The cost of money (2026)

From the March 2026 issue of the Socialist Standard

A musical ensemble undergoing a restructuring has formed a small committee to consider the details. An important factor was the membership fee. Although the musicians were all amateurs, in the best sense of that word, there were regular costs to be met. This meant that while the fees were not exorbitant, none the less they were significant. This raised an issue: an aim of the ensemble was to encourage players of various abilities to participate, including those whose financial circumstances would make the fees prohibitively expensive.

The simple solution was to accept that individual circumstances could be taken into consideration, with fees reduced or waived. One committee member, in particular, was enthusiastic in his support of this arrangement, declaring, ‘As a socialist I’m all in favour.’ He was an active member of the Labour Party, obviously mistaking a commendable act of social altruism as an expression of socialism. Indeed, it could appear to conform with the socialist maxim, from each according to ability, to each according to need.

However, while individual needs in this specific context were to be met, the ability referred to in this instance was the ability to pay, not play. A skilled musician’s opportunity to play would depend on a financial arrangement. If at some future time expenses were such that an accommodation of non-fee payers was no longer sustainable by the ensemble then the concession could be withdrawn. The player’s desire and ability to play would still exist, but would be denied.

The determining factor, money, remains decisive in straightened circumstances. The ensemble’s proposed inclusive action is an example of solidarity, again giving the lie to the oft-voiced opinion that human nature is greedy and selfish. There is no requirement for the ensemble to be so considerate as there are a goodly number of members already. It has grown over the decade of its existence and continues to grow. It is now looking to develop a youth section if that can be funded. Back to money again as the crucial factor before the needs and abilities of young people can be identified and met.

The ensemble meets weekly to develop its skills and programme of public performances. The individual musicians devote a significant portion of their time to daily practice at home. In other words they work hard, but entirely unremunerated. Another refutation of the seemingly ‘common sense’ argument that people will not work unless paid. Rather, they pay to work.

This is but one example of what is happening across society, people working voluntarily in a wide range of circumstances, already freely giving of their abilities to fulfil needs both personal and communal.

A moment’s consideration should enable most people to think of those they know and circumstances where they come across volunteers. If all volunteers withdrew their efforts tomorrow, society would severely suffer as a consequence. There are many volunteers who devote more time and enthusiasm to their volunteer activities than ever they do, or did, to the drudgery of their paid employment. This seems particularly the case for those who are officially retired.

The claim that socialism won’t succeed, because it relies on the great majority working cooperatively and voluntarily without financial incentives, is contradicted by the evidence. It is happening now, even though the dominant ethos is all about money. If the social, economic and political context was socialism, having been actively achieved by the vast majority, then what might now be termed altruism would actually be the norm. Very different to how things are presently arranged.

Council services

The borough in which the ensemble operates has recently issued its council tax requirements for the coming financial year. The rate has risen again, to a chorus of much grumbling. There is also a breakdown of the council’s spending. Two major items of expenditure are social care and children’s services. In the jargon these are ‘big ticket’ items. The problem is they become ever more expensive year on year. Social care has become a huge fiscal responsibility because many more people are failing to die in their seventies as was the case until fairly recently. Medical science and technology has advanced markedly, while working in the unhealthy atmospheres of heavy industry has declined, along with smoking,

What should be a cause of widespread celebration is marred by the cost. That science and technology comes at a price, as does the residential and home care for those requiring it. Families opening their council tax bills see the increase as putting further strain on stretched household budgets.

While the council is working under legal obligations to provide these services, a sense of responsibility also motivates councillors to do their best for those with needs. As Labour councillors they may well consider themselves socialists in this context. Theirs is a ‘socialism’ trying to mitigate the worst consequences of capitalism. Social care, for example, to look after elderly workers past the stage of being exploitable labour. In previous times it would have been the workhouse. The workhouse system was developed, at least in part, as a response to perceived rising costs on the parish rates of poor relief, such as the Speenhamland system. Council tax is the modern equivalent of the parish rates and is equally a matter of contention amongst those who must pay.

The bottom line, as it is often called these days, determines how needs are met. Whether it’s being involved in an ensemble, or some similar group, or looking after the elderly or children, the fundamental factor is money. No matter the political perspective, left, right or centre, debates and discussions revolve around the sums of money involved. For some such as the ensemble the decisions are collective ones, made by the whole group.

With public finance, local or national, the arbiter is the law. The price, paid by those who are dependent on what is described as the public purse, is rationing. If a need cannot be met due to there being insufficient funds to pay for it, then it will remain unmet. Even if provision is made it may not be sufficient or of suitable quality. Even in a social, and sociable, organisation such as the ensemble, a change in financial circumstances amongst those who pay may result in the withdrawal of concessions for those who can’t, albeit with heartfelt regret.

Socialism requires the maxim – from each according to ability, to each according to need – to be fully realised for everyone. This can only occur in a society in which the profit motive no longer operates and there are no prices for anything, money having become redundant. Until then, the Labour – and all too common – misunderstanding of socialism will continue to equate it with forms of charity, whether voluntary or legally enforced.

D. A.

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

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.

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

Labour in sickness and health (2025)

From the July 2025 issue of the Socialist Standard

We are told the NHS is a ‘national treasure.’ That it was built by socialists. That it belongs to us. That if we just had the right funding and the right managers, it could be restored to its former glory.

But we know better. The NHS is often cited, especially by those still enthralled by the Labour Party, as an example of ‘socialist’ legislation passed during the 1945–1951 Attlee government. Even people who now admit Labour is not socialist cling to the NHS as proof that it once was.

Let’s be clear: the NHS was never socialist. It wasn’t created to empower workers or take profit out of care. It was built to keep the workforce functional – to patch us up and send us back to work. A healthy worker is a productive worker – and a productive worker generates value for the boss. That’s why the capitalist class signed off on it. Not out of compassion. Out of calculation.

Sure, there was high-minded rhetoric at the time. Aneurin Bevan, considered the founder of the NHS, said: ‘No society can call itself civilised if a sick person is denied medical aid because of lack of means’. And William Beveridge, architect of the welfare state, said: ‘A revolutionary moment in the world’s history is a time for revolution, not for patching’. Later he stormed the barricades of the House of Lords as he became a Liberal peer.

The real context was fear. The ruling class had just dragged us through mass unemployment and a world war, and it now faced an angry, armed working class returning home. It saw what had happened in Italy. Reforms were made not to end capitalism but to save it from social and industrial unrest.

Bevan once asked: ‘How can wealth persuade poverty to use its political power to keep wealth in power?’ He blamed the Conservatives, calling them ‘vermin’. But take the party labels off, and the question becomes sharper. The problem isn’t just the Tories. It’s a system that ensures poverty exists in the first place.

Bevan couldn’t see that. For him, the enemy wore a blue rosette. For us, the enemy is the wages system, the class system, the profit system. That’s what’s killing the NHS. That’s what’s killing us.

Now, 75 years on, they’re not even pretending. The NHS has become a marketplace. Drugs are bought from profit-hungry pharmaceutical firms. Cleaning is outsourced to contractors who cut wages and corners. Just this month, a scandal was revealed over botched cataract operations performed by private clinics cashing in on NHS contracts.

We used to joke the NHS was held together with duct tape and goodwill – now they’ve outsourced the duct tape and privatised the goodwill. They say this is a Tory problem. But what has Labour done?

Wes Streeting – dubbed ‘Wes the Rat’ by campaigners – is Health Secretary and says he’s ‘not ideological,’ which is odd for a politician. He wants to ‘use spare capacity in the private sector’. He calls patients ‘customers.’ He says the NHS is no longer ‘the envy of the world’ – not because it’s been gutted, but because it hasn’t been modernised. That’s code for markets, contracts, fragmentation. The same failed model, just rebranded.

Starmer campaigned in 2020 on ending NHS outsourcing. That pledge disappeared like a junior doctor’s lunch break. Now it’s all about ‘outcomes,’ ‘efficiency,’ and ‘value for money’. In his worldview, health is a product, not a right.

He’s cited NHS England as an example of excessive bureaucracy, duplications, and inefficiency. NHS England’s functions are now being absorbed into the Department of Health and Social Care. The transition will take about two years – less time than it takes many trans people to get a first appointment on the NHS waiting list.

Around 9,000 jobs are being axed in the process, as AI systems take over. One of the main tech firms involved is Palantir, a data analytics and armaments contractor with deep ties to the American MAGA state.

Palantir’s NHS involvement began with a £1 (one pound) trial contract in March 2020, part of the pandemic response. Then came:

• July 2020: £1 million contract
• December 2020: £23 million, two-year deal
• June 2023: £25 million contract
• November 2023: £480 million for the Federated Data Platform (FDP)

Now, the NHS is locked in.

Palantir was co-founded by billionaire Peter Thiel, a Trump backer who once called the NHS a ‘monstrosity’. The company built software for the US Immigration and Customs Enforcement agency (ICE), the CIA, and for predictive policing systems. Its platforms – Gotham and Foundry – have been used for deportations, drone strikes, and surveillance. The CEO, Alex Karp, bizarrely refers to himself as a ‘socialist’ and a ‘neo-Marxist,’ despite running a firm helping military and police forces worldwide. He studied the Frankfurt School and Marxian philosophy but now says Western tech should serve national power and defence. In his book The Technological Republic, Karp argues that declining interest in Western civilisation has left tech without ‘patriotic duty’. Palantir, in contrast, builds tools for ICE and the US military – showing where its duty lies.

This company now runs NHS data infrastructure. There was no public debate. No vote. Just a quiet, technocratic handover, sold as ‘integration’ and ‘efficiency’. It sounds like an IT upgrade. In reality, it’s a power shift – from public stewardship to corporate control.

Palantir claims it doesn’t own the data. Maybe not. But it owns the system. The architecture. The infrastructure. That’s vendor lock-in – like getting a free coffee machine and finding the pods cost £12 each and are only sold in Texas.

This isn’t reform. It’s enclosure. The same old privatisation, dressed up as innovation. And the outcome? A two-tier system. A burnt-out workforce. A public service run like a business where care takes a backseat to cost-cutting.

They say the NHS is free. But people pay for it – with taxes when they pay them, with our labour and with our time. It’s not free. We are. Free to wait. Free to suffer. Free to die while shareholders get dividends and algorithms determine care.

The Socialist Party stands for more than better management or fresh branding. We advocate the abolition of the wages system. The end of profit in care. A world where there are no customers, no contracts, no markets – just people, meeting each other’s needs.

Health is not a service. It’s a condition of freedom. The NHS can’t be saved. It must be superseded – by a system where care is not rationed, outsourced, or monetised. Where no one waits, no one pays, and no one profits. That’s not utopian. That’s socialism. And we’re not asking for it. We’re organising for it.

A.T.

The elderly – who cares? (2025)

From the June 2025 issue of the Socialist Standard

I had driven past the old mill owner’s mansion a number of times. I hadn’t really paid any heed to it other than as the marker of an obscured lane I drove down to deliver my granddaughter to her destination. This time, though, an approaching vehicle had me pulling into the sweep of its gateway. I had a moment to look up. What had once been the domicile of a very obvious capitalist had become a care home. A plaque on the gate post gave its original name below a larger, more prominent, name board. I read, therefore, ‘Saint Mary’s Residential Home’ and only then ‘The Ashes’. There’s a statement of reality, I thought.

One of the undoubted benefits of capitalism has been a general prolongation of life, at least in its heartlands. It is undeniable that more people live to a greater age than ever they did even in fairly recent history. This is an unintentional consequence of the way society has developed due to the scientific and technological advances capitalism has made, had to make, to protect and advance profitability. A growing elderly population is itself a source of profit. Age brings with it a multitude of longer-term conditions and ailments that is an expanding market for the pharmaceutical industry. And when the point is reached that medicine itself cannot sustain those with failing health, then there is another market, social care.

Capitalism is an exemplary system in providing commodities to meet people’s needs. However, there is a caveat. All commodities are available to all, just as long as they are paid for. This is not callousness, but the very essence of capitalism.

Care as a commodity

There are basically two types of social care; external, carers coming to the person’s own home, and internal, with the person accommodated in a care home. On average, external care costs between £20 and £25 an hour. Internal home care averages at £1,000 plus per week.

Care as a commodity must realise both the monetary value of those actually giving the care, care workers, and surplus value for the providers. The providers own the means for care-giving, the actual buildings and all the paraphernalia required to adequately cater for their residents’ needs. Once these expenditures have been met by the care providers – who may be individual business owners or, increasingly, care providing companies – whatever monies remain constitute the profits. This model is classical capitalism. Therefore there is always the tension between the cost of labour and the requirements for material expenditure and financial returns for owners/shareholders. Careworkers are skilled labour and yet their salaries hardly reflect this, often being on or close to the minimum wage.

The minimum wage has become the determining factor for these salaries. When that rises to accommodate cost of living increases, so do the salaries. This is, therefore, an increased cost to the providers. Also, a cost of living increase will affect other elements vital for the care of residents, food, energy and such like. These costs could be taken away from financial returns, but an increasingly less profitable business loses viability, perhaps even ends in bankruptcy.

The alternative is to increase fees, so the plus part of the aforementioned £1,000 per week gets ever larger, moving towards £2,000 per week. This becomes a growing drain on individual means to pay, more rapidly diminishing whatever assets were accumulated throughout a working life. This may lead to families contributing to elderly relatives’ care, which then becomes a strain on those families’ financial resources at a time when living costs are rising. A need to increase those family resources becomes pressing, so higher remuneration is sought. In this way some of the care costs are shifted, indirectly, to other sectors of the capitalist economy.

State funding

Perhaps the state, either directly or through local authorities, takes up the shortfall. This may be done directly through funding in part or whole, an individual’s care needs, following assessment via means testing. Further expenditure will then be incurred through the requirement to employ administrators to carry out the assessments. As the state and local authorities do not have any income other than what is raised through direct or indirect taxation, taking on a significant extra financial responsibility requires extra funding. Any subsequent tax increase, direct or indirect, initially reduces the incomes of workers who pay it.

This has a political consequence for the party imposing the tax increase. Vitriolic elements of the media will make great play of the avaricious state picking the pockets of hard-working families. Come an election, local or national, and the ‘low-tax’ party wins the vote. However, once in power, that administration is immediately faced with the same financial dilemma. The closure of underfunded care homes, with residents put out into the streets, is not a vote winner. Demanding greater contributions from individual assets would also be unpopular as prospective inheritances are reduced.

If the administrating party manages to survive the tax rises, workers whose salaries have been reduced actively seek salary increases, or perhaps reduce spending, or both. The result is the tax increase is ultimately transferred, yet again, to other sectors of the capitalist economy.

Not a drain

When a person retires from employment they do not retire from capitalism. Those, the majority, not requiring care, though receiving pensions, do not constitute a drain on the economy because they are not economically idle. They are providers of unpaid childcare. All the financial factors set out above for social care of the elderly, apply to the care of children to enable their parent(s) to work. Capitalism depends on a constant supply of labour power, so provision of childcare is crucial.

Then there is volunteering. The argument often levelled against socialists that people would not work unpaid is given the lie by the ‘retired’. An often-voiced trope amongst those no longer in paid employment is they don’t know now how they ever had time enough to go to work.

Those who take advantage of out-of-season holidays are redirecting some of their assets to businesses whose commodity is leisure. Pensions being deferred parts of wages/salaries are being spent in much the same way as parts of wages previously saved in bank accounts and such like.

Capitalism has evolved to become a highly complex organism in which each part affects other parts. The elderly requiring care, the retired, like the very young, are as much a part of that organism as any other. However, the avaricious nature of capitalism, ever trying to reduce its costs, can lead to a perception of some members of society being almost parasitic. Only a society not obsessed with money and costs can truly fully value all its citizens and willingly strive to meet their needs, whatever they are. In a word, socialism.

Dave Alton

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.

Capitalism and health (1966)

From the March 1966 issue of the Socialist Standard

Twenty years ago the advocates of a National Health Service asserted that capitalism need not be detrimental to the health of working men and women. Speaking as Prime Minister in the spring of 1944, Winston Churchill stated that it was the policy of the Government to establish a National Health Service which would make accessible to all, irrespective of social class or means, adequate and modern medical care. With the introduction of the Health Service four years later the Minister of Health, Aneurin Bevan, also promised that it would be a classless service. Thus both Labour and Conservative Parties committed themselves to the same objective and they have now had the best part of two decades to. achieve this end. Have they succeeded?

In Britain chronic bronchitis is a widespread and killing illness, to such a degree that it has become known as “the English disease." The Registrar General's statistics reveal that in 1963, in England and Wales alone, there were thirty thousand deaths from this cause. Bronchitis is largely due to atmospheric pollution, cigarette smoking and the unfavourable, dusty conditions associated with jobs such as foundry working and coal mining. Pick up any medical text-book and you can read passages similar to the following, taken from a standard work : “If the individual's economic status permits he should be advised to live in a warm, dust free area . . ." “If the occupation is a dusty one then the individual should be advised to change it although in many cases this may not be a feasible proposition.”

If working men and women are complacent about the general standard of health, this can only be due to ignorance of the facts. The trends in death rates reveal that while some of the older traditional working class diseases—such as tuberculosis—are on the wane, others are becoming more common to take their place.

(Respiratory diseases, including bronchitis, were of lesser importance in 1964 than for the previous three years, this was probably due to the exceptionally mild winter. The long-term trend still shows an increase.)

The causes of lung cancer and coronary artery disease are not known with any certainty. It has been noticed with the latter, however, that there is a very high incidence among men whose work provides considerable tension and anxiety, with little opportunity for exercise. How many millions of “white- collar" workers—chained to a desk for eight hours a day and then jammed into a commuting train for a further period—would meet this description?

One of the main causes of chronic bronchitis is atmospheric pollution. This is a feature of towns and cities in every advanced capitalist country; 133 tons of industrial dirt fall on to the town of Duisburg (about half-a-million inhabitants) in the German Ruhr every day and the sulphur dioxide level in the air is far above that which is believed to be dangerous for humans (see report in the Daily Mail of 5th April, 1965). The same kind of muck falls on to Sheffield, Birmingham and London. It is a withering criticism of capitalism that the “cleaner-air" campaign, conducted in the Ruhr during 1964/65, was judged to be a success for the simple reason that it resulted in the first winter when the German industrial belt was not brought to a standstill because of smog. Any benefits to the health of the inhabitants were of secondary importance.

Perhaps some of .the most frightening statistics are those concerned with mental illness, In barely 10 years the number of patients entering mental hospitals has virtually doubled.

In Britain today patients with severe mental disturbances (the psychoses), together with serious cases of neurosis, occupy almost as many beds in hospitals as those suffering from all other illnesses put together. In his book on social medicine, S. Leff, M.D., D.P.H., describes the situation in the United States: approximately four out of every ten patients there are said to consult doctors with complaints due at least in part to emotional disorders; some 600,000 mental patients are in hospitals and 150,000 are admitted every year; eight million persons are suffering from mental disorder and one out of twenty of the United States population at some time requires psychiatric care. One million of the twenty-four million children now in schools in the United States are likely to spend some portion of their lives in a mental hospital. There are between three and five million people suffering from amentia or dementia who are not in institutions and about six million are incapacitated because they are on the border line of mental disorders.

In Great Britain no comprehensive field survey has yet been made into psychiatric illness, but less extensive studies have been conducted. One such study, which was designed to give a conservative estimate, showed that in a typical group practice in South London psychiatric illness could be observed in one year in 14 per cent of all patients who consulted their doctor. In addition a further five per cent of the registered patients showed distinct “abnormal" personality traits. Two large surveys in factories have revealed that from one-quarter to one-third of the total sickness absences from work are due to neurosis. Another study of 30,000 workers employed in thirteen light and medium engineering factories showed that one in ten suffered from disabling neurotic illness, and two in ten from a minor form of neurosis. Although there has been controversy over the validity of some of these figures, these “findings have been reinforced by a series of estimates which have been made of the prevalence of psychiatric disorders in the total populace." (Modern Trends in Occupational Health—K. S. F. Schilling, 1960.)

We may be accused of taking every unpleasant feature of the modern world and using it unfairly to illustrate the social bankruptcy of capitalism. It might be said that we are not justified in concluding that it is the social environment which gives rise to mental disease. The Ewing Report on The Nation’s Health to the President of the United States argues our case for us:

Man's mental as well as physical health is very much at the mercy of what goes on about him. The economic insecurity of unemployment and old age, the lack of opportunity for education and adequate health services, poor housing and lack of good sanitation, prejudice and discrimination, failure to share in the civil liberties guaranteed to all citizens, inflation, the threat of atomic war—these are very real every-day problems and they are the kind of social factors that can wear away personal defences and destroy mental health.

It makes bitter reading to look back and see that in 1944 the workers in Britain were guaranteed “adequate and modern medical care.” The hospitals, for example, are in a sorry mess. The general situation is one of too few doctors struggling on with out-dated equipment and facilities. The Government’s official publications admit as much: " . . . under present conditions work properly belonging to consultant posts is being regularly discharged by senior registrars and members of more junior grades.” This is simply because the number of consultants “is still inadequate to the needs of the hospitals.” The reasons for this include “financial restrictions to which hospital authorities are subject” and “inadequacies in accommodation and facilities, especially operating theatres and laboratories.”

And what about that section of the working class which runs the health service? Probably if one conducted a census, at least 90 per cent of doctors, nurses, dentists, etc., would deny that they were members of the working class. But whether they choose to face up to reality or not is largely immaterial; every working day of their lives they are confronted with the hard facts of their wage earning status. They, too, are forced to conduct a ceaseless struggle to maintain their salaries and working conditions. On top of this they find themselves faced with the problem common to all working men and women—such is the pressure on them, they must work to a standard far inferior to that which they are capable of. One dentist recently referred to the “sheer vocational frustration induced by the fact that practitioners are virtually denied the opportunity of practice at the level which their ability and enthusiasm could achieve.” What other working man, forced to prostitute his skills and talents, could not echo this?

It is axiomatic in medicine that the doctor should concentrate on eradicating the disease itself and not waste valuable time and effort on palliative treatment for individual symptoms. The working class could do worse than apply this principle to capitalism—a system of society which brings each one of us little more than poverty, insecurity, frustration and ill-health.

John Crump

Voice From The Back: Kids are dying (2004)

The Voice From The Back Column from the November 2004 issue of the Socialist Standard

Kids are dying

Defenders of capitalism are fond of depicting it as a system that gradually improves the lot of the world’s population, but how do they defend the following? “The number of malnourished people worldwide has grown to 840 million – including 300 million children – even though there are ample supplies to feed them. James Morris, World Food Programme director, said the number of malnourished was growing by about five million a year. ‘There is enough money, enough food and enough goodwill in the world. Everybody simply needs to do a little more,’ he said” Herald (14 September). We intend to do all we can by propagating socialism – the only answer to this problem.

No mean city?

The City Fathers are fond of dreaming up fancy slogans about it – City of Culture, City of Architecture and so on, but there is another side to Glasgow far removed from Art Galleries and Opera Houses. ”A generation of ten to twelve year old Glasgow children will be lost to drugs because their parents do not care enough. According to a study, the city has at least 60 pre-teen heroin addicts, and there could be many more . . . Jim Doherty, of Gallowgate drug prevention and family support group, warned: ‘Tragically, we may have to concentrate on saving the next generation.’ And Professor Neil McKeganey, who led the research, added: ‘If we fail to meet the needs of vulnerable children, we face the prospect of increasing numbers addicted before their voices are broken.’  . . . But it may be too late for some, Mr Doherty added: ‘I have addicted sons. Sometimes I feel the only help I can give them is to ensure they get a decent burial’” Scotsman (24 September). This story could be repeated in many other cities in Britain. Surely you can see that there is something dreadfully wrong with a society that has 12 year old drug addicts.

The uncaring society

Capitalism is a society based on commodity production with the only driving force being the need to create more and more wealth for the tiny handful of privileged parasites who own all the means of production. If you are poor in this society – tough! If you are poor and disabled in this society – tougher still! Here is an example of how the owning class treat the disabled. “Nearly half of families with disabled children receive no support from the NHS or social services, according to research published today. Centre-right think-tank the Centre for Policy Studies (CPS) found that 48 percent of families with disabled children received no help from outside the family and a further 30 percent received less than two hours support a week” Guardian (1 October). Think about the new socialist society wherein we all look after each other whether we can speak well, read well, see well or hear well. This is why we are socialists.

Poverty in the UK

The thinktank Catalyst in their recently published paper “Why Inequality Matters” has come up with some child poverty figures that illustrate the uselessness of Labour’s tinkering with the system. “The international comparisons are as embarrassing as ever: in purchasing power, the poverty of the poor British child is 11 percent worse than that of their American counterpart and nearly 30 percent worse than in France. It’s a shocking thing to say, but if you are going to be poor you’d be better off in America” Guardian (11 October).

Poverty in the USA

“One in every five US jobs pays less than a poverty-level wage for a family of four, according to a study by the nonpartisan Working Poor Families Project. The result of so many low-paying jobs is that nearly 39 million Americans, including 20 million children are members of ‘low-income working families’ – with barely enough money to cover basic needs like housing, groceries and child care, the study found” Yahoo News (12 October). Socialists don’t go in for comparing different levels of poverty in capitalism. As far as we are concerned capitalism causes poverty amidst plenty throughout the world and should be abolished.

Desperate lies (2006)

From the September 2006 issue of the Socialist Standard

The man who faced the choice of dropping dead while waiting on the NHS list or bluffing.

Early in August, a story broke about retired painter and decorator, Roy Thayers, having to lie in order to be free of terrible pain he’d been suffering for years, because of heart trouble.

A cardiac specialist warned the 77-year-old that he needed a lifesaving operation as soon as possible, because he was in danger of having a fatal heart attack at any time. He was told the coronary angioplasty treatment he required would not be available from the NHS for nine months because of a waiting list, but added that by going private, Roy could have the operation within a week. Being penniless, Roy had the option of dropping dead while waiting on the NHS list or bluffing. He chose the latter, and said he’d pay, when he knew he couldn’t.

He managed to stall requests for payment by hospital administrators, claiming he mislaid his chequebook. His operation took place quickly, he wrote out a “Mickey Mouse cheque” for the £8,500 cost the very next day, knowing he’d have to face the consequences later.

Speaking of his ploy, Roy said: “I love life, I love my dogs, I love fishing – why should I die for the sake of money?” Indeed, why should bits of paper decide who lives and who dies, or who eats and who starves, or who has a comfortable home and who has a stinking hovel, and so on?

 

It’s sick and idiotic. But seeing how, under capitalism, goods and services are provided to make profit – not meet needs – this system has created a universal comparison commodity (a.k.a. money) against which other commodities can be measured. Comprising paper notes, metal discs or mere digital data, this comparison commodity exists in order that those with something others need can make its supply dependent upon receiving a specified amount of this measuring tool. No money, no provision.

When Tony Blair developed a dicky ticker, naturally, he got treated very quickly. No long delay for the likes of him. Not forgetting that the Oxford Radcliffe NHS Trust, having provided the PM with his cardiac catheter ablation operation, shortly afterwards decided to deny this treatment to others in order to cut costs and meet the government’s six-month waiting-list targets.

Of course, Roy hasn’t managed to defeat capitalism by writing his rubber cheque. For a start, as he said himself, “I paid into the NHS for years to look after me, but the doctors were telling me they wouldn’t, so who’s robbing who?” Furthermore, the Primary Care Trust (PCT) in charge of the hospital that treated him was soon threatening to send in the bailiffs, and he eventually settled on repaying his debt at £25 a week from his meagre pension.

No doubt, private health care enterprises will now do their utmost to ensure people have sufficient funds before they get treated in future. So although the money-loving Sun tabloid praised Roy for being “canny”, and the profit-hungry Mirror said “well done”, don’t count on acquiring desperately needed medical care by the same method.

The fact is, no one should have to come up with devious methods to obtain critical health care or any other essential services and goods. In a decent and rational world these would be available according to need – not how much money people have depending on how much, or little, capitalism has allowed them to have in return for their exploitation and control by a minority ruling class.

The only reason this appalling and damaging situation continues is because we allow it. If all those unhappy and irate with the way they’re made to live, work and struggle on pitiful pensions came together with the aim of getting rid of the system which allows a super rich minority and their money mechanism to control, deprive and manipulate this majority, then capitalism would be in serious trouble.

Roy Thayers is also quoted as saying: “The real working classes of this country – the ones who have very little money – have been abandoned by their own government.” From his own experience, Roy might well now accept that this government (and those before it) has never had the needs of the electorate as its priority. The main concern has always been looking after British capitalists, not the working class majority.

The answer isn’t more money for the NHS – since in a competitive world, there’ll always be pressure on all governments to keep cutting back on state funding, and increasingly make people pay directly for what they need. No. The answer is a society with no money at all.

That’s the only way to end the idiocy where, these days, NHS hospital employees are being told by PCTs to stop “overperforming” by providing treatment too quickly, because the government then financially penalises the Trusts for not adhering to minimum waiting times (as a result, one gynaecologist said he now spent more time doing sudoku puzzles than treating patients). And a moneyless society is also the only way to end the obscenity of driving people to desperate lies and deceit to obtain vital life-saving treatment that should be available to all – not just those sufficiently well off or powerful.

Max Hess