News in Review: Respectable revolt (1965)

The News in Review column from the March 1965 issue of the Socialist Standard

Respectable revolt

Straws which are currently in the wind of British capitalism are rumblings of militancy in the so-called middle class, and the re-occurrence of the plea for more unemployed.

Some teachers and doctors have recently considered withdrawing their labour power, the former from schools and the latter from the National Health Scheme. Their reasons, basically, were concerned with their pay.

Doctors and teachers have long considered the strike as unprofessional, and in bad taste. But capitalism does not exempt any worker from the need to fight to maintain and increase his standard of living; and if doctors and teachers remain quiescent their standard of living must suffer.

Before the war when unemployment was widespread the “secure” teachers grumbled about their pay. Doctors got their patients in a free market, and many in the poorest working class districts were little better off than their patients.

Now both groups are complaining about their financial rewards; they are finding that a sense of vocation is no weapon in this competitive society. So they are considering the withdrawal of their labour power—in other words, using the weapon which marks them as members of the working class.

There is another way of losing your pay.

Lord Plowden, former Chief Planning Officer and Chairman of the Economic Planning Board, also chairman of Tube Investment Co. Ltd., and director of four other companies, was reported in the Daily Telegraph in January as wanting . . . ”better use of the labour force . . . this would lead to transitional unemployment . . . to do everything possible to mitigate the resulting hardship.”

“This is what we mean when we say that we want increased productivity, and why should we be mealy-mouthed about it?”

Capitalists are not opposed to unemployment if they think it necessary. Plowden wants to replace the carrot with the stick, on the theory that there is nothing like a dose of unemployment to increase productivity.

Is Lord Plowden himself prepared to live on the dole? Or is that a fate reserved for the workers on whom he so coldly theorises? These are questions which no highly paid servant of capitalism should want to duck.

Unless, that is, he is being mealy mouthed.

Everlasting Milk

The news which came out during the first week of last month, that British scientists had developed a method of treating milk which will make it last for months, was greeted in the newspapers with all the customary enthusiasm.

The chairman of the Express Dairy, Mr. W. E. D. Bell, helped the enthusiasm along a bit by proclaiming: “At last, we can feed milk to the two-thirds of the world that is starving.” He might as well have said that at last they could break into a market which up to now has been held by dried milk, which is easier to handle and transport than the liquid.

The Express are not, of course, about to throw in their hand with OXFAM and become a charitable institution. They quickly set up a new company to deal with the export of the new milk. Orders have been received from Central America and some shipping lines, and more may follow from the British and United States Navies.

It was not the desire to feed the hungry which was responsible for this haste. Mr. Bell made it clear: “We must,” he said, “Pull our fingers out and get this project going before the Swiss or anybody move in.”

At the time of writing, the new process has not been approved by the government for milk sold on the home market. Exported milk is not covered by the need for official approval. If the new milk is approved for home distribution, there will probably be considerable savings for the dairy industry whose bugbear, like other branches of agriculture, has always been the expensive business of rush distribution.

Agriculture is as much tied to the need to make profits as any other industry, and it is constantly looking for ways around its distribution problems. Hence the development of massive, mechanised farms, of the broiler hen and the beef factories. Hence the rise of the frozen food industry.

Some people, derided as crackpots, have questioned the effects which all this has on the food. But as long as there is a profit to be made, or increased, who cares about quality? Capitalism encourages the shoddy rush job in many of its industries, and there is no reason why agriculture should be an exception.

This is the motive behind the everlasting milk. The Sunday Times thought that, apart from anything the Express will get out of the new product, “. . . it offers a way of giving the dairy farmers more for their milk without raising the price to the public.”

The profit priorities of capitalism affect every aspect of our lives. Everywhere we go, everything we wear, the very air we breathe, everything we eat and drink, is polluted by it. And all the time there is the smokescreen of hypocrisy about human interests—about, for example, feeding the world’s hungry when the real motive is to make life more comfortable yet for the privileged few.

Vietnam

For some reason, it has suddenly become fashionable for journalists to use some peculiar words about the war which is currently being fought in Vietnam.

They have called it the “unnecessary” war, the “tragic” war, the “forgotten” war. As if all wars are not tragic, unnecessary affairs.

The Americans, deeply involved, have their own description of the war. It is, they say a vital war, because it is being fought to defend freedom. Every time the American jets go in, President Johnson claims that they fire their rockets in the cause of liberty.

We are, as usual, invited to accept the story that in Vietnam one side (the North —theirs) stands for brutal dictatorship and the other (the South—ours) stands for liberty and brotherhood.

But the South Vietnamese have shown what they mean by freedom and brotherhood by the manner in which they maltreat their prisoners. One of their recent tricks was to use a wounded prisoner (who later died) as a human mine detector—to send him wading across a river to detonate any mines on the bed.

This is only one piece of the surface evidence which shows up that it is barefaced nonsense to claim that the war in Vietnam is for freedom. In fact, the United States are involved in the war for familiar, classical reasons.

They are interested in the strategic position of Vietnam, and in the bases which they have set up there. They are desperately concerned that the expanding Chinese threat to the established powers in the Far East should be held in cheek.

The British capitalist class, who have their own troubles a little further south, are reluctant to become involved in Vietnam. British influence in the Far East was extensively diminished during the last war, and although there is still a lot of British capital invested out there, the protection of it is largely the concern of the U.S.A.

The Soviet Union is also reluctant to get involved, but is having its hand forced. They also fear Chinese ambitions; hence the belligerent words from Moscow —which remain no more than words.

The Economist’s prophesy of the outcome of Premier Kosygin’s visit to Hanoi was remarkably accurate:

“Mr. Kosygin is virtually certain to proclaim . . . that (American) attacks would involve the risk of nuclear escalation. In exchange, the Russians may well urge the North Vietnamese not to push their present military advantage in the south too far.”

Vietnam is a typical local struggle in the wider conflict of interests between the great blocs of capitalism with China, struggling for its place in the world power line up, an aggravation. China’s belligerency is customary for an upstart capitalist power; customary also are the efforts which the established powers are making to stifle her.

This could mean that the Vietnam battle will not escalate (ugly word) into a major nuclear war. But mistakes and miscalculations have been known before.

If Vietnam does prove to be the first spark in a world wide conflagration the result will be an unnecessary war, a tragic war but one which, if there is any-one left to remember it, will not be forgotten.

Gordon-Walker and immigration

The defeat of Patrick Gordon-Walker at the so-called safe seat of Leyton provided both press and politicians with a field day for comment and speculation. A number of reasons for the surprise result were suggested; in a survey just after the by-election, The Observer placed coloured immigration at the head of the list, with Labour voters the majority to voice dissatisfaction on this problem.

When the Conservative government introduced a bill curbing the flow of immigrants into this country, the Labour Opposition resisted it, creating the impression that they were in favour of unlimited free entry. Disastrously for a party seeking mass support, they overlooked the political climate. It is possible that their slender majority at the general election was caused partly by this. Gordon-Walker had the job of opposing the Tory bill in Parliament and this has made him an obvious whipping boy in what the press is fond of calling the white backlash.

At Smethwick, his Conservative opponent, by using an extremist minority as his supporters, played on the electorate’s prejudices, and their fears of the growth of a large coloured population in Britain. While the fascists ranted and raved and worked on a suppressed sore, the Tories got the benefit. At Leyton the racial question and immigration were smothered by the three main candidates, but Gordon-Walker was pestered by Nazi gadflies.

Most workers, irrespective of colour and race, fear a sudden mass influx of foreign workers because they see them as a threat to their jobs and as an aggravation of the housing shortage. On top of this is a fear that people coming from less developed areas may be willing to accept lower wages and social standards.

Immigrants have entered Britain before, but they have been mainly European and were therefore quickly assimilated. It would, for example, be difficult to trace the whereabouts of the Germans who came to Britain in Edwardian times. The recent wave of immigrants is vastly different. The colour of their skin makes it impossible for them to be quickly submerged and forgotten. They stimulate a multitude of primitive fears among the working class.

But what will happen if the coloured population of this country increases enormously? Most coloured people are just part of the working class, subject to the same rough end of the economic stick as their white brothers. In time the demands of industrialism will destroy their own customs and they will appear similar to the Anglo-Saxons, Celts, Poles etc, that go to make up the British population.

Smethwick, Leyton and Gordon-Walker are examples of how it is impossible to operate vague humanitarian concepts in a capitalist society. The government has in fact already announced much stricter screening of coloured immigrants at the points of entry. Thus do capitalism and a non-socialist working class destroy the best laid plans of mice and men.

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.

News from Austria: Danube Doctors dilemma (1962)

From the December 1962 issue of the Socialist Standard 

If Austria is said to be the land of classical winter unemployment, it might also be called the classical land of strikes. After a whole series of strikes and strike threats in such diverse trades and industries as iron, engineering, mines, hotel and catering, and dairies, a general strike of postal workers was averted only at the eleventh hour. This was when it was shown that the damage to the economy would have been far greater than the “overwork bonus” conceded to the workers after days of negotiations. If only they had been a tiny fraction as obdurate as the Vienna doctors!

These medicos have for over two years been conducting a bitter fight with the City's Health Service Administration; although primarily a struggle for better pay, they have been fighting also over the form of remuneration proposed by the administration and have refused to continue working under the status of “ salaried employees of the panel.”

In a world where everything is commercialised and state interference is becoming more usual, the creation of national health service administrations is hardly surprising and has spelled an end to the doctors’ former practice of fixing their own fees and collecting their “honorariums” by individual arrangement. “Honorarium” sounds so much better, don’t you think? Apart from the illusion of independence and respectability, it helps to foster the equally false dividing line between the “social status” of doctors and dockers. Now the doctors in Austria are to become salaried state employees and they do not like it one bit.

Most workers of the world have long acquiesced in that degrading way of life —working for wages to secure the necessities of life for themselves and their families. It is deplorable that they should not only tolerate it, but vote repeatedly for its continuation with the inescapable contradictions and incongruities. The resulting social evils include, of course, recurrent crises and war. But do the Vienna doctors share our Socialist viewpoint? No, unfortunately. In any case, unless rebels against this insane set-up can enlist far greater numbers to their ranks and organise politically for its removal, any sections of workers still enjoying a certain independence will sooner or later be engulfed in the mad vortex. And for all their apparent fighting spirit, the doctors seem to be amongst those in the very rear of the revolutionary movement for fundamental change.

Yet they have adopted all the methods used universally by workers in the class struggle, and have demonstrated their identity with the working class. There have been strikes, street demonstrations and marches, even skirmishes at hospitals and collisions with the police. All rather unacademic and undignified, and quite unusual in these intellectual milieux.

When the old Health Insurance Scheme expired in April, the doctors presented their new demands, including what was considered a sensational and hitherto unheard of increase of 65 per cent. in basic salary. The claim was later said to amount even to 88 per cent. It nearly took the panel executives’ breath away and needless to say, after recovering from the shock, they rejected the demand. Hard and fruitless negotiations went on for months. Elections held within the medical profession overwhelmingly confirmed its stubborn radical element, and their solidarity frustrated all the earlier attempts to break their resistance.

Of course, the doctors found no support in the press; an important part of it was even outspokenly hostile to them. Neither did they get any shrift from the so-called “Socialist” politicians. Vice Chancellor Dr. Pittermann, for example, referred to the medicos’ leaders as “that gang” or “clique,” or as “wild demonstrating doctors in white overalls, whose place was in the dispensaries and hospitals.” At the same time, the mass of the population were more or less indifferent, though grumbling because they now had to pay cash down for every consultation or visit, while contributions to the panel had to be paid as before the strike.

No doubt under financial strain after months of struggle, the doctors had to accept a compromise timed provisionally to the end of the year. Nothing even approaching their original demands was obtained. As against their 65 per cent., they were offered 14.6 per cent, and were ordered by the government to "accept and negotiate afterwards.”

Doctors do not as a rule consider themselves as members of the working class; they think they are superior. But on whatever rung of the social ladder they may fancy themselves to be, they are workers and their economic position remains precarious and insecure. Illness, accident, unemployment or other vicissitudes of life under capitalism, imperil the workers’ economic existence, if they do not cause a virtual family catastrophe.. The doctors must learn that neither freelance work nor salaried employment will raise them to the status of our six hundred millionaires, or for that matter of the rest of the Austrian capitalists, for these people do not sell their labour power and therefore do not need to bargain with anybody over its price.

While one must sympathise with the doctor’s (or anyone else's) struggle for a better life and greater security, the unpalatable fact remains that so long as people are dependent for their living on finding a buyer for the only commodity they possess, their labour power, they cannot share the amenities and the security enjoyed by those who own and control the means of production and who live on surplus value. Their incomes are not endangered by illness and will continue to flow even when they are pleasure cruising around the world.

It may be as hard for doctors as for other potential “rung climbers” to see their fellow academicians and intellectuals in lucrative positions in industry as managers, as heads of state departments, and as ministers getting up to double and treble the average doctor’s income. They see them travelling the world, wining and dining with the big boys in their palaces and mansions. No wonder they feel bitter! But bitterness is not enough. Knowledge is the answer. Knowledge of the capitalist system and how to end it

Rudolf Frank

Who cares for the nurses? (1982)

From the December 1982 issue of the Socialist Standard

It is important that nurses, in contemplating strike action, are rejecting their image as self-sacrificing and dedicated professionals. By acting in a militant and self-interested way they are questioning an oppressive ideology long associated with this form of employment.

There are all sorts of moral values attached to nursing. You just have to look at the words which the public, the unions, the media and nurses and patients themselves, use about the job. Nurses are expected to have a sense of “vocation", to function in a dedicated, committed and devoted way. These characteristics are to some extent hang-overs from the historical association with certain religious orders which have traditionally cared for the sick and needy; the terminology in nursing with "sisters" and “matrons” (mothers) — confirms this. But if you think about what these words really mean, then you have the problem in a nutshell. A nurse's sense of vocation is supposed to suggest a “calling”, in a literal sense by a god or some other external power. To be “committed” and “dedicated" to that sense of vocation means to “give oneself over” to it, to lose a sense of self in pursuit of an activity or purpose outside of oneself. In other words, to be self-sacrificing rather than —self interested.

Why is it that nurses are questioning the notion that they should be selflessly committed, and are beginning to act in a self-interested, class-interested way? The most clear cut reason arises directly out of their actual day to day experiences at work: contradictions between what they expect and what happens.

What are nurses' expectations? Most people who enter training do so out of a genuine desire to help people. The sick need to be looked after. Most reasons given by nurses for their choice of job are associated with helping people and the social usefulness of the work (Maguire: The Role of the Nurse, RCN Research Project, 1966). Yet in practice nurses are frustrated at every turn by their inability to do precisely that. There is a stark contradiction between the real desire to care for and give to other people and the economic realities of working in any capitalist health organisation. The NHS is a low class service oriented basically towards servicing the sick and making them socially and economically useful once again (in much the same way that the parts of a vehicle need to be serviced every so often); it exists to patch up workers and send them home — and back to work — as quickly as possible.

The allocation of finance and skills within the NHS is on the basis of cost-effectiveness. Well-equipped geriatric care units are of a much lower priority than surgical units. The economic return on removing an infected appendix from an otherwise fit young male is higher in this society than is the allocation of resources to the terminally ill. The young male will be fit for the labour market after his treatment. whereas the old person is no longer economically useful to capitalism: literally, he or she can be considered fit for nothing.

This “needs allocation” decision-making process is actually mirrored in the nurse's daily routine. Given an environment constantly lacking adequate resources (of people and equipment), simply because these are not allocated on the basis of human need, the nurse must decide which needs can be satisfied. And there is very little choice in what is a priority. The needs of those who are likely to go on living take precedence over the needs of those who are almost certain to die. A nurse will cause trouble on a short-staffed ward by insisting on sitting with and comforting an old person who is dying, rather than giving out drugs, helping to feed or wash patients, or anything else which in a simplistic way will — like a certain orange, fizzy glucose drink — “aid recovery”. The nurse, like the administrators, makes decisions according to social and economic norms associated with the rationale on which the NHS is based — on what is most "profitable". It is profitable to service fit young people; it is not profitable to spend time or money on the dying.

Perhaps the most explicit contradiction which the nurse experiences is that between the theory of nursing practice and the practice itself. This must create unpleasant tensions. The main contradiction is between more or less intelligent and scientific approaches to caring for sick people, which are learned during training, and the fact that these cannot be put into practice. For example, the nurse is taught to have a view of the patient as a “whole person”; to “empathise”, and respond to perceived physical and psychological needs. If in practice the nurse can only act as an automaton, a dose of Lucozade, and respond only to selected physical needs, a tension is felt. It is a commonly held view among nurses that what they are taught is irrelevant to how they must perform as practitioners. It is naively idealistic to believe that nurses can care for the “whole person”, or meet such varied needs, in a working environment where those needs must be systematically ignored. Rather than begin to believe that the training is impracticable or faulty, nurses have to resolve the tension by realising that it is the economic structure of society, and the consequent nature of the health service itself, which creates the problems. Neither a genuine desire to help people nor to care for them in the most effective way possible, can be satisfied in a health care system organised to “cure” the largest number for the lowest cost. In such a system the weakest go to the wall. When a nurse has to decide who to neglect, day in and day out, the idea of being able to “empathise” becomes a sick joke. The tensions are endless.

Another singular aspect of nursing as employment is the rigidity of its hierarchy. To experience the authority structure in a hospital is to learn to tread carefully — an unpleasant mixture of walking a tightrope and a cat on hot bricks. Not only is there the medical contingent “above” the nurse, but there is also the army of ancillary workers to whom the nurse is “superior”. On one level the experience of the different status of co-workers seems bewildering and intimidating; on a more complex level it engenders another contradiction.

Nursing is an unusually “co-operative” activity. Anyone who has been in hospital may have witnessed the enthusiasm created by a group of nurses trying to do their work, often under pressure, in the most effective way possible: they have a common and human aim to do as much as they can for their patients, and often it is up to them to organise this as best they can. One quality of a “good” nurse is “team spirit”, an ability to co-operate and co-ordinate effectively with others. This is only one side of it however. This cooperative situation only exists when nurses actually perceive that they have an aim in common — a goal to work towards together. As soon as nurses enter into a game of one-upmanship this is no longer the case: and unfortunately, one-upmanship is often the game to be played.

Trainee nurses are in competition with one another, as well as having the cooperative aim of getting the work done. Each one will be graded by the nurse in charge of the ward, and each one will attempt to be evaluated more highly than fellow workers. Similarly for qualified staff: they constantly seek promotion to higher grades, and must therefore win the approval of the hierarchy. This competitive behaviour conflicts with the cooperative endeavour. On a practical level this means that the nurse you were working with in a fulfilling, friendly, useful way five minutes ago, has suddenly gone sneaking off into the office to report something to the sister which you just noticed — so scoring your point.

Why is it that the types of working relationships created in nursing have to turn peoples’ illnesses and lives into a matter of scoring points? This is a question which most nurses must sense. Mow they answer it is of vital concern. They have to see the tension between the competitive and cooperative nature of their work as a product of the entire power structure within their profession. They are induced to compete because a hierarchical structure requires competition for positions of status. And more than this, it is vital also to recognise it as a mirror of the way in which workers compete with one another, to score a few points in the status stakes, rather than cooperating in their interests as a class.

There is another important factor which encourages nurses to question traditional expectations and, alongside, the values and ethics of a society which creates their oppressive and perverted role. In hospitals there is a clear-cut sexual division of labour according to status. Ninety per cent of nurses are female; 80 per cent of doctors are male. As one ascends the nursing hierarchy, the proportion of males increases, while in the medical profession women are decreasingly represented in the higher ranks. The difference in the representation of men and women in medical and paramedical jobs occurs largely in terms of gender expectations.

Doyal and Pennell, in their book The Political Economy of Health, give an historical analysis of the development of this situation. They quote Eckstein:

. . . the Nightingale nurse was simply the ideal Lady, transplanted from home to the hospital . . . to the doctor, she brought the wifely virtue of absolute obedience. To the patient she brought the selfless devotion of a mother. To the lower level hospital employees, she brought the firm but kindly discipline of a household manager accustomed to dealing with servants. . .

In their own analysis, they go on to say:

A basic division was therefore created between what were regarded as the hard-headed, diagnostic attitudes of medicine, the "curing" that male doctors did, and the “caring" which was to be done by women. . . 

In other words, to be a nurse is to be the stereotypical woman: selfless, devoted, committed and unassertive. In fact this is becoming less and less the case. Changing social attitudes to masculinity and femininity have enabled nurses to he more critical of tradition — and this has encouraged their greater militancy in the traditionally male arena of trade union action. To be involved in action for better pay and conditions means leaving selflessness and unassertiveness behind: means abandoning, to some extent, passive femininity and recognising a class interest. This is a vital step in the development of women's consciousness. Unless women reject traditional femininity, they will not develop a critical attitude toward society. Nursing creates many contradictions, which can be resolved in a class conscious way.

But we start with indignation. Nurses are rightly indignant about their position. They are sick of working for a pittance. Anyone can see that for a nurse, trying to get everything done is like trying to bail out a leaking boat with a sieve. It is time for nurses to express this real indignation — and not just about being paid “too little". It is time to get up and say “Look, I'm sick of being put upon, of being paid a pittance to watch people suffer needlessly. There comes a time when I just have to express my own needs — there’s just too many demands being made on me. I am being exploited in every sense of the word — as a worker selling myself for a salary as well as a person wanting to help other people".

Within capitalism, genuine caring cannot flourish. For nurses and other workers, self and mutual interest only begin with fighting for better pay; beyond this is a necessary political struggle to create a society in which the desire to be co-operative and caring people can be realised.

Chira Lovat

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.

Cooking the Books: Are nurses exploited? (2023)

The Cooking the Books column from the June 2023 issue of the Socialist Standard

Most of the recent and ongoing strikes are in the so-called ‘public sector’, by those working for the government at national or local level or for semi-state bodies such as the health service or schools and universities. The work they do is not sold but is a service provided by the state. They are not producing for profit; how then can they be said to be exploited?

If you work for a private (or state) enterprise producing something concrete that is sold, it is fairly easy to see that you are being exploited in the sense of being legally deprived of a part of what you produce.

But what about those employed by the state to do work that is not sold?

The first thing to note is that such employees are in the same basic position as any other worker. The means of production being monopolised by a tiny section only of the population, everybody else is driven by economic necessity to find an employer to get money to buy what they need to live. Workers get a living by working for wages, irrespective of who that employer is.

Wages are a price, the price of something that is being bought and sold. The textbooks say that this is ‘labour’, or the work done for the employer. In fact, however, it is the employee’s capacity to work, what Marx’s translators called ‘labour-power’. What it describes is the capacity a human has to use their physical and mental energy to perform a particular type of work.

Some people who work do sell their ‘labour’ in the sense of the product of their work — the self-employed; what their clients are paying for is the price of their work. But this is not the case with employees. They are selling their capacity to work and their employer is paying the price of this, not that of their work. This price — wages — depends on what it costs to produce it: the cost of the food, clothes, housing, travel, entertainment and training needed to keep them fit to work at their particular trade or profession; in short, on what is called ‘the cost of living’. Wages reflect this cost and are not the same as the work done for an employer. In fact, the work done to produce what workers consume is less than the work they perform while working for an employer.

A part, therefore, of their ‘labour’ is not paid for. In the case of those producing something for sale this is profits, realised when the product is sold. In the case of those working for the state or semi-state bodies this unpaid labour means that the service is being provided cheaper than otherwise. The state or semi-state employer seeks to provide its particular service as cheaply as possible; in other words, to maximise the amount of unpaid labour extracted from their employees. After all, the money they spend comes from taxes that ultimately fall on the profits of capitalist businesses and doing this reduces that.

If employees were being paid for their work — what they do in the course of their time at work — there would be nothing left for the employer’s profit. In the case of state and semi-state employees they would have to be paid much more than they are, much more than they need to create their labour-power.

Workers in the ‘public sector’, like that of their fellow workers in the profit-seeking ‘private sector’, also perform unpaid labour for their employer even if it is not monetised as profit.

So, yes, nurses too are economically exploited as they perform unpaid as well as paid work for their employer.

The Passing Show: TV trash (1965)

The Passing Show Column from the April 1965 issue of the Socialist Standard

TV trash

How often do you wash your hair? How often do you have a bath? If someone (other than perhaps your doctor) asked you those questions, you'd probably tell him to mind his own business. Such matters are considered personal enough not to discuss them generally in public.

However, that’s in the everyday run of affairs. But if there was money in it, you might well swallow your pride and tell the questioner what he wanted to know. And if the exercise were repeated often enough and lucratively enough, it’s possible you would forget you were ever annoyed and would even offer other personal but just as worthless titbits, such as the number of times you blow your nose in a day. I could go further, but I won’t.

Why am I mentioning this? It's just that one Friday evening a few weeks ago, I had the misfortune to sit through one hour of concentrated rubbish put out by I.T.V. under the title Ready, Steady, Go! As far as I could tell, it was a collection of pop groups and “ singers ” bleating, moaning, groaning and grimacing to the accompaniment of twanging guitars and the shouts of hysterical teenagers; Usually they merely mime to a background recording, but this time it was a “live” show, and having seen samples of both now, I’d say the more objectionable by a short head.

With Keith Fordyce as the compere trying hard to sound wildly enthusiastic over the nerve racking extremes of sixty minutes sheer row, and his assistant Cathy McGowan, calling everything “ fab ” and “gear”, the high spot—or punch line if you prefer—came when the Rolling Stones appeared and their Mike Jagger answered puerile questions about his bathing and washing habits. At the end of the programme, such was the frenzy of his audience, that he was saved from being devoured only by the intervention of some strong arm men, no doubt retained for the occasion.

It would be stupid of course to blame television as such for trash like this—just as logical as blaming weapons for the outbreak of war. It would be putting the cart before the horse. Like so many things in this world, T.V. has a vast potential for benefiting mankind, but is twisted and debased to suit the needs of a profit making system of society. And this applies just as much to the staid old B.B.C. as it does to the cruder and brassier I.T.V. So if there is a vast teenage demand for Beatles, Animals, Jerks, Kinks, Pretty Boys and Rolling Stones, then T.V. has to sink to the occasion. No matter if some of the characters look like Rowton House rejects; their records sell, don’t they? In their millions?

Indeed they do, and while that sort of condition obtains, all sorts of people will swallow whatever pride they may once have had, in the frantic race for the fast buck. A survey a few years back pointed out the size of the teenage market, running into hundreds of millions of pounds a year, something which certainly didn’t exist before the war. So no wonder we have manufacturers sitting up and taking notice, making things specially for the “teenage character” and changing the styles at a bewildering speed to maintain the myth of teenage exclusiveness, trying to keep the youngsters sufficiently obsessed with themselves to bolster sales.

Gramophone records are no exception to this rule. Generally the pop recordings are of poor quality, and not intended to last. Teenage restlessness in the demand for “new” numbers and boredom with the old. will be encouraged by the disc companies. It’s good for turnover and sales, but reduces the level of performance to an all time low with each new group or record to appear. Hence the spectacle of Ready, Steady, Go, Jukebox Jury and others.

The tragedy of it all is that teenagers are so unaware of all this. They really do believe that they are “different" from the rest of us and that the current hullabaloo is merely a recognition of this at last. In fact their wage status in society guarantees their “sameness” with everyone else and places similar restrictions upon them. They are being taken for a long and bumpy ride with a rubbish tip at the end of it.

Doctors' dilemma

Not so long ago there was no National Health Service in Britain. You just had to scrape the money together to pay the doctor if you were unfortunate enough to need his services. And of course, a stay in hospital meant hospital bills, although how many workers managed to pay them is another matter.

The family doctor was often held in awe and reverence—a pillar of respectability, financially very comfortable and independent. That was obviously the impression that East End slum dwellers gained, perhaps because the doctor always wore a clean shirt and looked smartly turned out. They did not realise just how great a struggle some medicos had to get by. but the going must have been tough at times, particularly in the depressed areas. A. J. Cronin gives us a glimpse of this in some of his novels.

Well, whatever delusions we may have had about the G.P.’s status before the war, there is certainly no room for them now. Most of his “ independence ” was swept away when the postwar health service was set up, and doctors in general can be seen now for what they are—and always were—working men and women. True, their income on average is still much higher than many other workers, but what of that? There have always been differing grades of training and pay under capitalism and here is an example. Their training is years long and their working hours atrocious. A Guardian article of March 9th for example told of resident hospital doctors often working a hundred hours and more a week.

And just like other workers, the doctors have to battle with their employers (the government) over wages and conditions, which is really what all the rumpus was about a few weeks back. The British Medical Association—the doctors' “trade union"—threatened to withdraw its members from the health service if the government's pay offer was not improved. This was not a strike, it was claimed, although just what other name it could be given was not stated. However, the government seems to have climbed down and granted some at least of the doctors’ demands. For them, however, the lesson of organisation has been a long time in the learning. The assiduously cultivated image of medicine being a calling rather than a job, with its practitioners’ sole aim to serve their patients, will be equally long a-dying; and this presents them with a dilemma.

To retain the all-important public support for their cause, the old picture is of help, but it can act as a double-edged weapon. The government has been quick to realise this and use it to the full in its negotiations with the B.M.A. As so many other workers have found, it is the strike or the very real threat of it, which gets things moving if they can be moved at all. And then bang goes public sympathy.

In the event, the medicos took the only course open to them and risked public hostility. Strikes are a constant feature of capitalist society—they are part of the fight which goes on all the time. And people usually get hurt in a fight, not just the direct participants but onlookers as well. It is one of the regrettable facts of capitalist life. End capitalism and you end the fight—for doctors as well as for the rest of us.

Eddie Critichfield

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

Striking (2023)

From the January 2023 issue of the Socialist Standard

Presently, news broadcasts carry frequent reports of ballots indicating a growing willingness of unionised workers to take strike action in pursuit of better wage deals. This is reflective of inflation running at double percentage rates, while pay offers remain in single figures.

Since the financial crisis of 2007-8 and the subsequent austerity policies, the real value of wages had stagnated at best or even markedly declined. However, this had been masked to a certain degree by inflation being at reasonably low levels.

The ebbing of the Covid 19 crisis to be replaced with greatly increased international tensions served to raise expectations just as inflation gathered momentum. What this lays bare is that all the pre-lockdown problems not only still exist, but are being exacerbated.

As examples, the NHS and social care continue to have rising funding and recruitment issues as those employed in these sectors, in line with workers generally, continue to see wage levels falling in real terms. At the same time there’s increasing demand leading to individual workloads becoming heavier.

Hardly surprising then that industrial disputes are becoming more commonplace. Crisis for capitalism is integral. As always it is the working class who will be expected to accept the consequences through reducing living standards.

The economics are simple and clear: inflation at 10 percent, wage increase of 5 percent means a pay cut, not a rise. The size of the figure on a wage slip is itself meaningless until it is reckoned against what can be bought with it. In crude terms, can more or less be purchased?

No surprise then that workers are reacting with their most potent means within the limits imposed by capitalism. It is also no shock to hear from a range of commentators condemning this as unreasonable militancy by union members.

The last fruit on the money tree has withered and fallen off, or the financial well has run dry. Pick your preferred metaphor; the message is clear. If workers succeed in ‘inflation busting’ pay rises, to use another common cliché favoured by politicians, it will only worsen the situation.

Meanwhile, those ‘selfish’ strikers will be careless of the suffering they inflict through their actions on their fellow workers. After all, we are – hard-pressed nurses and hedge fund managers alike – in it together.

The media, in its role as necromancer, raises the spectre of the 1970s, the ghost of the winter of discontent is conjured to haunt society. After all, striking workers and rising inflation are the twin demons ever lurking in the shadows.

They were eventually exorcised by Saint Margaret of Grantham and subsequently held at bay by each prime minister, Conservative or Labour, who came after her. They ensured the market place was not possessed by the dark forces of organised workers and capital’s values were enshrined and realised.

One of the prevailing myths is that higher wages are a cause of inflation. This is indeed a wondrous act of prestidigitation, as the outcome precedes the cause. Firstly, prices begin the rise rapidly to the point where wages are being seriously devalued and then, and only then, workers demand higher wages. The impoverishment of workers is therefore somehow caused by workers after they have already become poorer.

One solution some politicians offer to make workers better off is reducing taxation. This is the myth of the state acting as the mugger of the wage earner. Wages, profits, expenditure and investment in all parts of the economy come from a single source, the value created by the workers collectively. The proportion going to each of these factors does change, but the source remains the same.

If there is an increase in taxation, while this might be collected from each worker’s income, the actual source of it is that the worker created value. It may cause an alteration in the distribution of the value, a little more to wages to pay for the taxation, a little less to profit or investment.

This can then be adjusted at some point, taking back from workers the little gained. This might be through reducing services workers use, thus lowering state expenditure and taxation. However, this does not make workers better off, except in the short term at best. Access to required services becomes limited as wages stagnate.

Inflation also, in effect, recoups from the proportion received by workers as the real value of what they earn falls, even if the monetary amount rises. Some workers may feel relatively comfortable financially with seemingly well-paid employment, home ownership and savings.

Should such workers make the mistake of living into old age and infirmity, the value stored in their property and savings will soon be absorbed by the social care charges levied by profit-making care companies.

Socialists, of course, support workers organising to defend their present living standards. But, no matter how successful the action they take, it will not, cannot, be a long-term solution. Most likely, gains made will eventually be taken back. Any graph of wages and salaries will show peaks and troughs, never a consistently ascending line.

Strikes also have a dual nature in regard to other workers not directly involved in the action. On one hand those who, in whatever manner, lend solidarity to those on strike show an enhanced level of class consciousness. An attribute that needs to develop further if socialism is to be achieved.

However, strikes can also become divisive when those inconvenienced, or worse, by strikes become oppositional. The pro-capitalist media uses all its influence to exacerbate such reactions, an ideological prophylactic aimed at preventing the germination of class consciousness.

Industrial action is an inevitable response to the imperative of capitalism to maximise its profits at the expense of the workforce. It is a necessary palliative, but not a solution to the economic precariousness of the wider working class.

There is one present aspect that gives the lie to the return to the 70s myth. Even if the trade union movement was to be successful in achieving inflation matching (or busting) wage rises, that would leave many millions of workers no better off. Membership of unions is half, possibly less than half what it was in the 1970s. Even then not all workers, by any means, were members of unions.

There is plenty enough wealth created by workers throughout the world to fully meet the needs of everyone without any need for strikes. After all, a strike is not all bad for capital as it saves on wages for the duration.

The only true cure for inflation is the abolition of prices through creating a socialist society in which money has no part. The myth of things as they are at present being the only way they could be needs to be countered by an increasing understanding of the potential workers have together to democratically create, worldwide, a commonwealth of co-operation.

Dave Alton