such relief brought economic advantage to the owners of industry would they fund such a programme. The NHS aimed to extend the existing "breakdown service” for workers to the poorest and most vulnerable to disease after the slaughter of the Second World War — who would be needed to rebuild the profitable economy in the post-war years. Similar attempts were made in other European countries at the time. In the end, however, the proclaimed commitment of the government of 1944 to ensuring "that in future every man, woman and child can rely on getting . . . the best medical and other facilities available" was empty verbiage. The amount of money spent on building new hospitals and health centres remained virtually constant throughout the 1950s, and staff training showed only a moderate increase. The prosperous industrial centres, where health services had previously been concentrated, continued to see the largest developments in health care, while the most outlying districts and those inner city districts where viable industry had been depleted by war, depression and the decline of established trades were generally neglected. Julian Tudor Hart, a GP in South Wales (one of the more deprived areas) has referred to this as the "Inverse Care" law, according to which the greatest effort is devoted to providing for those least in need. The others, who because of their birthplace or their bad fortune offer insufficient returns on commercial exploitation, must go short.

The same artificial economic restriction leads to an emphasis on "curing" rather than caring, and to the neglect of services to the elderly and the mentally handicapped. Life expectancy has increased since 1870 as a result of improved food and water supplies and sanitation. Therapeutic medicine has had little effect. Improvements in the conditions of the working class within capitalist society are only paid for if they can generate an overall increase in profitability. It has been clear since 1948 that the NHS could not hope to improve health care for workers up to the standards enjoyed by the rich.

Aneurin Bevan's Ministry of Health, after protracted squabbles, left the consultant physicians and surgeons ample opportunity to keep pay beds in NHS hospitals, even giving their private patients priority in the use of NHS staff and facilities (the practice is still widespread). From the start, these private beds were set in comfortable surroundings which contrasted sharply with the spartan appearance of the wards. Private clinics continued to grow separately, and Labour administrations have turned out to be as keen as any other to scotch moves towards their abolition. For while no government would dare to cut off its pay-masters' access to the best medical care, at the sort of price that only they and their best-paid hirelings could afford (up to £1,600 a week in some chic London hospitals) no government could hope to provide such facilities for the whole working class. Even BUPA can provide its poorer clients with no more than cheap nursing-home accommodation and decidedly second-rate treatment.

All this must not be taken to mean that the NHS is cheap. Government predictions put its net cost next year at £8-9 billion (around 40 per cent of total "public expenditure"). So it is hardly surprising that in a recession expenditure is cut back — by Labour and Conservative governments. The closure of hospitals, the growth of waiting lists, the continuing discrimination against the "Cinderella services" and the mounting toll of deprivation and disease (for example, whooping cough) in under-financed districts are in a very real sense inevitable to the working of the present social system, as is the call for increased efficiency (lay-offs) to compensate. This is the profit motive in action: this is the legacy of capitalism. And if, at the same time as the hospitals are closing, ad-men still pimp for the booze and tobacco companies, fortunes are spent teaching children to suck their teeth away, factories spew their toxic wastes into the environment. and homelessness, poverty and unemployment eventually drive one in nine of us into mental illness — then that is also the inevitable legacy of capitalism.

So no special responsibility for the plight of the patients can be laid with the health workers. The profit system created much of their sickness to begin with. The profit system required the running-down of the health service in response to the recession in the trade cycle. And the profit system obliges nurses and porters, like all other workers, to resort to desperate and sometimes inhuman measures, if they are necessary for their survival.

Strategy for victory

Certainly, the history of the trade union movement contains some relative successes. After 1824, when unions were first legalised in Britain, wages and working conditions showed a marked improvement. Since that time, employers have seldom dared to impose such inhuman conditions upon unionised workers (in peacetime at least) as were commonplace before 1824. Both private employers and governments regularly consult unions over wage-fixing, and from this fact there has arisen the popular myth of union power.

But, like the provision of health care, the legalisation of union activity could only take place when it was likely to contribute to the smooth running of capitalism. To a certain extent, legalisation was prompted by the realisation that the unions simply would not go away; but there was more to it than that. For in so far as they discipline their own members, maintaining order on the shop floor, unions play an important part in capitalist production. In a recession. when production is being cut back anyway, the strike weapon is far less effective than in times of boom.

Trade union action is weakened by the lack of democracy, where decisions about the running of strikes are left to minorities. The elevation by union members of some workers as leaders makes it easier for the employers to defuse the impact of the action by selective sackings, such as that of Philip McIntee. NUPE shop steward at the London Hospital in Whitechapel, on 19 August.

Workers are forced to struggle constantly through trade unions even to prevent living standards being reduced, and sometimes in this circular struggle the insanity of the system of wage labour leads to painful dilemmas such as that faced by the NHS workers. Strikes by any workers, be they coal miners, sewage workers, lorry drivers or fruit pickers, if they are to hurt the employer are also likely to hurt other workers. They must also hurt the strikers themselves, if only by the temporary drop in earnings. It may make them generally unpopular, and it may lose them their jobs. If they win their dispute, it may be at the cost of other concessions; if they lose it. much bitterness will remain. Whether the industry concerned is private or state owned, and whether the government is Labour or Tory makes no difference to this. Labour governments tried to limit wage increases by legislation and have called in troops to break strikes, as well as making cuts in public services. British Rail workers are the latest to have learned the true position of state employees, and the NHS workers must do so too.

The real solution to the health workers' dilemma lies beyond the struggle over wages. All of the wealth in society is produced by wage- and salary-earning workers. This society exists because workers consent to profits and wages, the factories which provide wealth as well as poisoning us, the media which enlighten and mislead us, and the hospitals which cure us, only to send us back to be damaged further. It now is time for us to take control of them all. to realise the next economic and social stage of human social evolution. Then, medical resources need be limited only by the rate at which it is possible and desirable to produce them, rather than by the artificial barrier of financial viability. The task of caring can be a joyful one, in which all can participate freely. 

PC

Blogger's Note:

I'm not 100% sure who 'PC' was. My initial thought was that it could have been an early pen-name for Carl Pinel, but I've since been told that it could have been (Doctor) Peter Cook. Fingers crossed that one of them reads the blog, and clears the matter up for me.

SPGB Meetings (1995)

Party News from the June 1995 issue of the Socialist Standard

Socialist Party Meetings (1996)

Party News from the June 1996 issue of the Socialist Standard

SPGB Meetings (1991)

Party News from the December 1991 issue of the Socialist Standard

. . . rough justice (2003)

From the November 2003 issue of the Socialist Standard

Capitalism is a system based on competition, and the criminal justice system, like all other institutions and activities, is dominated by this drive. Thus, trials of those accused of crimes are battles between the prosecution and defence teams. Being able to afford a good defence lawyer affords a greater chance of being acquitted than if a defendant is poor and has to rely on legal aid. Winning a case rather than obtaining justice for the accused is the goal. This has led to police forces presenting selective evidence in some cases and ignoring facts that could prove an accused person’s innocence. But, like other organisations, they have to produce results and investigating cases which do not result in a conviction does not help their “clear-up” rate when compared with other police forces. Innocent people have been imprisoned because the defendant’s defence team has not had access to all the information in the case.

The recent trial of Trupti Patel, charged with murdering her three children, has highlighted some of the ways the justice system works. It seems that if an infant dies suddenly there is a presumption that one of the parents – usually the mother – must have injured the baby in some way. The presumption of guilt leads to the parents being treated unsympathetically at a time when they are grieving and adds considerably to their distress.

An estimated 90 per cent of sudden infant deaths are from natural causes (Independent on Sunday 29 June) but, because the cases occur irregularly and infrequently, it is difficult to pinpoint precisely what the causes are. It is also clear, though, that social factors are involved too. The 1996 Confidential Enquiry into Stillbirths and Deaths in Infancy showed that there was a link between poverty and cot deaths. Low income, poor – and especially damp – housing were major risk factors. There is also a link between using second hand mattresses and cot deaths. And poor mothers are more likely to use them.

The 1996 Enquiry, and its link with poverty, was poorly publicised. Smoking is implicated in causing cot deaths and mothers are blamed for this behaviour. However, for a single mother or a mother in poor and stressful circumstances, smoking may be the only relief from a dreary existence and may help them to cope with their lives. Poverty, and its elimination would require a political change which the capitalist class is not prepared to contemplate. And to highlight the continuing effects of poverty and the way that it blights workers’ health as well as all other aspects of their lives would underline the failure of reformism to change the world for the better.

Governments hold enquiries when tragedies occur or when there is an outcry from the public over serious miscarriages of justice. Capitalists concede a few reforms, but it is the system which is at fault. Until the working class democratically decide that capitalism is a society which does not operate in the interests of the majority then they will choose socialism.

Carl Pinel

SPGB Meetings (1996)

Party News from the October 1996 issue of the Socialist Standard

SPGB Meetings (1990)

Party News from the October 1990 issue of the Socialist Standard

SPGB Meetings (1995)

Party News from the September 1995 issue of the Socialist Standard

SPGB Meetings (1991)

Party News from the September 1991 issue of the Socialist Standard

Will the nurses strike? (1995)

From the April 1995 issue of the Socialist Standard

Nurses have been offered a 1 percent play rise in the current round of pay talks with the possibility of an extra half to two percent on top of that to be negotiated locally out of existing budgets. Some trusts may fund the extra pay rise out of existing funds but this would be at the expense of staff redundancies and a reduction in the quality of patient care. The Industrial Relations Services surveyed 180 trusts and found that almost half of them expected staff numbers to fall in the next 12 month (Nursing Times, January 1995).

The government's proposal angered the ruling council of the Royal College of Nursing and, for the first time in the 11-year history of the pay review body, it rejected out of hand, without balloting its 300.000 members, a pay offer.

The Royal College of Nursing has a no-strike policy which has been in force since it was founded in 1916. Five ballots have been held to try to overturn this policy but each time the moves to do so have been defeated by large majorities. But the mood is beginning to change. The RCN is considering balloting its members to end its no-strike rule again and this time it is likely that the policy will be changed.

Nurses seem to be waking up to the fact that withdrawal of labour is the chief weapon in the armoury of trade unionists. Without it, or at least the possibility of strike action if negotiations fail, a union is severely handicapped when fighting employers for better pay and working conditions.

When the previous secretary of the RCN. the late Trevor Clay, wanted to discuss nurses' pay awards with the then Health Secretary, Kenneth Clarke, because of nurses’ anger over the levels of pay. he was not granted an audience. Clarke, of course, was under no obligation to negotiate with an organisation which had abrogated its power to strike and therefore posed no threat.

If the RCN’s campaign to persuade the government to fund the full 3 percent is successful nurses will still be worse off. Inflation is currently running at over 3 percent and could go higher still. Last year's pay rise for public sector workers was only 1.5 percent. Nurses' living standards will continue to fall. But while nurses have received low rises, trust executives have awarded themselves average rises of 6.6 percent and the highest paid of these now receive over £100.000 a year (Nursing Times, January 1995).

The RCN has co-operated with the health service union UNISON (an amalgamation of COHSE, NUPE and NALGO) in recent months and a combined strike by both unions could paralyse British hospitals. But the unions have already backed down from a claim of 8 percent at the end of last year when inflation was running at less than 3 percent. It seems that the RCN. in calling for the government to fund the full 3 percent nationally, is giving the government a chance to retreat from its original position and yet still keep nurses' pay below the level of inflation. The government could feel satisfied with this result and the RCN could claim a victory without having to resort to strike action: only the nurses would be the losers.

Deteriorating conditions

In the meantime, nurses may decide to stop working the average 4.8 hours unpaid overtime that they work each week saving the NHS £180 million a year (Observer, 19 February). Nurses have seen their working conditions deteriorate in other ways: patient turnover has increased while the number of trained nurses to look after them has fallen. Newly qualified nurses, if they can obtain employment at all, are offered part-time, temporary posts. Ward sisters’ posts are being phased out in many hospitals, limiting the career prospects of staff nurses.

Some Health Service trusts have been training support workers to carry out tasks presently performed by trained nurses. A few trusts have tried to downgrade trained nurses to support workers, but the legal protection of nurses' registration may prevent this from happening.

There is no doubt that the exploitation of nurses has worsened: fewer nurses work harder for. in real terms, less pay whilst patient turnover continues to rise. But, due to fraudulent manipulation of statistics, it is difficult to assess just how much working conditions have deteriorated or how badly the trusts are performing. Much higher numbers of part-time nurses are employed, making the total number of staff seem greater whilst the number of hours worked continues to fall. In the drive to increase turnover there is pressure to discharge patients prematurely. If these patients have to return to hospital as a result of being sent home too soon they are counted as new admissions. Poor care masquerades as efficiency in the statistics.

If a patient changes consultants this is recorded as a new patient. Rosie Williams, the RCN's policy adviser, claims that nurses in Casualty Departments are having pressure put on them to record misleading information to help trusts improve their position in hospital league tables. But lengthening waiting lists highlight the continuing shortcomings of the NHS: the waiting list for treatment in London has risen by five percent in the last year (Observer, 19 February).

The increasing number of people needing treatment indicates a problem which capitalist politicians are careful to ignore. Poverty is the main cause of ill-health. Unemployment; lower wages for workers whose labour is in plentiful supply if they are unskilled or in occupations in which the demand for traditional skills is in decline; poorer housing have all affected the working class. Politicians, whether enthusiastic supporters of capitalism or apologists for the system, are unable to remedy the human misery that capitalism causes. It will take more than a strike to permanently improve nurses' conditions and people’s health. It will take a completely new way of organising our lives.

Carl Pinel