News in Review: Hurrah for the NCB (1962)

The News in Review column from the March 1962 issue of the Socialist Standard

Hurrah for the NCB

Who was it who once prayed to be protected from his friends?

When he was plain Mr. Oliver Lyttelton, Lord Chandos was a prominent member of the Conservative opposition which duelled with the Attlee government over its nationalisation bills. They fought in the House of Commons all day and. sometimes, all night as well. So effective was their propaganda that to many voters nationalisation became a very-dirty word.

But what is Lord Chandos saying about nationalisation now that he is a big industrial boss, chief of the mighty Associated Electrical Industries combine and of the Institute of Directors?

“Nationalisation of a fairly substantial sector of industry has come to stay. Whatever I may have thought in the first place about the wisdom of this policy, it is quite clear that every loyal citizen must try to make our nationalised industries work efficiently … As an industrialist I want cheap fuel and reliable supplies and I believe that with a little more working together that is what you [Lord Robens, chairman of the National Coal Board] will secure for us.”

Lord Robens need not feel embarrassed at this new friendship. Nationalisation was designed to give just what Lord Chandos wants — cheap and reliable supplies of vital commodities.

The only pity now is that Lord Chandos did not tell us this some years ago, when he was spreading the fairy tale that nationalisation had something to do with Socialism.

New Hospitals

One of the things which have missed out on the post war boom is the hospital. Over a fifth of those taken over by the National Health Service in 1948 were built before the American Civil War. Nearly half of them were built before the beginning of this century.

What has been done to put this to rights? Since the last war only one large general hospital has gone up—in Northern Ireland.

To the reformers who have been worried about this, the recent government White Paper must have come as a ray of hope. For plans are being laid to spend nearly £800 million during the next ten years to give us, in the words of the White Paper.” . . . the physical equipment and the pattern and the setting which will everywhere place the most modern treatment at the service of patients.”

This sounds fine. Who can disapprove of bigger and better hospitals? But we have heard this sort of promise before.

We heard it about the roads and the railways and about the Health Service itself. For Capitalism is full of problems which are left to fester until a government decides to tackle them with heavy expenditure.

Many of these grandiose plans have been axed out of recognition in successive economic crises, when, the government has been looking for ways of reducing its expenditure.

There will be more economic crises. Which means that there will be more cuts in expenditure. Which means that Health Minister Powell’s beautiful hospitals may never see the light of day.

Expensive Royalty

Many tongues were clucked at the news that the Royal Family is to have some more money spent on them.

It must cost around £400 a year in fees alone to send the Prince of Wales to Gordonstoun School. The fees, says the school, vary with the parents’ financial circumstances; which does not mean, of course, that the school is full of clever, deserving boys whose parents pay no fees because they cannot afford them.

It will cost about £85,000 to renovate the wing of Kensington Palace where Princess Margaret and her husband are living—£15,000 more than the original estimate.

Some critics say that Prince Charles should be sent to a comprehensive school, like a sizeable part of his subjects. Others think that the Princess should be content to live in a council semi-detached, which to them seems roomy enough for a couple with only one child.

These views are way off the mark. The Royal Family stand for the possessions, rights and privileges of the British ruling class. It is, therefore, only appropriate that they themselves should live in lavish privilege.

And nobody has yet explained how sending a prince to a council school, or sticking a princess in a small house, would help the working class parents who struggle to keep their children at school past the age of fifteen and who have to renovate their house during their summer holiday.

These problems are typical of what faces workers all over the world, under monarchies and in republics.

While the tongue-cluckers do their measly, pointless sums, Capitalism grinds merrily on, providing a fat living for a few of its people and condemning the rest to dull poverty.

Tory Unrest

The Government took on a slight list last month, under the blast of criticism from many quarters.

The strikes of railwaymen and engineers encouraged The Guardian to sigh that, although they reproved the strikers, industrial unrest was the inevitable result of the Government’s policy on wages. Other critics thought that the trouble was caused because the Government had not explained the pay pause properly to the workers.

Some standard bearers for free enterprise were disappointed at the Government’s refusal to interfere with the free enterprise take-over bid from ICI for Courtaulds. Labour had a go on Lord Home’s criticism of UNO. To cap it all Tory M.P. Sir Harry Legge-Bourke suggested that fellow Old Etonian Macmillan is getting past it and should hand over to a younger man.

It would be interesting to hear how a government could explain a wage freeze so that the frozen workers accepted it. Workers sell their energies to their employers, which means that they are bound to resist any effort to keep down the price of those energies, whatever tricky name it goes under.

Such problems are typical of the confusion of Capitalism and are bound to cause unrest as the Government—any government—grapples with them. Critics and rebels may flex their muscles impressively, but when it is their turn to do the grappling they never shape any better than the men they have criticised.

The fact is that the individuals who say they are in charge of the affairs of British Capitalism really have little control over events. And that goes for their critics as well.

So it does not really matter whether or not Macmillan manages to ride this latest storm. We shall still all be in the same boat together.

Letter: A View from the Hospital Basement (2026)

Letter to the Editors from the March 2026 issue of the Socialist Standard

A View from the Hospital Basement

To the Editors,

I write to you as a 53 year old working class logistics porter for NHS Scotland, and someone who has recently come to terms with a lifelong reality: I am autistic. Having spent my younger years in the frantic ‘activism’ of the far left, I find myself now, in the quiet of my fifties, looking at the world through a lens sharpened by both my diagnosis and the consistent logic of socialism.

For the autistic worker, capitalism is not merely an exploitative system; it is a sensory and social assault. The ‘wages system’ demands a specific type of human raw material, one that is flexible, socially performative, and capable of enduring the chaotic, profit driven environments of modern industry. If you cannot ‘mask’ your traits, if you cannot navigate the arbitrary social hierarchies of management, or if your nervous system recoils at the bright, loud, and disorganised nature of the capitalist workplace, you are branded ‘inefficient’.

In my eighteen years within the NHS, I have seen the machinery of the state attempt to patch up a broken population. We are a class of ‘repair men’ trying to fix the damage caused by a system that prioritizes the accumulation of capital over human well being. My job as a porter relies on lists, logic, and routine, elements that suit my autistic mind. Yet, the overarching system is one of irrationality. We see the ‘crisis’ in our hospitals not as a failure of funding, but as a failure of a system that treats health as a commodity and workers as mere expenses on a balance sheet.

The Socialist Party’s ‘Impossibilist’ stance, the refusal to advocate for the mere ‘crumbs’ of reform resonates deeply with the autistic need for systemic consistency. In my youth, I chased the ‘immediate demands’ of reformism, only to find that every hard won ‘right’ can be stripped away by the next budget or the next shift in the market. For my daughters, one who shares my neurodivergent wiring, I have no interest in fighting for a ‘better’ version of their exploitation.

A socialist society, one based on the common ownership of the means of life and production for use, is the only environment in which the neurodivergent person can truly thrive. Consider the logic:

First, the abolition of the ‘interview’ and the ‘personality test’. In a world of voluntary labour, the social ritual of ‘selling oneself’ to a master disappears. An autistic person’s focus and ‘special interests’ cease to be a commodity and become a direct contribution to the community.

Second, the end of sensory exploitation. Capitalism builds cheap, high stress environments because they are profitable. A society producing for human need would, for the first time, design spaces for human comfort, accounting for the diverse sensory needs of all its members.

Third, the removal of social hierarchy. My alexithymia and my struggle with social cues are only ‘disabilities’ because capitalism demands a specific type of social compliance to maintain the master servant relationship. In a society of equals, where no one has the power to command another’s labour, the ‘unwritten rules’ of the workplace vanish.

I have stopped apologising for the way I am wired. I have realised that my autistic brain, with its preference for facts over rhetoric and systems over leaders. We do not need charismatic leaders to tell us we are exploited; we need only to look at the ledgers of our lives.

Socialism offers a ‘case’ that does not shift with the political winds. It is a list of principles that holds up to the most rigorous logical scrutiny. For the worker in Scotland, for the porter in the basement, and for the autistic child yet to enter the fray, the message must remain clear: the system cannot be mended. It must be ended.

Yours for the Revolution,

Pablo Wilcox

Scotland

The Health Services (1966)

From the November 1966 issue of the Socialist Standard

The school medical service was the first national health scheme to be established in Britain. In the earliest days of compulsory education a constant source of anxiety for the capitalist state was the suspicion that it was wasting money on many of the underfed and underclad children in its elementary schools, simply because their physical condition prevented them from really applying themselves to their books. But what finally shook the reformers into action were the press reports of widespread physical defects found in the young workers recruited into the army at the time of the Boer War. It was feared that the bulk of Britain’s. “C3 population” was not even fit enough to die defending the imperialist interests of the ruling class. Hence in 1904 the Inter-departmental Committee on Physical Deterioration emphasised the need for a system of medical inspection of school children. This led to the Education (Administrative Provisions) Act, 1907. It is, of course, no coincidence that the other principal improvements to the school medical service are linked with the First and Second World Wars. The drafting of hundreds of thousands of working men and women on both these occasions again showed to what extent social conditions had undermined health. It is against this background that the Education Acts of 1921 and 1944 can be understood. These made it a duty for all education authorities to provide routine health inspections to be conducted on school premises.

However, the Education Act of 1944 was largely overshadowed by the discussion which raged around the Beveridge Plan and eventually materialised as the National Health Service Act, 1946. If ever there was a case of a government feeling it could simply plan away the problems of ill-health arising from the capitalist system, this was it. What was envisaged was a unified scheme available for the whole population, except for those who had the money and inclination to pay for private treatment. As can be seen from the diagram following, in theory every form of illness was adequately covered.

Under the Act the vast majority of hospitals were transferred to the Minister of Health (i.e. formal ownership of the State) on July 5, 1948. The Minister was charged with the responsibility for providing adequate hospital accommodation together with the required medical, nursing and other facilities—including the services of specialists. Eighteen years later accommodation, in terms of the number of hospitals and the number of beds, still remains inadequate. As one government publication put it: “Scarcity of capital resources seriously limited hospital building in the early years of the service.” But, it proudly goes on, “. . . the annual expenditure on hospital building rose from £12.5 million in 1956-57 . . . to an estimated £54.6 million in 1963-64 . . .” To put such figures in perspective they must be measured against the “defence” expenditure for comparable years (£1,483 million in 1957-58 and £1,837 million in 1965-66—see the Socialist Standard, August, 1966).

But the problem is not just one of too few beds, even though the Guardian mentioned on June 9, 1966, that there are now about 10,000 patients waiting to enter a hospital. Low wages have resulted in a chronic shortage of nurses and doctors. Earlier this year the general secretary of the Confederation of Health Service Employees reported to his union that 13 per cent of the beds in the hospital service could not be used anyway at present—because of the lack of staff. Most doctors are continually overworked and reports of individuals putting in well over 100 hours a week are commonplace. However, despite all the statistics that could be quoted, perhaps the best appraisal of the hospital service can be made by referring to the comment of a Manchester consultant, reported in the Daily Mail, August 22, 1966:

“When I was doing my house training I’d do a stitching job in casualty after being up all night, and I’d know it wasn’t my best work.

"Today I should hate to be knocked down and become a patient. The odds are I’d get a young doctor who had been on duty for 48 hours. How could 1 expect his best work?”

Unless you can afford the fees of a private surgeon or those of the London Clinic, this is what the hospital service means for you.

The general medical and dental services are under the supervision of the local executive councils. There is one of these to each county and county borough and it is their function to organise the doctors, dentists, pharmacists and opticians in their areas so that a comprehensive medical service exists. Supplementing these are the local health authorities who are responsible for the ambulance and midwife services as well as employing health visitors, home nurses and so on. The fact is that everywhere in this supposedly “comprehensive medical service” there are gaps and inadequacies resulting from lack of staff and facilities. A few details should make this clear.

Ten years ago the report of a working party on health visitors (Min. of Health—1956) suggested that a total force of 11,500 would be required “for the Health Visitor to effectively discharge all the duties required of her.” Years later, when this estimate is outdated anyway, there are still only the equivalent of 8,000 whole-time health visitors employed in Great Britain. Similarly, there is still throughout the country an unsatisfied demand for home helps—especially among old people. At present the average for England and Wales is that for every 10,000 people only 68 are receiving some form of assistance in this way. Section 25 of the National Health Service Act places on local health authorities the duty of providing home nursing for invalids who require such attention. As one writer euphemistically put it: "The limiting factor for some time to come will probably be the number of nurses available.” (The New Public Health —F. Grundy, London, 1965). Again, under Section 21 of the same Act, the local health authorities were ordered to equip and maintain health centres in their areas. “(This) duty on local health authorities has not been enforced, largely because of the restrictions until recent years on capital investment in health and welfare projects . . . By the end of 1963 only 18 health centres had been opened . . .” (Health Services in Britain, HMSO, 1964).

One service not mentioned so far is that of health inspection. Every council, other than county councils, is required to appoint one or more public health inspectors who supervise slum clearance, inspect houses and factories, check food supplies and so on. In the same year that the National Health Service Act was passed, a report of the Central Housing Advisory Committee outlined a 16-point standard for a “satisfactory” dwelling. It should be stressed that these were minimum requirements and merely included such stipulations as that the house should be dry, equipped with a proper drainage system and have adequate heating facilities for each room. It was pointed out back in 1946 that it was not then practicable to put this standard on a statutory basis and immediately have the public health inspectors enforce it. Twenty years later this is still the case. Millions of workers continue to live in damp, insanitary, squalid buildings which the authorities label with the bureaucratic understatement of “unsatisfactory”.

The health services, just as much as the mines and factories, are organised and run by members of the working class. There can be no doubt that many of the overworked doctors and underpaid nurses stick at their jobs simply because of their conviction that they are doing worthwhile work. But, like all workers under capitalism, they find that their efforts are hemmed in and frustrated by a social system where health comes very low down on the list of priorities.

John Crump

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

Why nurses are angry (1993)

From the November 1993 issue of the Socialist Standard

In September nurses from University College Hospital (UCII) in central London went back to work after a six-week strike. What made them angry enough to strike?

Why is it that approximately two months ago south London hospitals were crying out for extra nurses to care for patients on the wards, but there was not an agency nurse to be found?

A recent survey done by the Institute of Manpower Services found that one nurse in four would leave the NHS if they could. Why?

The creation of the internal market within the NHS has meant there is increasing pressure on trusts to keep within their budget. With the old system it did not matter if budgets weren’t kept to, the money was just replaced. In the new system if you don’t keep within your budget, then you don’t meet your contracts and eventually you go bankrupt like any other business.

In trusts most of the money goes on nurses’ wages (they are the majority of the workforce).

Constant pressure

There is constant pressure to cut this budget and this lias been addressed in a variety of ways.

First, freezing posts as nurses leave. Second, possible redundancies, though on the whole this has not been widespread as yet. However in the College of Health Studies where I work, there has been an amalgamation of two colleges of nursing which involved redundancies. The College is about to amalgamate with a further two colleges of nursing and more reductions are planned. It has been suggested that the 183 teaching posts in the three colleges will be cut to 52.

Third, alteration to nurses’ hours. Nurses have traditionally worked a shift system of earlies, middles, lates and nights. The hours are different from hospital to hospital but used to be roughly: Early: 7.30am to 3.30pm; Late: 1.30pm to 9.30pm; Night: 9pm to 7.45am.

Managers did not see why there should be an overlap of nurses on duty between 1.30pm and 3.30pm. This did not appear to be cost effective. What were the nurses doing during this time? On investigation it was found that education of students and professional updating of staff went on. As the extra nurses were not directly involved in patient care, managers felt it was a waste of time having them and altered the hours accordingly. Extra money was also being paid to the night shift for working "unsocial hours"; again managers fell this could be tampered with in some way.

At one particular hospital the nursing shift hours are now: Early: 7am to 3pm; Late: 2pm to 10pm; Night: 9.45pm to 7.15am. This hospital may have reduced the nursing budget on hours, but its sickness rate has soared and it is having to pay agency staff to work.

Finally, alteration in ward skill mix. There is a trend to employ more care assistants (unqualified nurses) instead of qualified staff, who are paid more. This leads to a decrease in the quality of nursing care given to patients.

Two research studies (Skill Mix and the Effectiveness of Nursing Care, Centre for Health Economics; York and Ward Nursing Quality and Grade-Mix, Report No. 504, York University’s Health Economics Consortium.) showed that where wards were staffed wholly by qualified nurses the standard of care given to patients was high, but where wards were staffed with combinations of unqualified and qualified nurses the standard of care delivered to patients was lower.

Fragmented care

This appears to be because unqualified staff cannot give the total nursing care to the patients. For example, they lack the knowledge to interpret signs and symptoms and cannot give out drugs. This means that patient care becomes fragmented and patients have to wait for qualified nurses to gel to them to give them the appropriate drugs or interpret symptoms.

All these points mean that there is an increase in pressure on nursing staff which results in frustration because they cannot give the nursing care they want to.

A Trust’s survival depends on getting contracts from Health Authorities and GP fundholders. Since the reforms there has been an increase in productivity within hospitals. This increase in throughput of patients has a tendency to mean early discharges, which puts extra pressure on nursing staff to ensure that discharge arrangements are ready and that there are enough beds for patients coming in. It may also mean patients go home too early — and have to be readmitted. The government says that wage increases will come from increased productivity. But if contracts are completed early. Health Authorities and GP fundholders have no more money to buy more treatment for their patients. So hospitals simply have to stop work. Eventually this will mean that hospitals cut the number if nurses so that, although the amount of work remains the same, there are fewer people to do it and it takes all year to complete. This situation is worse in London due to high overheads and London weighting etc. For example Camden and Islington Health Authority stopped all elective surgery at some central London hospitals in September because it had used up all its money with these expensive Trusts.

The planned reduction in junior doctors' hours means that some things previously done by doctors will become the remit of the already overburdened nurse. Again, nurses are cheaper to employ than increasing the number of doctors.

All these things mean that the nurses are increasingly having to alter the way they care for patients and are increasingly leaving the patient's bedside, for which they have been trained, to deal with administration issues such as discharge arrangements or managing bed vacancies.

No wonder the nurses at UCH said enough is enough.

If the Tories win another general election, the next step is obvious. Trust hospitals will simply become private hospitals, contracting with both private health insurance companies and Health Authorities for their income. And Health Authorities themselves will simply stop buying some treatments. A Labour government would be no better as they would still face the fundamental problem of how' to finance an NHS which will need more and more money for research, new drugs and so on.

Within capitalism it is impossible to deal effectively with disease and illness with the NHS or any other healthcare system as the emphasis is on profits rather than peoples' health and researching into causes of ill health. The only way in which to have a proper Health Service is to form a society which is based on peoples' needs: socialism. Finance and the fundamental problems it brings will disappear as it would be a society based on need rather than profit. Emphasis would be on prevention — at the moment this is too costly. The McKinleys’s river approach ( where individuals are falling into a river and drowning and Health care staff pull them out. patch them up and send them back to the top of the river, where they fall back in again) would stop and society will address the reasons why people fall into the river, such as bad housing, air pollution, etc. All individuals would be looked after in the appropriate place hospital or community. In hospital, there would not be the pressure on beds that there is now and people could spend as much time there as they need, and when discharged to the community there would be the proper resources available

Adele Atkinson

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.

The "Free Health Scheme" Myth (1976)

From the September 1976 issue of the Socialist Standard 

It was all worked out so that sick people in Britain could be looked after and seek treatment undeterred by the financial disaster it previously entailed. So they were told — but it didn’t work out that way. In capitalist society you get nothing for nothing and the politicians (outright callous Tory or two-faced hypocritical Labour) make no bones about their ‘need’ to modify workers’ wages for (and limit the benefits of) a health scheme which fails to satisfy the “cheap healthy work force” expedient of those who planned it.

For let there be no mistake about the motive of those who devised the idea of a National Health Service, telling the world it was to ensure unfettered medical attention for all who needed it. It was (as many publications inadvertently disclose) to cut the cost to British capitalism in working hours lost to their businesses through workers’ sickness.

Now, these Capitalist interests are not happy with their own deal. They feel that British doctors are not doing their bit in the cheap maintenance of healthy wage slaves, but are spending too much capitalist money in the process by “overprescribing” for the sick who turn to them for help. A “free” health scheme (in fact it costs 20p per item on each prescription and there’s a lot of Parliamentary agitation to make it more) is all very well in the interests of the country’s employers — but if general practitioners take the thing too far they will have to be pulled into line. Thus Mr. Mike Thomas, Labour MP for Newcastle, has introduced a Bill demanding that registered medical practitioners be limited in the drugs they may prescribe to a small list and that their surgery treatment notes be made available to a panel who may have to “discuss” with them the treatment they arc making available to patients on the “National Health”.

Quote, from the doctors’ periodical Pulse 10.7.76: —

‘‘The Government may be forced into taking more radical action to reduce the level of prescribing, both within general practice and the hospital service in order to peg the rising drugs bill. Minister of State for Health, Dr. David Owen has called for ‘better prescribing overall’ and has reminded the profession, yet again, that it is now having to make economic decisions within the context of tightly reined resources. Unfortunately both Dr. Owen and Social Services Minister, Mr. David Ennals have reached that stage where they are issuing repeated warnings on the need for constraint in each sector of the Health Service, but no one knows precisely how the Government intends to cut back costs or what level of toughness it is prepared to use. The Department of Health circular issued last week, for example, was supposed to represent ‘Guidelines’ on the much-vaunted review of NHS management costs . . . Dodging the perfectly justifiable suggestions from one Tory questioner that there was need for a realistic uprating of prescription charges which still remain at their pre-inflation rate, Dr. Owen replied: “What is needed is better prescribing overall and a recognition by patients that not every ailment is cured by pills . . . The medical profession must recognize that it has to make economic decisions. At present the prescription Bill has no cash limit and is open-ended . . . But if the medical profession is not able to show some form of economic restraint in its budget, any Government would be forced to look at other measures ... At the moment we prefer to rely on education and we hope to keep the drugs bill within reasonable bounds by that method.’ ”

The article in Pulse continues:

The drugs bill to which Dr. Owen was referring amounted to £379 million during the last financial year in England. At £7.00 a year per person, was that not good value for money? Dr. Owen took this opportunity, replying to Labour back-bencher Dr. Maurice Miller, to confirm that the pharmaceutical industry was not guilty of drawing any excess profits — and that any blame for the escalating drugs bill lay with an over-demanding public and over-generous profession.

In other words, Dr. Owen has the gall to represent himself as unaware of how notorious drug firms are for their enormous profits, and upset by patient’s demands for adequate treatment and doctor’s desires to provide it!

Health at a Price

Quoting from the doctors’ periodical General Practitioner, 16.7.76, on page 8 we read:

A blunt warning that the National Health Service must ‘live within its means’ was given by the Prime Minister last week. Only 24 hours after the Cabinet began a series of meetings to prepare for public spending cuts totalling about £1,000 million next year, Mr. Callaghan made it clear that the NHS would not escape the treasury act. He told members of the Royal College of Surgeons at a dinner in London that ‘difficult choices and unwelcome decisions’ lay ahead in many areas of public expenditure. Doctors would be faced in their everyday work with a difficult period of adjustment from a fairly rapid rise in the amount of resources available in recent years to more stringent conditions.

This, of course, is a typical politician’s mealy-mouthed way of avoiding saying that National Health Service patients will have to suffer neglect by being denied benefits once promised by the British capitalist class. But to add insult to injury, listen to the sheer two-faced double-talk the Labour Leader follows it up with. Quote: “At a time when the ordinary wage earner is voluntarily cutting his own standards, the health service too must live within its means.”

In other words, Mr. Callaghan feels that if workers are being deprived in one way it is only fair that they also be deprived in another! This is the depth to which opportunist politicians will sink and a measure of the contempt they have for their wage slaves’ discernment.

This is but one of the many degrading aspects of life under capitalism, where men can dictate how much medical attention and care their fellows are “entitled to.” In a Socialist society such inhuman parsimony would be impossible. There would be no leaders able to hoodwink anyone, and not just  health care but all goods and services would be free to every one.

R. B. Gill

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

Running Commentary: Clerics’ confusion (1986)

The Running Commentary column from the August 1986 issue of the Socialist Standard

Clerics’ confusion

Are we all god 's children, or are some of us — women — rather more distant relations of his — nieces perhaps? Are we all made in his immaculate image or are those of us in the female sex less capable than those of the male gender?

The Church of England, which purports to instruct us in morality and keeping our place as docile wage slaves in the capitalist order of things, is having difficulty in deciding whether to allow women the same opportunity to be ordained as men. The recent vote of the Synod, to refer the issue to a panel of 53 bishops, was not so much a decision as a deferment, in the hope that the slickest religious brains in the church can use the next six months or so to cook up a face-saving compromise.

This is all rather curious. The church has been operating for centuries as a bunch of intellectual storm-troopers (although latterly rather more like a company in Dad's Army) for class society. Do they think they might perform better, on behalf of the ruling class, if women were allowed to dress up in those silly clothes, perform the same meaningless rituals and preach to us about the rewards waiting in heaven for all who do their duty for capitalism?

On the other hand, why should any of them oppose women priests? (Graham Leonard, the Bishop of London, hinted broadly that he would leave the church if women are to be ordained. Not exactly a grievous loss to us if he did). Other churches have female priests, as does the Anglican church in some other countries. They don't seem to have any problems in doing the church's work of putting across the baseless, reactionary nonsense of religion.

This brings us to the most important question, of why women should want an equal right to become priests, especially if this means first being insulted by people like Graham Leonard. Of course, it's all part of the drive for sexual equality, for proving that women can do any job as efficiently as men. So far the jobs where this has been proved have included the armed forces (in some states there are female combat troops); the police (watch Hill Street Blues of a Saturday night to see how a girl can handle a truncheon); the prison service (there are now female governors of male prisons in Britain, making sure the prisoners are firmly locked away and punished appropriately); and of course there's the Prime Ministership . . .

Perhaps there are some women libbers who think it is a worthwhile result for their long campaign, that they can now do the same dirty work for capitalism as men. In fact, there are worthier aims to campaign for. Like a society free, not just of sexual inequality and repression but also of the religious hypocrisy which has helped to keep us all — and especially women — enslaved for too long.

Health service priorities

Another recent demonstration of the perverse priorities in capitalism is the statement by Norman Fowler, the Social Services secretary, that he has authorised health authorities to pay managers bonuses of up to £3.960 for making cuts in health service expenditure — cuts that are likely to entail the closure of hospitals.

Health service managers who don't mind acting as the government’s hatchet people can expect an extra £ 1.660 a year if they are general managers (five per cent on top of their annual salary of £33.200); for district managers £3,160 (ten per cent of their maximum of £31.600); and for unit managers. who run individual hospitals, an extra £3.960. or up to 15 per cent of the maximum salary of £26.400.

One of the ways in which the government seeks to justify its programme of hospital closures is through the cosy euphemism of "community care". This is the name given to the plan to remove many long-term sick, disabled and mentally ill from hospitals to be "cared for" in the community. Most people would accept that being looked after by loving friends, family or neighbours backed up by appropriate medical, nursing and social work support is preferable to incarceration in impersonal hospital wards. Unfortunately the reality of "community care" is often very different. Many long-stay hospital patients have remained in hospital precisely because they don't have family or friends willing or able to care for them; social services and community medical provision are already over-stretched and are unable to provide the support that would make "community care" a reality; there are insufficient resources being put into sheltered housing, group homes and day centres. The result is that the reality of "community care" for many people is a lonely, near-destitute existence in a depressing hostel; or homelessness or. for some, relapse into illness and a return to hospital.

Health service managers are being offered bribes to close hospitals, not because they are no longer needed but because meeting the needs of those who make up waiting list statistics is too expensive. Neither are hospitals being closed because "community care" is a more humane alternative. They are being closed because it is a cheaper alternative.

Policing pupils

Over the last few months the government has done its best to try to divert attention away from uncomfortable, but real, issues such as the continuing suffering caused by apartheid in South Africa, the failure of economic policies to stem the rise in unemployment, questions being asked about the nuclear power industry after the Chernobyl nuclear accident, and so on. Instead we have had our attention focused on a series of pseudo-issues which can be "solved" easily. Litter in the streets: solution — call in capitalist entrepreneur Richard Branson to start a "Clean-Up Britain" campaign. Hippy peace convoys in the New Forest: mobilise an army of police at five in the morning to break up and disperse the camp. Sexual promiscuity among the young: introduce an amendment to the Education Bill to require teachers to stress moral values and family life in sex education classes.

This amendment to the Education Bill attracted considerable media attention and yet at the same time another two amendments were being tacked on to the Bill which, although they attracted less comment, are perhaps more insidious. They will require school governors to pay attention to the view of Chief Officers of the police when making decisions about school curricula and head teachers to take account of Chief Officers' views when organising lessons.

Are the police going to use their newly-acquired influence to ensure that children are taught about road safety, or the necessity of having lights on their bicycles, or what to do if they witness an accident7 So far the evidence suggests that this is not what the police have in mind. The 1983 report from the schools inspectors suggested that the value (to the police) of closer liaison between the police and schools would be that of "intelligence-gathering":

Police forces generally attach considerable importance to the advantages to be gained through unofficial contact with schools. Home-beat officers “drop in" at school during break for a chat with pupils or teachers . . . Most schools welcome and encourage this informal contact and may ask home-beat officers or juvenile bureau officers to have an unofficial "word" with pupils, or their parents, about whom they feel anxious in relation to criminal activity.

Of course there's an official term for this informal, unofficial contact between police and schools — "multi-agency policing". In practice this means that as many different people as possible are co-opted to do the dirty work of the police and inform on their neighbours and fellow workers through neighbourhood watch schemes and the involvement of social workers. Now it seems that the police, having got their foot in the door of school, are going to be allowed some input into the curriculum too.

Most teachers who attempt to talk about the morality of family life in sex education lessons will simply be laughed down by sophisticated teenagers who have their own moral code. But it's much harder to laugh down a police officer who enters the classroom to glean information through chats with pupils or teachers, or a Chief Constable who insists on his right to vet the curriculum.

Blogger's Note:

Though this Running Commentary column is unsigned, there's a strong chance it was written by Janie Percy-Smith. During this period, she was on the Standard editorial committee and was one of the journal's most prolific writers, and the 'Clerics' confusion' piece indicates that the author is female.

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.