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

Proper Gander: Going public about going private (2024)

The Proper Gander Column from the May 2024 issue of the Socialist Standard 

There are several connotations with the word ‘private’, in relation to ‘private hospitals’ or ‘private healthcare’. The description means that they are privately owned companies with the purpose of generating profits for their shareholders, with medical treatment as the product they sell. The word ‘private’ also suggests that these hospitals are select, and separate from the NHS and the majority who use it. This isn’t always the case, as shown in Panorama’s investigation NHS Patients Going Private: What Are The Risks? (BBC One). The word ‘private’ also implies being reluctant to reveal too much, so the documentary was of some use in highlighting issues which private hospitals would sooner be made less public.

One of the symptoms of the ailing NHS has been increasing delays for treatment, with more than six million people in England in the worrying position of coping with a worsening condition while they wait their turn. In an effort to reduce the length of waiting lists, some of these patients have been referred to private hospitals for surgery, with the costs paid from NHS funds. In 2023 around 800,000 NHS patients were handled by private hospitals in this way. Many of these went to one of the 39 hospitals run by Spire Healthcare Group plc, the second-largest private provider in the UK. Since 2021, Spire has treated more than half a million NHS patients, contracts for which have made up around 30 percent of its revenue. Reporter Monika Plaha looks at two aspects of how Spire runs which have had a devastating effect on some of its patients: staffing and arrangements for dealing with emergencies.

Spire’s management of its staff was questioned after two surgeons they employed were separately exposed as dangerously incompetent. Since then, concerns have focused on low staffing levels, especially at nights and weekends, and how alert people can be during back-to-back shifts. Resident doctors have been contracted by Spire for up to 168 hours a week including nights on call, whereas doctors’ working hours in the NHS are capped at 48 a week. Almost all the ex-Spire doctors interviewed for Panorama were worried about the consequences of their high workloads and protracted shifts. Hiring insufficient numbers of staff is one of the most obvious ways of minimising costs to maximise profits, regardless of the more obvious risks to patient safety. For the documentary, Spire provides a bland statement that it now has ‘robust safeguards’ and resident doctors only work ‘when adequately rested’.

The programme also describes failings in how private hospitals have dealt with complications during surgery, whether suffered by referred-in NHS patients or those paying directly. Most private hospitals don’t have intensive care or high-dependency units, so when a patient’s condition deteriorates or a procedure fails, they have to be transferred to an NHS hospital for emergency treatment. Moving a patient during a crisis carries risks, made worse by having to rely on an ambulance which could take hours to arrive, even when the hospitals are close to each other. The programme features interviews with people who have tragically lost loved ones due to complications which Spire hospitals couldn’t cope with and which weren’t dealt with by an NHS hospital in time.

Private hospitals don’t have facilities to deal with crises because they tend to treat medical issues less likely to have serious complications which require care in a high-dependency unit. And they tend not to deal with high-risk operations because these come with additional costs for specialist surgeons or equipment, and would therefore be less profitable. In other words, patients with complex conditions aren’t financially attractive. As Sally Gainsbury of the Nuffield Trust points out, around a third of NHS patients have health issues too complicated to be managed in private hospitals, so they must wait longer for NHS treatment. This is exacerbating a two-tier system where healthier people can be treated quicker privately. One way of reducing this disparity would be for private hospitals to have adequate intensive care facilities, avoiding the risks with transferring patients back to NHS hospitals in emergencies. But this requires investment, raising costs which will mean that fewer people will be able to afford private treatment, whether funded through the NHS or not. So far, private healthcare organisations like Spire have been reluctant to invest in facilities for crises, or sufficient numbers of staff. Despite this, and the criticisms made of it, Spire is aspiring to carry out more complex procedures and have longer-term contracts with the NHS. This isn’t with the aim of helping out the beleaguered ‘public’ sector, but to extend its market share. Last year, Spire’s profits increased by over 30 percent to £126 million, and any expansion will be guided by what’s likely to generate further profits rather than by meeting need.

Reformists call for the NHS to have more funding so it doesn’t need to refer patients to private hospitals, but there will never be enough money for the utopian NHS they want. Even if a government wanted to adequately fund the NHS, other economic imperatives would prevent this, especially the need for profit which guides the system overall. The ‘public’ ownership of the NHS means that it isn’t directly profit-driven, but it still has to survive in the profit-driven system, alongside and inter-dependent with private healthcare.

Every day, skilled and dedicated staff in NHS and private hospitals perform life-saving operations which would have looked like miracles just a few years ago. Somehow, they carry on despite the obstacles put in their way by the system they work in, such as the routine of long shifts in understaffed wards because this minimises costs, or having to gamble on surgery being straightforward because other hospitals with facilities for dealing with crises are overstretched. Trying to overcome these obstacles with reforms or revised contracts or reallocated funding is a never-ending struggle because this approach can’t change the system which creates the problems. It only addresses the symptoms without curing the cause.

Mike Foster

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

Voice From The Back: Bad Day, good day (2001)

The Voice From The Back Column from the March 2001 issue of the Socialist Standard

Bad Day, good day

It was 1 February when the news broke. Corus, the Anglo-Dutch steel giant, announced that there would be more than 6,000 redundancies at five main sites across the country. An example of how devastating this could be is summed up by Vernon Lewis who worked in Ebbw Vale steel plant for 22 years: “Corus hasn’t just ripped the heart out of a steel works, it has ripped the heart out of [the] community.” Times, 2 February. So widespread gloom throughout the country? Well, no, not quite: “Meanwhile, the city was happy at events with shares in Corus shooting ahead on news of the restructuring. By midday, shares had jumped 10 percent, up 7.75p at 82.5p before closing at 82 percent, Herald, 2 February.

Blairing a new tune

Four years ago our TV screens were filled with a smiling Tony Blair being worshipped by devout Labour supporters to the accompaniment of loudspeakers blaring, “Things Can Only Get Better.” But that was four years ago. Elderly people are waiting for up to 25 hours on trolleys in hospital accident and emergency departments, according to the soon-to-be-abolished Community Health Councils. Nigel Crisp, NHS chief executive, admitted that there was still a “problem” with waiting times. Times, 1 February.

Breakthroughs and heartbreaks

“The principle was accepted last November that insurers would be able to make use of some kinds of genetic testing information. If such tests become more widespread and insurers are given greater access to the results, a lot of the insurance market could disappear altogether in the long run. If building insurers jack up premiums in houses on floodplains, you can bet the same will happen to vulnerable people’s medical cover, permanent health insurance, critical illness, life cover and long-term care plans.” Observer, 21 January. Inside capitalism even scientific breakthroughs turn out nasty for the poor and vulnerable.

Business as usual

Their followers may hate each other and shout about 1690 and 1916, but the leaders of the Unionists and SDLP are co-operative when it comes to the really important issues to Irish capitalism—business and profits. “David Trimble and his Catholic counterpart, SDLP leader Seamus Mallon, are flying into Paris this morning in a bid to drum up investment by French firms in Northern Ireland. They will meet Medef, the French employers’ association, and then head off to the Elysée Palace to see Jacques Chirac, the President.” Times, 31 January.

Drowning not waving

“Government scientists from 99 countries, including major oil producers, have agreed that the earth’s atmosphere is warming faster than expected. In an unprecedented display of unanimity, their evidence points to human activity as the culprit. The United Nations Intergovernmental Panel on Climate Change (IPCC) now projects the earth’s average surface temperature will rise 1.4 to 5.8 degrees Celsius between 1990 and 2100, higher than its 1995 estimate of a one to 3.5 degree rise . . . Sea levels are predicted to rise between nine and 88 cm (3.54 and 36.64 inches) from 1990 to 2100, potentially displacing tens of millions of people in low-lying areas such as the Pearl River Delta, Bangladesh and Egypt.” Herald, 23 January. Capitalism in its drive for profits is ruining the planet. Only socialism with production solely for use can save it.

Economy Class Syndrome

“Even though the Observer first warned of the dangers of economy class syndrome two years ago, airlines have refused to act. Now fresh research to be published in the British Medical Journal reveals that a tenth of blood clots treated at one London hospital were caused by sitting immobile on flights. If these figures were represented nationally it would point to 3,000 cases a year and 300 deaths, making death from a blood clot a greater risk than a plane crash.” Observer, 21 January. In their efforts to increase profits airlines are cramming as many people as possible into their aeroplanes. If that means reduced leg room leading to fatal risk—tough.

The NHS — nothing for something ? (1977)

From the April 1977 issue of the Socialist Standard

“The love or my life”, Barbara Castle called it, and her successors still try to tell British workers that they’re getting something for nothing.

But what are the facts? Dr. David Owen, until recently the Health Minister, says: “The NHS was launched on a fallacy. We were going to finance everything—cure the nation—and spending would drop. That fallacy has been exposed now we realise that no country, even if prepared to pay the taxes, can supply everything.”

“Supply everything”! What does it supply?

On the “free” health service a specialist consultation for a patient requested by a general practitioner has to wait for anything up to 10 months. In some places an appointment for a child with recurrent tonsillitis to see the ear, nose and throat surgeon may take 4-5 months and then, if the surgeon thinks removal of the tonsils is indicated—the wait for operation is measured not in months but in years. A middle-aged woman may have to wait as long as seven years to receive her hysterectomy.

And most of the hospitals where the operations are done are ramshackle, overcrowded and out of date. Beds are close together, operating rooms have damp-stained ceilings and peeling walls. Furniture is battered and linen thread-bare. Only 41 of Britain’s 2300 hospitals are less than 30 years old.

The sport at Oldham General Hospital among patients is taking bets on the number of cockroaches crossing the floor in a given time span. One local medical officer says: “This hospital is so permeated with the filth of the ages that the only answer is to raze it.”

One feels there should be an energetic programme to build new hospitals, but the reverse is the case. New hospitals are not being completed and existing ones being closed down. John Pilger in the Daily Mirror (25th Jan. 1977) tells us of the coming closure of the Connaught and Metropolitan Hospitals as part of the Government’s public spending cuts. Both hospitals' secretaries say that closure will mean “unimaginable suffering” for ill patients who will have to be sent home. Quote: “Mr. Peter Richardson, secretary of the Connaught, a 121-bed community hospital, which closes on Monday said last night, 'To close down now, in the middle of winter, is madness. We have a “yellow alert” at this hospital right at the moment and that means the beginning of an emergency. Many of our 100 patients are the elderly with chest infections, such as bronchial pneumonia’.”

Also from John Pilger, the Daily Mirror (26th Jan. 1977) quotes the surgeon at the impoverished Northampton hospital who pleaded: “How can I allay the fears of a woman who has to wait weeks and weeks for a breast cancer operation?” And at the Hackney General Hospital the casualty department was being forced to turn away children. The Daily Mirror continues: “Northampton and Hackney are typical of a great many British hospitals which have been starved of funds for years and are now being called upon to make cuts which are impossible without incalculable suffering and—as the doctors have said—deaths.”

But “solutions” appear to be on the way—though not very pleasant ones for the working class. Apparently the time has come for them to pay (even more) for their “free” health service. A front page headline in Medical News, 19th Jan. 1977, announces: “£2 a Day Charges for Hospital Patients would raise £300 million.” Below we read: "BMA Council believes that the Royal Commission should consider approving hotel charges for hospital patients . . . Council is recommending daily charges for bed and board in hospital, and increases in prescription charges. It believes a flat rate weekly compulsory payment for health services to be paid into an independent NHS fund should also be looked at . . . Basically the Council was unanimous in feeling that a totally free NHS at the point of consumption led to the undervaluing of the health service. Charges would impose a more thoughtful attitude on the part of the public, and also among doctors, who sometimes have no idea what the treatment they prescribe is costing.” Says Medical News: “. . . the feeling was that quite serious illness could be treated at home by a GP, and the patient there had to pay for his accommodation and food, so there was no reason why the hospital patient should not do so.”

And on the front page of Medical News 26th Jan. 1977: "Doctors Warned to Monitor Prescribing Costs —or Else.” The article reads: “If doctors do not monitor their prescribing patterns in terms of both efficacy and cost more effectively, they may have controls imposed on them.

"This is the underlying message for doctors following a report into the work of the Prescription Pricing Authority (PPA) published last week.

“The main recommendation of the report is that the work of the PPA should be computerised to speed up the processing of prescriptions and also to provide a better flow of information on prescribing patterns and costs.”

Mr. Tricker told Medical News, amongst other things: “The report makes no recommendations on the control of prescribing, and I argue for self monitoring by the doctor. However, the report does raise the question of alternative forms of control by the state if doctors seem unable to control prescribing for themselves.” Various forms of controlling prescribing were considered. Two suggestions were the exclusion of certain drugs from free treatment under the NHS, or restricting doctors’ prescribing to the BNF (British National Formulary).

Another form of control would be to introduce a local drug expenditure based on the population of an area. Funds would be allocated by the DHSS. The budget could be monitored by the local medical and “local peer group interest could be brought to bear” on a doctor. (In other words—set general practitioners to compete with each other to supply the least and cheapest treatment.)

In Doctor (10th Feb. 1977), however, we read: “Mr Ennals (Social Services Secretary) was full of praise for the prescribing standards of GPS. They were unequalled in the world, with the cost of drugs per head of population being lower in this country than elsewhere in the EEC.

“ ‘But there may still be scope for further economy (in drug costs) without harm to patients,’ he added.” Thus we learn from the boasters of the best community health service in the world that although we’re doing it the cheapest—we might still do — “better?”!

And now there are new worries for those professing to have the welfare of the sick of Britain at heart. Quote: General Practitioner, 21st Jan. 1977: “Fears Mount on Doctor Surplus. The BMA is demanding an immediate inquiry into the threat of unemployment among doctors in the early 1980s. Fears that medical schools are producing too many graduates have been highlighted by the Hospital Junior Staffs Committee after a four year investigation. The BMA is to ask for an interim report on whether these fears are justified in its evidence to the Royal Commission. The juniors believe that unless medical school places are cut immediately by 1000 a year, there will soon be too few jobs for newly qualified doctors.”

And in Medical News, of 26th January, 1977, Cyril Clarke, the retiring president of the Royal College of Physicians, has urged Britain’s 26 medical schools to consider cutting back student intake to prevent the hardship of an unemployed “bulge” later.

“The situation, he said, could not wait for the Royal Commission. It was far too urgent.”

“We must not run into a school teacher situation,” said Sir Cyril. “We should not bank on too much NHS growth.”

So, while patients wait for months for appointments, years for operations and queue up for hours in outpatients’ departments to see junior doctors who are elsewhere and working 80 hours a week, the powers that be are at pains to decrease medical manpower. Tragically—like other unenlightened workers—some junior doctors think that this is a “solution”. They fear the threat more help from an increased number of colleagues would make to their industrial bargaining power. There is, of course, and will be for a long time to come, a dreadful shortage of doctors in real terms. Apart from the dearth in existing premises there is a desperate need for them to man many vital hospitals. The trouble is that those hospitals are either not being built, or not being completed or being closed down.

The situation is similar with trained nursing sisters. They find themselves redundant whilst their colleagues desperately try to cope with endless lines of patients.

It is a “teacher situation”. Students rallied to the call for more teachers to reduce the numbers in school classes. Result—most of them out of work and still we have overcrowded classes.

And it’s all because people aren’t working hard enough, isn’t it. Mr. Callaghan? They’re not getting their backs into it and paying their way. Why don’t you leave it to the Tories to tell the working class that the trouble is they don’t like work? They’ve had (a bit) more practice at it than you have!

All this rottenness doesn’t have to plague us. There are enough men and women who want, and have the ability to be—good doctors, nurses, teachers, hospital and school-builders and organizers, to make mankind healthy, happy and secure. Only the capitalist system, which the vast majority of workers support, maintains need amidst potential plenty in every sphere of human life. Why not vote that system out of existence?

R. B. Gill

NHS priorities (1991)

From the March 1991 issue of the Socialist Standard

In recent years the National Health Service has suffered as a result of reduced expenditure. District health authorities have closed wards and reduced services to stay within their dwindling budgets.

These cuts in income have led to announcements that a further 3,500 beds will be closed to the public as hospital administrators are ordered to clear existing debts before the implementation of the government's changes to the NHS that begin in April (Guardian, 26 January).

Despite the government's attempts to reduce the politically embarrassing waiting list for treatment of a million people this has continued to grow. North East Thames regional health authority with the worst waiting list, for its size, in the country has found an answer to the difficulty in reducing its huge waiting list: in the future certain categories of patients will be prevented from joining the queue.

There have been informal restrictions for some time and it is claimed that a million operations have been cancelled in the last three years (Radio 4, 4 February). Screening for cancer could save an estimated 1,250 deaths a year by the end of the decade but the programme may have to be curtailed in some areas because surgeons are unable to cope with the extra work that would be involved (Guardian, 31 January). The women most affected by breast cancer who could be helped by the screening are in the 55-69 age group and, from capitalism's point of view, at the end of their economic usefulness.

The operations for which it is now difficult to even join a waiting list tend to affect people’s well-being rather than their ability to work. These operations are still available privately for those who have the means to pay. But the poor will have to live with uncomfortable disabilities.

In January the NHS was provided with more money to open beds for certain categories of patients—casualties from the Gulf War. Some districts have opened beds which had remained closed due to underfunding from previous years. Professor Angus McGrouther, head of surgery at University College Hospital, London, has stated that the NHS is fully prepared for the chemical injuries, burns or conventional war wounds that may arise from the Gulf War (Daily Telegraph, 28 January). These type of injuries are not new to British hospitals. There were many burns and war wounds sustained during the Falklands' War and victims of chemical weapons from the Iran-lraq war in the 1980's. The chemical disaster at Bhopal also provided grim experience of chemical poisoning on a large scale.

The effects of sulphur mustard gas are well-documented as it was extensively used by both British and German armies during the First World War. The continuous development of chemical and biological weapons in Britain has enabled knowledge to be accumulated, and provides deadly materials ready for offensive use.

War casualties
Two psychiatric patients have been staying in a doctor's office at St Bartholomew's Hospital, London, because of a shortage of beds. A hospital spokesman, while denying that this was a result of accommodation being set aside for war casualties, stated: "It was thought appropriate to create additional space" (Guardian, 28 January).

At a time when the government is urging workers to settle for smaller wage increases. members of the armed forces have been offered a 12.2 percent increase to encourage them to kill others and risk being killed themselves for oil and profits. Nurses have been offered a 9.2 percent pay rise instead of the expected 6-7.5 percent. Student nurses have even been offered 11 percent. This is because nursing skills are going to be in short supply if the expected 500 casualties a day start to arrive from the Gulf War. The government cannot afford to have a repeat of the strike action taken by North Manchester General Hospital's night nurses in January 1988.

Security in British hospitals has been increased on the advice of the Ministry of Defence and employees are being issued with identity passes. There have been an increasing number of assaults on patients and staff in recent years but attempts by nurses’ unions to obtain better security have been largely disregarded. The Gulf War has changed all that and money has been found very quickly.

Although poverty is the cause of the greater degree of ill-health and premature deaths suffered by the working class the NHS does help relieve some of the misery of illness. The resources to run an efficient health service are available as the response to the Gulf War has shown. The preservation of workers' health in a recession is not important under capitalism because there is always a supply of unemployed labour which can be used to maintain production. But keeping workers in uniform fit enough to kill those who have temporarily been designated as “enemies” is. The provision of beds to assist in the prosecution of a war for oil and profits while the rest of the NHS is slowly being dismantled shows capitalism’s anti-working-class priorities.

Carl Pinel