Crisis in the Health Service: The Socialist Solution

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CRISIS IN THE HEALTH SERVICE THE SOCIALIST SOLUTION |

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First Edition: IMG Publications, April 4976 ISBN: 0-85 612 014-6

PHOTO CREDITS: pages 3.6 and 12; Chris Davies (Report). page 11: Michael Tomlinson (1FL). cover! Mike Sheridan (IF L),

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Distributed by: Red Books, c/o 97 Caledonian Rd., London N1 SBT.

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I. THE INTERNATIONAL CRISIS OF HEALTH-CARE People all over the world, from Britain to South America, the diseases thal seem-to be extending within or beyond are bombarded every day-in the mass media with the the territories in which they usually occur.” The same wonders and marvels of “modern medical science” —kid- WHO report concludes “the connection seems to be loose ney transplants, heart transplants, plastic bubble houses between the modern medical scene and the death rate of for the treatment of leukaemia, coronary care units, etc, these people.” Absolutely 100% right!!

Finally, even an open capitalist concern like the World etc. ... These things are put forward to indicate that our Bank is forced to admit, “Malaria eradication campaigns medical problems are being solved, But what do these “brilliant discoveries” really mean launched in the "50s were largely successful in 37 countries. for the mass of the world’s population, how do they con- However, there is evidence of recent setbacks in Indonesia tribute to the general state of health of the people? and the Indian sub-continent.” “Sleeping sickness (Trypa- The potential of scientific progress cannot be questnosomiasis), by the 1950s was under control in most areas, toned. But what we must have isa balance sheet with However, the disease Aas started again to become more which to assess ifand how scientific discoveries have serious since the mid-60s. ... Schistosomiasis, a disease improved the health of orlinary people,ind also the transmitted by snails, of which there are now perhaps 200 effect of the economic crisis of international capitalism million clinical cases in the world, and its impact is growon health care. ing.” (Health Document, March 1975).

Such a balance sheet shows not the optimism of the Now, with increased incidences of diagnosing rickets media, but. rather a story of pious promises and increasing (for the first time in fifty years) in the deprived and overcrowded estates of Glasgow, we are seeing the beginnings During the last quarter of the nineteenth century and at of a return to the dark ages even in “advanced” capitalist the outset of the twentieth, the standard of health of the countries, people of the imperialist countries, primarily Britain, USA, This then is one aspect of the situation—the failure of France and Germany, improved considerably, And in the capitalist medicine to meet the needs of health care on a first half of this century significant advances were made world scale, with the appearances of specific examples of towards the climination of diseases which have killed and a worsening of health care, Yet this is at a time of fantas- — disabled millions annually. This was done with improved tic developments in science, diverted into defence forces, nutrition, better, less crowded housing, new sewage, draintather than used to improve general health standards. age and running water systems, measures which must be classified as methods of medical treatment.

THE OTHER SIDE OF THE COIN Medical treatment was thus collectivised and demons- But there is another side to the coin, We have been looking trated to-all the material link between social deprivation at the situation in the two-thirds of the world still and incidence of disease, and finally eliminated not one strangled by capitalism, In those countries which have illness, but a number of diseases such as cholera, dysentery broken historically with capitalism, such as China, Cuba, and typhoid. Similar, though much smaller, collectivised Russia and Vietnam, health care is not deteriorating but Programmes followed on from this in the colonies of taking massive strides forward. India, Africa and South America, which cut down malaria, Firstly, starvation and famines have been eliminated sinalipox and other endemic diseases. entirely in some of these countries, The resulting improve- However, the real balance-sheet of the last 25 years and ment in the level of nutrition is strengthening resistance the prospects for the future—often depicted as the golden to other diseases, This isa startling contrast with the age of medicine with great individual advances—is very situation in capitalist India. . different from this. The millions upon millions of pounds Secondly, with the mobilisation of the mass of the being spent throughout the capitalist world on research people, endemic diseases are being eliminated. In the produced: case of infestations this means action such as that taken firstly, no significant improvement in death-rates from against the snail-borne schistosomiasis. With mass health the major diseases in the advanced capitalist world. In education and the involvement of millions in the search fact, with lung cancer, heart disease, mental disorder and for the river bank snail, this has been virtually eliminated suicides, the picture is, if anything, worse.

Secondly, for the first time ever in countries of Africa, in many areas.

Yet in a capitalist state such as Egypt, fifty per cent Asia and South America, still deep in the grip of capitalof the population has the disease. ism-and imperialism, we are seeing the beginnings of a Thirdly, in the workers’ states, the incidence of venereal roll-back-of the advances made in health over the past 75 disease has been reduced almost to zero. Yet in the USA years, We are seeing how the deepening economic crisis and Britain, despite all their much publicised antibiotics, of international capitalism is forcing an eectual deteriora these diseases are becoming more common, than in werld Aeaith. The possibilities of the beginnings of ‘The capitalist method of delivering health care is able a teturn to the famines and epidemics of the nineteenth to contribute less and Jess to the health of humanity, Agcentury are placed on the agenda. ainst the buffeting of the chronic economic and social Even the Journal of the right-wing “American Medical crisis of capitalism, the discovery of yet another ‘super- Association” admitted last year, “modest progress towards drug’ counts for nothing in the general health of the popimproving world health was made in the first half of this ulation. Against the social organisation of society, which century; in the third quarter (last 75 years), progress dictates the organisation of its health service, the training halted or, worse, regressed.” of twice as many doctors or the building of another ten Further, the recent “Third Report of the World Health open heart surgery units are mere pin-pricks— ; Situation” (Geneva, WHO) states that “‘one of the features But his does not mean that socialists should sit hack of the past decade was the reappearance of certain while past gains in health services are torn down as sacdiseases ... The outstanding example was the revival of rifice to the economic crisis, Analysis of the reasons for venereal diseases, plague, the spread of rabies and trypathe situation is needed and armed with this a campaign of nospmiasis (sleeping sickness) and the re-establishment of action against all threats to the health care of oppressed ancylostemiasis in areas from which it had apparently sections of capitalist society must be mounted. disappeared some vears ago. Even more troublesome are

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In the course of such a campaign the labour movement class end push forward the struggle for a health service asa whole can debate the health needs of the working class. and a society organised,in the interests-of workers.

Il. CAPITALISM & HEALTHCARE The crisis of capitalist healthcare is reflected in vatious 2. SEPARATION OF PHYSICAL CAUSES FROM ways in different places, Nonetheless, in the arena SOCIAL FACTORS IN ILLNESS of health care, as in any other part of social life, the class The central theme of medicine under capitalism is the struggle is manifested very clearly, Even in the countries forced separation of the physical cause of an illness from where the working class have won many reforms the intersocial and environmental situations. Capitalist medicine ests of the ruling class are dominant and consequently concentrates on curing life threatening diseases by the inthere are clear differences in the method of delivering tervention of one individual (always a doctor) dealing health care from a health system where working class with the individual patient. interests dominate, Medical technology by itself has not contributed to [tis our contention that the capitalist type of health health care to the extent portrayed. ‘Increases in health service is incapable of furthering the welfare of humanity standards in Europe were brought about much more by and that it must be transformed. Further, that no amount improving social and economic conditions than by medical of patching up of this, or papering over of that is going care per se’—Werld Bunk health paper, March | 975. ‘In fo produce a service to cater for working class interests the United States, TB deaths went down from 200 per while the state machinery is in the hands of the capitalist 100,000 population in 1900 to 3 per 100,000 in 1967. class.

Yet the modern chemical drugs for TB became available Despite all the good intentions of reformists, the politonly in the 1950s, when the rate was already below 30 per ical ideology and priorities of the capitalist system will 100,000° (Same source), produce a health service downplaying policies to meet the Infant mortality in Scotland remains rélatively high needs of the working class. despite spending more than England on these medical What are some of the most important characteristics of services. A Government department study has shown this ideglogy? There are four main categones: that infant deuths are directly related to overcrowding in 1. Economic priorities:

Certain areas: : 2, ‘Separation of social factors from physical causes:

But perhaps the most naked example of medical dis- 3. Health education and prventative medicine: lortion is in the treatment of mentiland nervous cliscer- 4. Individual solutions and collective solutions. ders. There can-be no doubt that social and economic Although these questions are interlinked, by €Xamining factors-are Often of primary importance in this field, each individually, at the risk of repetition, we can gain im- Yet psychiatrists are obliged under the present system portant insights; tO pay to more than lip service to altering social condilions. Instead, almost all attention is devoted to filling 1. ECONOMIC PRIORITIES patients with drugs. For a short time this may appear toimprove things for the patient, but may be creating When it comes down! to basics, for the ruling class more Uifficulties in the longer term as the basic problems health care is to provide and maintain'a productive work Tema: force. All other aspects. are secondary. Thus, illnesses or Fhe separation of physical and social factors in the conditions which last a long time or for which there is face of overwhelming evidence against this is jealously no known cure, and illnesses difficult to treat are relativeguarded, The niost recent example of this was in 1974 ly ignored, because it is unlikely that these people will be when under NHS reorganisation and the Seebohm report able to get back to full time productive labour. which was accepted, all NHS social workers came out of Example |. Mentally handicapped kids are packed like the department of health and went into local authority inimals into isolated understaffed underheated institutions services. And these are thé very people who spend most in the middle of nowhere. On average £25 per week is of their time in the homes of thase they are trying to help, spent on each person for full services compared with £100 seeing and knowing how important the home and family per week in an acute hospital for the simple basics, Comconditions are-to their health. The reason why these extramunity facilities for these people are undergoing 50 per cent ordinary things take place is clear if the links start to be cent cuts at the present time. made between the social and physical causes of illness, 2. The elderly, considered an unproductive section of and these are developed and discussed in the working the population, and afflictions associated with old age, class movement, they open enormous questions and lead are regarded as unimportant. Virtually no facilities for to demands and actions about health care and its telationresearch of rehabilitation are provided and the longest ship to where people live or work, This the ruling class Waiting lists in the whole NHS, between two and three can not afford, years in many places, are for operations on arthritis of the No-where is this point more clearly brought out than hip, a problem many old people face. the situation of occupational health services. In many 3. The second longest waiting lists, one to two years, of these cases the environmental element cannot be ignorare for operations for vaginal and womb conditions of ed. But the ajedical profession and the state have historwomen in their late forties. Yet there is no waiting perically used their monopoly of knowledge to obscure the iod at maternity units. The priorities are obvious; women real causes and real responsibility for such hazards, bearing the next generation of workers are cared for, but Of course, it is always said that it is the fault of the others, no longer able to bear children are forced to a painindividual worker and not of the company or state indusful wait before attention is given. try. Asbestosis, and bladder cancer from aniline dyes There are jist three ¢xiimples, There are many more. tell a different story. But not only docs the capitalist state have priorities with- # in the health service itself. but within its general expenditure, Examining this it is evident that-such items as 3. HEALTH EDUCATION AND PREVENTATIVE nuclear submarines and investment handouts to company MEDICINE nuindgements are invariabley cut back after health, education and housing services have had their budgets plunder- If disease is to be eliminated it is essential for understanding of the most common and discomforting disezses ed. to be shared by all, Health education can be done in a

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units’ to treat the individual person in a very intense way after the individual heart attack. As it happens in the way that reaches the maximum number of people, through last few years these units have been proved to have been television, radio, newspapers and comic books. But the a complete waste of money, a5 the incidence of recovery ruling class refuses to organise this, Although this would from the heart attack is the same, in or outside one of lead toa reduction in the cost of health care, there is-no attempt to. push forward such an education scheme bethese expensive units.

The second way is a distortion of health education cause of an over-riding fear that it would open debate within the working class likely to spill into directly poland preventive medicine, whereby one individual doctor does blood fat tests on one individual patient and advising itical questions. him/her alone what diet changes ought to be made, How- This dilemma is faced in different ways by different ever, outside, ten to twenty million men and women in states. In New York the authorities have started a limited danger from this disease remain unhelped in any systemhealth education scheme in an attempt to save money, In atic way. Meanwhile as these two capitalist methods constrast the British Government responds with a miserly continue to fail, the death rates continue to rise. one million pounds on health education, one fiftieth of one per cent of total health spending.

4, INDIVIDUAL SOLUTIONS AND COLLECTIVE We can see from these four sections that wherever health care systems are attempting to operate, if capital- SOLUTIONS ism holds the reigns of power, then these four forces — = economic priorities, ignoring secial factors, absence of mass health education and therefore preventive medicine, and individualised solutions—gain a deeper and deeper hold over the running of that health system.

THE POWER OF THE MEDICAL PROFESSION

At present the pivot around which healthcare revolves, is the doctor. The doctor is the only person supposed to know all; the doctor's decision is final and not to be questioned; the doctor can prescribe any and all treatments, and the jealously guarded monopoly of medical knowledge stays locked in his/her head. These backward characteristics are defended vigorously by doctor.

Around them a whole cult of importance has developed about doctors and with their inflated social position and strong economic bargaining power, they have o very clear material interest in maintaining the status quo of the patient's ignorance, and of capitalist medicine in general, What follows from this is that this whole picture has an important effect on the doctors’ relationships with other health workers. Despite the partial attempts in one or two places to develop a team experience, the ideology obscuring the role of the doctor has forced the return to rigid hierarchy structures almost every where The idea that ‘doctors can be left to look after our health’ because ‘doctors know best”, can lead to the most absurd misuse of resources by doctors. For example it was reported very recently in Argentina, a country in great crisis with thousands unemployed and virtually no adequate health facilities, that six lop surgeons are spending their time finding ways to put hair back on é The ruling class strives continually to keep oppressed fald men’s heads. in Britain the working class won a significant victory sections of society fragmented. Asa consequence, cxin 1946, when it forced through the setting up of a nationcept in rare circumstances, it refuses to implement coll al health service. The task of the labour movement now, active solutions to health problems, An exception is thirty years later, must be to examine and debate through where the patient remains a passive uninformed receiver how the crisis of international capitalist health care has of treatment, as in the case of immunisation schemes. worked itself out in our situation-and what has been the But this is quite different from the type of active popular real balance sheet of trying to operate for these last thirty involvement needed to push medicine forward, years a health service through bodies of the state, with- The refusal to countenance such involvement results out having broken the stranglehold of the medical profin massive inefficiency. In the United States, for instance, ession. Has this reform been able to-serve the needs of seven per cent of its gross national product is spent on the working class, or has it been even further withered health care, yet its infant mortality rate is actually climbing. Expenditure of this order is only operated in times away from Bevan's proposal This analysis and debate is of central importance for of boom, in recession the state attempts to cut back, as the whole workers’ movement, for dependent on it will is the case today.

This strategy is falling apart af the seams, A further be how we fight and whar we fight for in the struggle to defend the NHS against the Healey cutbacks une agaist example of the failure of this type of medicine concerns private practice in the next period, the epidemic of coronary heart diseases in the western countries. Attempts to deal with this have been made in two ways.

Firstly, in the last ten years by building ‘coronary care

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Il. 30 YEARS OF THE NHS — A SHORT BALANCE SHEET the mass of the people, Bevan on the other hand put more The working class in Britain was the first to win a relemphasis on the Parliamentary aspect — on talking. Inevatively free, almost comprehensive system of health care itably Bevan was forced to back down by mass action, and in a capitalist society. However, from the very beginning the NHS is to'this day sufféring from-that defeat. it had a restricted conception of what a national health The way Bevan and the reformists fought out this batservice should do. This was a reflection of its origins. tle is important to draw out and to bear in mind for both in that capitalist society. In the struggle over the formathe present and future struggles that will be fought in the tion of the NHS in 1946-48, there were three elements NHS; we shall return to these later. operating. For the working class the inadequate and appalling standards of the pre-war years were no longer acceptable.

DRUGS AND OTHER SUPPLY INDUSTRIES For the ruling class two things stood out — on the one hand it was clear that the pre-war system with its separat- The second central defeat suffered by the working class ed voluntary and municipal hospitals, and its poor disin the setting up of the NHS, was the refusal of the Labtribution of doctors, was too inefficient to maintain at low our Government to nationalise the drug and other supply cost, a healthy labour force:.on the other hand there industries, in order to properly plan and organise a comwas a genuine fear about what the mass of the working prehensive health system. class would demand after giving up millions of lives for The drugs, as well as all the other medical equipment capitalism in-the war. This fear was born of the experand machinery industries have been able to grow fat out jence after the first world war, when 10,000 mutinied of the exploitation of illness on a world scale, and in partin Calais on the way to being de-mobbed, and when region icular out of the NHS. Drug sales in 1971 were estimated regional strikes, forced the calling in of the army to crush to be around 16 billion dollars.and the profit rates of the workers’ revolt on Clydeside. drug-companies easily outstrip those of any other manu- The combination of these two factors made the ruling facturing industry. Roche, the British part of the biggest class not unsympathetic to the setting up of the NHS at company in the world, has recorded rates of return of up that particular time. to 2000 per cent. That the drugs industry can be so suc- At the outset there is no doubt that the interests of cessful in making huge profits is directly related to the the capitalist class won through in the formation of the practice and nature of capitalist medicine. As we have NHS. shown the ideology of capitalist medicine justifies med- That is not to say that embodied in the NHS there ical treatment as almost exclusively concerned with the: were no advances in health care for the working class, physical symptoms. Instead of investigating social caus- But it is important to realise that these reforms were es, capitalist medicine has two main ways of treating the only conceded in the face of massive working class presillness.. By surgery and by the use of medicine and drugs. sure. At the same time the state never let go of the The prescribing of drugs is both more profitable and less reigns,al no time did the workers movement have any politically dangerous than probing the changes in social control over the newly emerging National Health Service, conditions needed to combat most illness, for example in The Regional Health Boards set up by the state to admindepression, anxiety, alcoholism. istor the NHS and run the NHS hospitals at a local level, The results of this are the most cynical exploitation of were composed mainly of business men, local dignitaries illness, and the keeping of the mass of the people in comand doctors, whe could be-relied on not to ask too much plete ignorance as to the nature and use of the treatment of capitalism. they are given, One central defeat that the workers movement suifer- The failure to nationalise this section of private industry ed which to this day hangs around its meck in this respect meant a massive waste of resources with duplication of rewas at the hands of the medical'profession. By allowing search, actual reversals in scientific progress by the use of private practice to be practiced both inside and outside drugs as false short cuts, and the loss of human life. At the NHS, the Labour government of the time ensured the present some 94 per cent of drugs coming on to the market dominance of the consultants in the NHS. It is important for the first time are direct copies or only slight modificato understand the lessons of this defeat. tions of existing medicines.

The strains of trying to bring together a partially plann- BEVAN AND THE MEDICAL PROFESSION ed health system and a private drug industry result ina number of problems, In the struggle with the medical profession it would |. The over-prescription of drugs which are either usehave been quite possible to win, and not to allow private less or too powerful — but often more profitable. As with practice to flourish and to prevent the GPs getting anti-biotics, this can lead to-a drastic decrease in usefulaway with their inefficient and complicated system of ness as bacteria develop resistance. Penicillin is a good payment according to the number of patients on their example of this; after years of use — not against specific books (capitation fee). When their threats to resian and infections — but for ailments like colds its effectiveness refuse to give treatment were being bandied about, many is greatly reduced, Trades Councils and union branches showed openly that 2. The lack of any scientific monitoring system they were prepared to launch a campaign to defend the exposes people to the dangers of inadequate testing. It NHS and put a block on these reactionary doctors in the was only in the last decade that the state set up @ drugs localities. commission to evaluate drug safety (Committee on Safety instead of mounting a broad working class mass camof Drugs). But this body only discusses the research and paign inside and outside parliament, inside and outside testing results submitted by the industry itself, and docs the Labour Party, which would have isolated the medics not concern itself about whether the new product is any and forced them to join the NHS, Bevan and the Labour improvement on existing drugs. government contented themselves with friendly profes- The results of this are that the dangers are often not sional negotiations, The medics were not so short sighted. seen for a few years. Thalidomide was prescribed for over They launched petitions amongst their patients calling — 3 years before ill effects were noticed, Over §00 children for “freedom for the doctors” to see patients as “friends were maimed as a result, At the same time, people are and individuals”. The doctors mobilised support from

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given, and pay for, relatively useless drugs. million it has progressively increased till now it is more than 10 times that — approximately £4000 million ex- 3. The drug companies justify their high profits by the risks involved in research. But only 10-2066 of drug research cluing inflation. The state on behalf of the capitalist class is devoted to the development of useful medicines. The began to tackle this problem, rest is concerned with slight chemical changes in already existing drugs to avoid patent laws, to the production of THE STATE PREPARES FOR THE OFFENSIVE relatively useless drugs (such as cosmetics) and the replacement of one drug by another which offers very It began, initally with the Younghusband report of little advantage but are normally more expensive. In fact 1958, commissioning report after report, on every conthe ‘risks’ of such drug research are no more than in deveeivable aspect of the running of the NHS — for example eloping a new model of car. about staff there was: Doctors (Cogwheel reports), This practice is encouraged and protected by the states nurses. (Salmon and Briggs), technicians (Zuckerman patent laws — which protect the monopoly of production report), social workers (Younghusband and Seebohm), and selling of any drug for years, énabling firms to accuand about re-organisation there was the Pouilt report, mulate massive profits. about productivity and bonus schemes amongst ancillary 4, The state has done little to combat or even limit workers, about day care hospitals, private practice there the extremely dangerous anarchy of drug research, manuwas the Sainsbury report, about medical administration facture and use. [tsfailure to provide adequate education there was the Hunter report etc, etc, for doctors after they qualify, has meant that they have This was for one reason and one reason only. Not to to rely on the advertising propaganda of the drug comfind out whether the NHS was working to the best in panies. The learned journals of the medical profession, terms of delivering health care, but to see where rationalimainly financed by advertising for drugs, are a mixture sation and cost cutting could be brought in and how they of a little medical science and a lot of business propaganda. were going to prune the NHS down to the bone, when The link up between the medical profession and the it might be necessary. Armed with all this information drug companies is very clear — from the very inception and al! these possible ‘solutions’ to these problems, the of the NHS they have both fought to keep private medicine determining factor of how hard to strike at the NHS was leeching off the NHS. It is very clear therefore that these the state of the British capitalist economy, and that time central problems, which the reformists failed to tackle now in the seventies has arrived, adequately in the setting up of the NHS, namely the The first strategic implementation of this pruing was questions of the medical profession, private practice, to take place through the Mental Health Document (later power at the regional level, private capitalist control of Act) of 1959. Historically, half the NHS beds were in the drug and other supply industries, stered up a pandora’s appalling 19th century mental asylums, with almost box of mechanisins to be opened up and used to sabotage half the cost of the NHS used in them. This was too the very basics of the NHS. All Bevan’s paper plans of a tempting a morsel"for cost cutters: The Act initiated community based health system have foundered on these a programme of closing down these asylums with the very rocks, corresponding based hostels in the looal communities, This was a progressive plan to be supported, as long as STRUGGLE OF THE CLASSES IN THE NHS no jobs or money were cut in the process, We see now after 15 years what the situation is. The cutting back of the mental hospitals began and is continuing at an ever From the beginning the capitalist class only grudgingly inereasing rate, BUT the building of local community accepted the National Health Service, and have seen its hostels for the patients has never been implemented, sole exsentiol task as that of maintaining a healthy workresulting in the scandels like Birmingham, where the force, only conceding reforms under the pressures of the patients, with no support, move from-one derelict dossworking class. . hose to another, ‘This ia now the state can we ina con- The working class on the other hand have fought tooth tradictiry way, what seem progressive steps — and it is and nail to extend the NHS to make it as comprehensive repeating this very thing with the National Priorities as possible: (i) through the building of anew generation White Paper — to implement the savage cuts that British of district hsopitals and old peoples homes; (ii) through capitalism is driving it to, the setting up of a fully comprehensive free ambulance The first ever strategic cutback was the programme to service; (iti) through launching massive health education close large mental hospitals: and build hosteis in the locprogrammes and programmes of preventative medicine. alities in 1959. The first part of this is increasing at an The class lines between these two perspectives could ever faster rate, whilst the second of hostel building was not be more clear, From the heights of 1946 the initiative NEVER STARTED!! has been lost and the balance sheet is that of a subtle, slow That experience of the Mental Health Act serves as an but virtually immediate counter offensive by the ruling class. Just 3 years after the NHS’s inception charges important lesson for us. The state had taken what seemed to be a progressive position on treatment of mental disfor prescriptions, spectacles etc were introduced 4y orders. Yet, in a contradictory way, by getting people's a Labour Government pushed on by the state. Harold support for the Act, it was able to move onto the attack Wilson, whose Government initiated cuts plunging simply by not implementing one half of the policy, It was a dagger into Hie very heart of the NHS, made a big to do precisely the same thing with all the other one hunstand and resigned from the government — well, fora dred and one reports it had commissioned in the first littl: while at least, This was the state testing out the 25 years or so of the NHS, namely to implement the reground. ports or those aspects of them in such a way that it AE this:time the naling class could afford to run the served the interest of the capitalist class in health care. NHS a5 a result of the post-war boom, and as the workers The watering down of the four NHS Hospital Building movement had been prevented from gaining any degree Plans is excellent testimony to this analysis. In 1962 (i.e. of control over the NHS the state could afford to tread after 13 years of no. hospitals or plans) a national network carefully, waiting to intervene in the NHS, pare it down of 265 seven hundred bed District General Hospitals and re-roganise it, when the time was right. As the boom (DGH) was proposed. In 1966 this was thought too am- ‘ began to tail off time began to get short. bitious, less new hospitals were this projected. In 1969 ; a The state then began to take stock, It had swallowed the DGH was thrown out in favour of the “Best Buy. to some extent the Beveridge report (1942) that with a Hospital” which was cheaper because it provided fewer rational planned health service, the cost would gradually beds per head of population (2 per 1,000 vs. 3-4 per decrease as people got more and more healthy. This was 1,000). Yet again in 1974 this was thrown out to be reproved wrong. From the cost in 1948 of some £400

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otganising the three aspects of the NHS (Local Authority placed by the Modular Hospital Plan, in which the bed Health Services, the Hospitals, and the GP's) under more number isdown to 300, and which can be built up in centralised state control. It wanted this for one reason stages of 100 beds or so. This process was a mirror of the only, that of carrying out a radical restructuring und ration: decline of the British capitalist economy, with the state alising in the health service sector to make the NHS tailoring its health building programmes in parallel with work more effectively and more cheaply for the capitalist the needs of capital rather than on the needs of working class. Even Richard Crossman’s watered down. proposals people. Bevan's reforms have remained and will continue for a reorganised NHS made during the '60-'70 Labour to remain paper plans with nothing on the ground, as the Government were inadequate for this task. It was only reformists have never seriously posed the question of under the Tory Keith Joseph, that asufficiently centralworkers control over the state and private health industry. ised bureaucratic structure with the chairman and half the Newham, in East London, has nothing to thank the remembers of the Area and Regional Health Authorities formists for. It was promised a DGH in the sixties, then a appointed from the Department of Health was achieved smaller Best Buy Hospital in the early "70s, now a The Re-orpanisation of the three sections of the NHS, Modular hospital is projected for the late “70s of 200 because it was not carried out under worker’ control, beds. Meanwhile in those 15 vears infant mortality, and lost its potentially progressive aspect of allowing a better ihe incidence of TB and other diseases have kept at 30% planned and integrated health service. 1t was now going higher than the national average! to be used to provide that centralised administrative structure which the state-could use asa more effective CENTRALISING THE ATTACKS tool in implementing those suggestions that had come up in the 20 years of those reports from the “50s to the During the post-war boom the above piece-meal stra- “70s. tesy was jist about adequate to the task. With the permenent character of the economic crisis of British capital- 2. The Royal Commission ism in the late "60s and ‘70s, a stronger medicine is re- The suggestions that will be implemented, and the quired. In this period capitalism is increasingly unable restructuring and reorganisation that will be needed to to provide both adequate profits for the basses and do this in reality simply mean- the planning and carryadequate public and social services for the workers. The ing out of cutbacks. However, the Labour Government international finance houses are demanding a radical reand the state fully understand that closing wards and structuring of the political, social and economic fabric hsopitals; sacking nurses, ancillaries, technicians and of British society in return for continuing financial even doctors (especially foreign junior doctors) and thus loans. Both the Labour Government and the capitalist decreasing health care and increasing waiting lists will state which historically, but in different ways, will always provoke a marsive response from the working class. The serve the interests of capitalism, are falling over cach new streamlined bureaucratic administration of the NHS other trying to do this: — Incomes policy, mass unemcould be too blunt an instrument to cut back the NHS ployment .public service cutbacks, £7,500 million of without causing the blood-letting of demonstrations, handouts to private industry are the results, It in this atrikes, occupations etc. lt is in that situation that we framework that we must understand what is. planned for must see the role of the Royal Commission. the health service, The central planks for this are the "74 Although it was created at the time of the consultants’ Reorganisation and the"75 Royal Commission. threatened resignations, it is now being turned into a 1. Reorganisation of the NHS means for sulling in the trade union and Labour Party bureaucracy behind its aims. The solution to the crisis in Since the early/mid sixties (starting with the Porritt the health service can only be resolved on the basis of a Report), the ruling class has been in favour of reoie

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The Royal Commission will be used as a battering ram re-allocation of money within e:framework-of an overall against any section of the working class that takes any cutback in finances available to the NHS. With the participation in this so-called impartial enquiry of labour direct action against the attacks on the health services. movement figures, the road to saying to workers that Uniess the representatives of the trade union and labour they must shoulder the capitalist economic crisis will be movement on the commission use their presence on it to issue minority reports, support calls for action and demonthat much easier, The recent document on Health prioristrations against the cutbacks and private practice then ties indicates and increasing cutback of the annual rate of growth of NHS funding from 4.32% in 1970 — 1974 they will be making legitimate a very subtle instrument to 27% in “75 —*80. If we subtract the inflation of which will be used against the working class and the 20% — 30%, the reality begins to be seen. health services it fought for and won.

IV. THE TRANSFORMATION OF THE NATIONAL HEALTH SERVICE In the first three sections of this pamphlet we have looked in ‘patients committees’, having trade union repreat the class nature of health care and the inadequacies of sentatives of health workers on management bodies of the hospitals, and above all having representation the National Health Service. In the rést of the pamphlet we will examine the different ideas put forward about how to of labour movement groups on the administration of the NHS—most recently the Area and Regional Health transform the health service into a socialist health service— Authorities. that is, a health service that is responsive to the health needs of working class people. ’ Lf these policies were carried through by a Labour gover- In doing this we will leave out the views of the right wing nment, the SMA says, we would again beable to talk of in the labour movement. Those people who are prepared to see the NHS being a socialist health service as we did when the the cuts in the NHS continue, and even take part in carry- NHS was set up. The ‘Tribune’ echoes the views of the SMA ing out those cuts, not only see no need to zo beyond the when, over articles arguing for the above policies, it puts present NHS, but are quite content to allow the re-emergthe headline “Putting Socialism back into the NHS’, ence of large scale private health care. We intend rather to examine the views of those opposed-to the cuts, those who DEMOCRATISATION AS A STRATEGY do see the need for both defending tlie gains made by the working class when the NHS was set up, and going beyond If we take a closer look at these policies we will sce that, the NHS-as it exists today. We believe that within the unity far from transforming the NHS into a socialist health service, of the left in taking action in opposition to the Labour govthese policies will actually lead the labour movement into émments attacks on the NHS, there must be the maximum turning its back on transforming the health service debate and clarity about what alternative policies there are Let us look at‘them policy by policy: to those of the government, and how to take up a strupele Firstly, the abolition of all private medicine. This for such policies. would undoubtedly be a major step forward for the working class. The abolition of drug production for profit and hospitals only for those who can pay, would at a stroke do DEMOCRACY AND THE NATIONAL HEALTH SERVICE away with the cynical profiteering on the basis.of other peoples bad health by the financiers, and {ree these res- By far the most widely held view in the labour moveources for more rational planriiig:The advantages are clear ment today about how to transform the health service into for all to see. asocialist health service, is that put forward by the Nationalisation of the drug and supply industries without Socialist Medical Association,-and campaigned for by compensation woul) mean an-end to the mcketeering of ‘Tribune’. : charging the NHS inflated prices, an end tothe misuse of The policies of the SMA have not changed a great deal resources Mm advertining, an end to drug research to avoid aver the last 25 years, indeed the SMA has been campaignpatent laws, and an end to research into new drugs being ing for them since the NHS was first set up and has played shelved because they are not profituble. an important role in drawing the attention of the labour The taking of private hospitals and clinics, as well us paymovement to the problems of the NHS. They argue for beds, into the NHS would considerably strengthen the NHS, three main things: allow the shortening of the waiting lists, stop the consuli) They say, quite correctly, that there can be no room tants use of NHS facilities to tine their own pockets through for private medicine in health care: When the NHS private patients who jump the queue. was set up they argued for the drugs:companies to be These policies must be fought-for as part of the fight to nationalised and made part of the NHS along with transform the NHS, but would they make tha NHS o sodiother supply industries. they argued against the accepalist health service? The answer is no. The fact that heatth tance of pay-beds being part of the NHS. care is nationalised will not make the health service-socialiat ii) ‘They have consistently argued for major reforms in any more than the transportsystem is.at present o socialist the NHS, and called fora massive increase of money transport system. The result of the nationalisation of the for the NHS to win those reforms. An occupational railways has not been socialist planning of the railways but health vervice, the extension of preventative medicine, a provision of cheap transport for private industry, improarchabilitative health service, the extension of health vement of the “Intercity route, and the closing down of ediuication—these were the things that the SMA conmost of the lines along with the increase of prices for workstanthy pointed out as missing from the NHS. ing class users. fii) They argued that if these reforms were to be carried The socialist planning of health care and provision of through, and if the NHS was to become responsive health care does notonly require that hospitals, staff and tothe needs of working class people, then the NHS supplies are brought! together in one planned national syscould not be left to the Consultants and DHSS burtem—it ao requires that health care gets at the social roots ‘@auctats to run—that there had to be “the democratic of idness. Socialist health care depends upon the demo ‘involvement of the peaple who consume’ in the muincratic planning of all social life-drainage, housing, producning of the NHS. The call for the ‘democratisation’ tion processes in the factories: all have to be freed from of the NHS for the SMA meant involving GP's patients the anarchy of the capitalist market before socialist health 7

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and parcel of the re-organisation of the NHS which involwed care can begin. closing smaller hosptials and concentrating resources in It is not possible to bring about socialism piece-meal, large ones, abandoning plans for new community health first the health service and education, later private housing and indstry. [tis because there can be no island of soccentres, etc. to achieve the massive cutbacks in spending ialist health care in a capitalist country that the fight to thal the government wanted to carry out. transform the health service has to be seen as-a part of the In order to carry out this ‘rationalisation’, the new fight for socialism and the ending of capitalism. pyramid structure was created, with all the people on the Regional and Area Health Authorities being appointed by We can see this still more clearly if we look at the second policy put forward by the SMA—the introduction of refthe DHSS. Only in this way could the rationalisation and orms into the NHS such as an occupational health service, re-organisation of the NHS be carried out with the minimum of fuss and the maximum efficiency’. At the time this preventative medicine and soon. Now we would agree one hundred percent with the SMA that we should be fighting caused quite a controversy. Organisations like the SMA carfor such refotms of the NHS: indeed, the fact that these are ried out a campaign denouncing this as bureaucratic and not a part of the NHS reflects the fact that the NHS sets out undemocratic and demanded that these bodies include repto provide individual solutions (patches people up one at resentatives of the labour movement. 8 time after they have become ill) rather than getting at the Keith Joseph did not turn his back on these demands social roots of illness through collective solutions—through entirely. Partly as a ‘democratic’ window dressing he creare-Organising society as a whole and educating people in ted, at the same time, the Community Health Councils. health care. But if we forced an injection of cash into the These were made up of 50% members appointed by the NHS and these services were set up tomorrow, would that AHA’s and 50% appointed by the Local Authority—and make the NHS a socialist health service? Again we say no. because of this they tend to include a minimal representa- If we look at the example of an occupational health tion of labour councillors, trade unionists and trades council service we can see why. As soon as you seriously begin to members. The purpose of these bodies, however, was cerexamine health hazards at work, il is necessary to begin to tainly not to facilitiate any labour movement control over question the whole of the way in which production is orgthe NHS, anised. In the car factories for instance, the speed of the To quote Dr. David Owen, now Secretary of State for line, the monotomy of the work, the constant noise, and Health in the Labour Government:.“The Community Health the machinery used, not only result in accidents on the Councils could be very important in orienting people shop floor but also affect the health of the worker in their towards a philosophy that health is not just something that personal life long after they have left the factory. is provided for by the NHS, but that cach individual has the responsibility for-his well-being..... They are very real- An-occupational health service that accepted the ‘rights’ istic about money and 1 think they could also be a way of of employers to make a profit, and therefore to organise bringing voluntary bodies into a closer relationship with the speed of the line, the division of labour, the machinery the NHS...... The Health Service has used volunteers in hosused, and all other aspects of the production process in order to maximise their profit, could not even begin to get pitals, and lam nowJooking towards ways to make more use of voluntary effort in the community, in such fields to grips with the problems of health at work. Indeed, us Caring for the disabled, visiting the elderly, and looking because these ‘rights’ of the employer ore defended by the courte and police, such an occupational health service would after psychiatric patients who have been discharged’. be forced to operate within those confines—trying to pre- In short, when the NHS is cut back it has an effect on vent the “worst excesses’ of the employers. An occupational those needing health care, and the job-of the CHS's is to find health service run by the NHS today would be a glorified ways that health care can be thrown back onto volutnary factory act, and just like the rest of the NHS would be help, and in particular—although Owen does not mention there basically to keep workers healthy enough to carry on this—back onto the working class: family, It will be the working for the employers. Indeed, like occupational working class family which has to find ways of taking old health services in othencountries, they would rapidly berelatives to the hospital for their check-up when ambulcome a method by which the employers are able to ‘get ance services dre cut; it will be working class families which more work out of their workers’. will have to find the money and space to look after bed- It is necessary to fight for these reforms in the NHS, but ridden relatives rather than use nursing homes for the we should not pretend that, in themselves they will ‘put elderly. a little socialism back into. the health service’, rather we The fact that these bodies are ‘undemocratic’ is should explain in the course of this fight that, at present, neither here nor there, The point is that they were created the NHS is not at all designed to serve the needs of the to carry out a certain job for the state—to cut the NHS back working class. which also required re-organising the NHS.

Let us now tum to the third policy of the SMA, because What sort of democracy is the SMA proposing? It appears even they do not see the above policies ax being, in themthat they are proposing that the workers movement ‘demselves, sufficient to transform the NHS into a socialist health ocratically' participate in bodies that are implementing the service. They would argue that this is only possible in a sitcuts in the NHS, that are licensing private practice, thal uation where the labour movement has a decisive say in are making nurses redundant. For at no time have the difthe running of the NHS—for the SMA the ‘democratisation’ ferent bodies running the NHS had any other role than to of the NHS is the main thing to fight for to create a run the health service in the interests—not of the working socialist health service. class—but of the capitalist class.

To fight for representation on these bodies is to mislead First of all, let us look more clearly at what the SMA and working class people as to their real purpose and the tric others mean by democratising the NHS. In the resolution nature of the health service. For example, what would we to the last Labour Party conference (1975), which was a say onan Area Health Authority when the DHSS says: composite of resolutions from the SMA, NUPE and Waver- ‘cutback thisamount now’. We would have to do what tree CLP, ‘democratisation’ was posed as follows: ‘Manageother‘representatives’ have done in the past—either walk ment bodies to be democratically elected and to include out of such bodies and say we will not participate in implerepresentatives of all grades of employees: within the menting the cuts, or start to haggle about “the best way to health service’, What are these management bodies? make the cuts’ as do those who argue for more for Brent As we explained earlier in this pamphlet, the present and jess for Merseyside, or those who say more for health administration structure in the NHS—the pyramid of the DHSS, the Regional and the Area Health Authorities,— and less for education. To participate with the state and the Medical profession in the running of the health service is was not created just because Keith Joseph was a Tory and to accept the arguments of Barbara Castie and the Labour wanted to exclude workers’ representation on these bodies. leadership—that cuts are necessary and what has to be dis- The creation of this highly centralised structure was part

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cussed is how they are to be carried out, the same—health workers and other members of the labour ; movement participating with the state and the Capitalist And what happens when the labour movement launches class in running capitalist industry, or in the case of the a campaign against the closing of a hospital, or the sacking health service, the capitalist health serivce. of nurses? The Area Health Authority will say: ‘But your representatives participated in the democratic decision to The end result of such participation is also always the make these cuts’. This is the confusion that participation same. Workers representatives accepting that they carry a in these bodies will sow amongst all those whose health responsibility for implementing attacks on the working care will be hit by the cuts. Workers will say ‘How can we class, confusing the mass of workers about how to fight fight these cuts when our representatives have taken part these attacks, and ending up trying to find ways of makin making the decisions about how the cuts are to be made’. ing these attacks somehow ‘not as bad as they might have To participate ‘democratically’ in the running of the been”. The real meaning of workers control however is lit- NHS is really to collaborate with the running down of the erally what it says—not workers participation, nor on the health service. Far from arguing about how the cuts are to other hand socialist planning and management, but conbe made we should be saying that we ACCEPT NO RES— trol over the activities of the state and the capitalists in PONSIBILITY FOR ANY CUTS, that we are OPPOSED managing the economy, What would this mean in terms of the health service? TO ANY CUTS IN HEALTH, OR EDUCATION, OR THE it would mean a situation in which the state and the med- SOCIAL SERVICES. It is because we reject any cut in the ical profession had to submit their plans to the workers social wage of the working class as a. way of solving the movement before they went ahead with them, and where crisis of British capitalism that we refuse to participate the workers movement would have the right to veto any in any way in making those cuts. aspect of that plan they wished. For example, the plans to centralise in large hospitals, closing smaller ones, and the IS TRADE UNIONISM ENOUGH? building of community health centres, would first have to win the agreement of the workers movement both locally Whilst we reject any idea of participation, whether it and nationally. be in the AHA’s, or in local hospital management by health It would mean a situation where staffing levels could not workers, it is not enough to limit ourselves to keeping our be cut without the prior agrement of the local hospital and independence from the attacks on the health service and other worker. [t would mean that hospitals could not be relying on trade union militancy. The reason why such proclosed without the prior agreement of all workers in that posals as the SMA‘s have such a wide acceptance within the area, who would decide not on the basis of how best to labour movement today is because these policies seem to ‘rationalise’ the NHS so as:to make cuts, but according to offera way in which the labour movement can take conthe needs of the working class locally. Such a veto does not trol of the health service. If the left is to meet the aspircome from participating in the ninning of the NHS with ations of many workers who want to see the transformation the state and the medical profession, but by retaining the of the health service, then an alternative must be put organised independence of the working class, and exerting forward to the SMA’s strategy of ‘democratisation’. control over the activities of the state regarding the health That alternative is not to be found in retreating into pure trade unionism, as groups like the International But to get to asituation, where the workers movement had Socialists suggest. For the 1S, who correctly reject particia veto as of right, certain other things would be necessary. pation schemes, the crucial thing is building up the trade First, in onder that the workers movement could take union strength of health workers; joint shop stewards cominformed decisions. and be able to keep a running check on mittees, rank and file papers actions against the cuts and any attempts by thestateand the medical profession to sabprivate practice in the hospitals—these are the most impotage their decisions, all secrecy regarding the running of ortant fgks and anything else must fit into this framework. the health service would have to be abolished, so that the Of course, it is very important to build up the trade whole breadth of the states activities were revealed before union strength of health workers and these tasks are the gaze of the whole of the working class. This would be central to doing this—BUT IN ITSELF 1T IS NOT ENOUGH. real democracy, where ‘professional’ and ‘state’ secrets Even the immediate defence of the health service at this were no longer restricted to those who alone have the time requires more than the action of health workers alone— knowledge to look after the health care of the working it requires the mobilisation of far wider sections of the class for them, The democracy of seeing the full extent working class: The willingness and-ahility of health workers of the cuts, and the priorities lying behind the health to struggle will be, and has been seen to be around the service; that is the sort of democracy that the working nurses and private practice disputes, a major factor in invclass needs. olving other sections of the class in action in defence of the Secondly, it would require the breaking of the dominance health service. In itself however it is inadequate—and the of the Consultants und professions inside the health hesitancy of health workers to go into-strugele at present service, An end to the threats of sabotage and emigration for fear of being isolated is testimony to that. It is only from the consultants every time their ‘right’ of private pracclass wide action that can bring about workers control of tice and other privileges are threatened. Jt would mean an the health service. end to the dependence of young doctors and nurses upon Consultants and senior nurses for promotion prospects.

WORKERS CONTROL This would be an end to the democracy the Consultants put forward—the ‘democracy’ of private care for the nich We have already explained that we are absolutely in and the introduction of the democratic right of free health favour of democratising the health service—but only if it care for-all, means democracy in the interests of the working class and Thirdly, it would mean involving all oppressed layers, not the ‘democracy’ of participating in the state's attacks . old people, women, students as well as the orfanised work- We are for the democracy of the working class exerting coning class, in discussing and enquiring as to the sort of tral OVER the decisions and activities of the state and the health care needed by working people. The maximum medical profession. Not participation with, but CONTROL democracy and involvement ofall layers in such discussion, OVER. in order to exercise a veto over the state, would allow the There are many different ideas in the labour movement workers movement to begin the preparation of a workers about what-workers control means. For cxample, the Instplan for the health service, in preparation for the time when itute for Workers Control calls the parti¢ipation that the the workers movment directly takes on the job of manag- SMA proposes Workers Control. However, no matter ing the health service itself. This would mean more than how you dress it up in radical terms, it remains essentially just, forexample, the health sub-committees of the TUC 10

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THE MEDICAL PROFESSION and National Trade union executives taking decisions on behalf of the working class.It means the involvement of rank and file members of the trade unions and it means It is also possible to begin immediately to take steps to beginning to.move beyond the present system and towards break the hold of the consultants and-the. medical profes: workers’ democracy and the establishment of a socialist sion over the health service. Two things underly the present state. dominance of the medical professions and in particular the Finally, we can see that-to achieve such 2 situation of Consultants in the health service. In the first place, the control over the running of the health service, the tight whole ideology of capitalist medicine is one of elitism, of veto, will not take place overnight. Imagine a situation of the ‘monopoly of medical knowledge’. Consultants are where “state secrets’ are abolished, where the AHA's have directly integrated into the Area and Regional Health to submit their plans, let alone the DHSS. Clearly the authorities because of their vital role in the health service capitalist class will not submit lightly to that. They would which results from this traditional ‘monopoly of knowledge’. squeal ‘this is an attack upon “western democracy" itself, The second consideration is the material benefits that what you are proposing is that the workers and not the result from this. The ‘ight’ of private practice which the state shall have the final say’. But if we are talking of dem- Consultants defend so dearly through threats of sabotage, octacy—this is, surely, far more democratic than the *demrepresents the improvement in theit standard of living that octacy’ of helping implement the plans of the state. Ta the Consultants gain from theit privileged position. create 2 situation where the working class could force the acceptance of the night of veto, and the opening of the books, will take more than resolutions to the Labour Party conference or any other conference, and more than a militant fight by health workers alone, It will need the systematic mobilisation of the working class as a whole, in defence of the health service, beginning to organise in the most democratic fashion through such bodies.as Action Committees, that we will move to a situation of workers control over the health service.

This must be our central orientation in defending the health service. That of building a class wide canfpaign against the attacks on the health service, basing that.campaign om mass action by all sections of the workers movement, We must reject the orientation of the ‘left’ MPs and trade union bureaucrats who fail to take any steps to mobilise the rest of the class preferring to carry out manouvres and pul pressure on the government to allow them’ to participate in its attacks. What is more, we must demand that they put their weight into building a class wide campaign. Equally ane must reject the view that trade union strength and militancy of health workers, in itself, is sufficient, as organisations like the [S seem to think.

The medical professions play the role of tying the Of course, this does not mean that we have to forget about Junior doctors to the coat-tails of the Consultants, because workers control until we have built a class wide campaign. the Consultants hold the key to promotion and job pros- On the contrary, it is necessary for socialists to consistently pects—for a junior doctor the possibility of becoming a take initiatives which can at one and the same time help Consultant is decided by those who are already Consultants, broaden the campaign and popularise workers control of and becoming a Consultant provides all the gains of private the health service amongst the mass of workers. We can practice for them. begin the fight for workers control now.

To begin to break this hold it is necessary to break down Let us firstly look at the Community Health Councils the myth of the ‘monopoly of knowledge’ and also to change which the social democrats see. as bodies which are worth the material basis of the medical profession’ The recent participating in. In some cases participation. can have some Junior hospital doctors disputes illustrate the need for the minor advantages—as for example in Maidenhead where the labour movement to take a stand which can begin to break CHC produced a report on the cuts for the local labour the Junior Doctors from dependence on the Consultants. movement, But such advantages are lost when balanced The labour movement should take it upon itself to champion the just cause of the Junior doctors for better pay and against confusion that such participation sows—the illusion within the workers movement that participation of conditions, at the same tife as demanding an END TOT HE INVOLVEMENT OF CONSULTANTS IN DECIDING THE ‘our representatives’ in these bodies can allow us to exert CONTRACTS AND PROMOTION PROSPECTS OF THE control over the health service. As against participation we should demand control—if we are offered representatives we JUNIOR DOCTORS. should demand that these bodies become bodies through Similarly, the labour movement must be the champion which the labour movement can really exert control over of the right of immigrant and women doctors to practice the health service. We should demand that meetings be medicine. It is-by taking action for the just demands of the open to all living within the jurisdiction of the CHC, that Junior Doctors, at the same time as fighting in every way everyone hag a vote, that decisions by a simple majority the existence of private practice, that the labour movement vote are binding on the local health service, and that all will win sections of the junior doctom away from their meetings are publicised well in advance to allow the fullest present reactionary course, to the side of the labour moveinvolvement of workers in the area. ment. Initially, it will not be possible to organise large It is highly improbable that bodies of the state could be numbers of doctors in trade unions in any case, but if the transformed in this way to bodies for workers control. unions are not at the forefront of winning other workers But in so faras many workers have illusions in the ‘demotoa fight for the just demands of the doctors then the ¢racy’ of participation we should pul forward demands workers movement will always remain unable to win the which can point the way to real workers democracy and confidence of the doctors. The ability of the working class: workers contral. to win over sections of the doctors and nurses in this way will be decisive in blocking any attempts of the Consultants to sabotage the health service. 11

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OPEN THE BOOKS health, education and housing, through a CRASH PROGRAMME OF USEFUL PUBLIC Wo RES.

Similarly, the fight for the opening of the books can begin now. We do not wish to open the books simply to see what BUILDING A CLASS WIDE CAMPAIGN money is avilable. On the contrary, we already know that the governments cuts are behind the current crisis in the NHS. We wish to open the books firstly so that we know in Neither the defence, nor the transformation of the health advance what cuts are being made. In fighting against, for service loday, can be carried through successf ully without adopting 4 programme of the most radical measures. The example, the closure of hospitals or the sacking of nurses, fight for workers control of not just the healther service but it is Necessary to know of these cuts in advance so that the of the economy asa whole must be at the very centre of any most effective possible campaign can be mounted against them. Secondly, there are many cuts which are not obvious programme of the working class to meet the crisis. The fight for such a programme must start from uniting the whole to all—for example the cutting back of ambulance services of the left in action against the Tory polici¢s of the present to take old people to and from hospital; initially this is leadership of the Labour movement, and the Labour only obvious to the families of these old people who have Government in particular. This is the first step in creating to take time off work to take them by car, or in many a class wide offensive against the attempts of the capitalist cases: the old people themselves, who somehow have to class, through the Labour Government, to force the workfind the taxi fare out of their pension, ing class to accept the burden of the crisis. The fight for In opening the books, we do not simply want the bare the defence of the health service and for workers control figures about cuts, we want to know exactly what effect of the health service must be an integra! part of that offenthey are going to have, so that the full breadth and effect of the cuts is revealed to all who rely on the NHS, Finally, sive, The last Labour Party conference passed a resolution on the opening of the books is not only a defensive measure— the health service which began to set out the sort of paliitis a way of revealing the way in which priorities are cies that are needed to begin this fightback—to launch a amived at, the causes of the lack of money. and the whole campaign for class wide unity in defence of the health class nature of health care. When the books are opened the service, Not all of the policies in that resolution are pood. AHA of the DHSS may well say “There you are, we told In particular, as we mentioned earlier, the policy of partiyou that there -was no money available’. And the workers cipation in the running of the NHS isa diversion lo any must say “We knew that there was no money available, but fight back. However, many of the policies put forward-in we wanted to know why—and now we see that all the the resolution are precisely the ones that the left must money is being spent on repaying loans to cut-throats who take up and fight foras altemative to those of the Labour make a profit at the expanse of our healthcare’.

Government, and around which the left can unite on the Why is there no money available? most burning problems facing the health service today— |. Because most of the money raised for social spending against the cuts and the cancer of private health care, These in the past was raised through loans, and with inflaare, to summarise the Conference resolution: tion the loans are demanding more interest.and shor- * OPPOSITION TO ANY CUTS, FOR AN IMMEDIATE ter repayment times. This is true not only for local CASH INJECTION AND FOR A SLIDING SCALE OF authority spending, where the amount of money HEALTH SPENDING TO KEEP PACE WITH spent on repaying debts is well known, but also INFLATION. nationally. In 1974 the amount spent on interest re- We would wish to unite with all those in the workers payment on national loans for social spending as a movement who, like the SMA, say that adequate res: whole was £740 million; by 1978-79 the Financial ources are the first step to transforming the NHS.

Times estimates that it will be in the region of £10 billion. * FOR THE ABOLITON OF ALL PRIVATE FRACTICE The current cutbacks announced under the last POR THE NATIONALISATION OF. THE DRUGS White paper by the Labour Government are simply AND ALL OTHER SUPPLY INDUSTRIES. aimed at preventing this getting any larger! But Pay-beds are just the tip of the ice-berg.. The finanwhy should health, education and housing suffer ciers must no longer be allowed to profit from the just because the financiers who ore now clamouill-health of the working class. There can be no ring for their pound of flesh want to increase their wealth still further through loan charges? Why should these people be allowed to extort more money at the expense of the social wage of the working class? We should demand an immediate end to all loan repayments, both locally and nationally, 2. We are told that this money is needed for re-investing in industry. In reality the government is making tmassive free handouts to the capitalist class, rather than maintaining the social wage of the working class, Lf capitalism-is so anarchic that there are 144 million unémployed while hospitals-are not being built and bricks are being stock-piled in their millions for want of a buyer, then let us see why the capitalist are not investing, We must demand the financial affairs of the capitalists are put under workers control, through the nationalisation of the banks and the finance houses so that investment can be planned and not left to the anarchy of the market as it is now. 3. At the same time, a3 money is being spent on ‘defence’ the social services are being cut back_Of course there iso money available if it is spent on all the wrong things. We must demand a maior cut in defence Dr Beaumont speaking on the health motion at last spending to allow the expansion of the social services, autumn’s Labour Party conference. 12

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sympathy and support received from other sections of rational planning of health care when the provision the workers movement, which forced Barbara Castle to of health care is subject to the anarchy of the introduce her plans for the phasing out of pay-beds, economy. and even then she was prepared to make a shoddy com- * FOR IMMEDIATE REFORM OF THE NHS. FOR promise with the Consultants by allowing them to keep AN OCCUPATIONAL HEALTH SERVICE, FOR pay-beds where no private health facilities exist outside PREVENTATIVE AND REHABILITATIVE HEALTH the NHS.

CARE SCHEMES, FOR MORE HEALTH CENTRES, Nor is it enough to take action with the hope of put- FOR THE RIGHT GF WOMEN TO FREE ABORTION ting pressure on present leaders of the labour movement.

CONTRACEPTION AND PREGNANCY TESTING A fight for the implementation of Labour Party con- AT THE TIME OF NEED. : ference policy necessarily means a fight to remove all The NHS is quite inadequate as it stands. The fight those in the leadership of the workers movement who against the cuts must be seen as a fight for the refuse to implement that policy, and put in their place extension of the health care of working class people, people who will carry out policies in the interest of Tesponsive to the needs of working class people. the working class, In the fight for the implementation of these policies Personalities have policies, and if they are the the contained in the Labour Party conference résolution the wrong policies, they have to be removed and replaced maximum unity. in action of the left can be achieved, with people who have the right policies and are willing around a real alternative to the Labour Government's to fight for them. This applies not only to David Ennals, cuts: This means more however than simply passing this Denis Healey, Jim Callaghan, Jack Jones and Len Murray resolution at the Labour: Party conference, or abstaining and all the other misleaders of the workers movment, but on the governments White Paper on socia)] spending in also to union executive members, trades council sec- Parliament. It means being prepared to unite in action retaries and everyone else in the workers. movementto fight for the implementation of these policies. from top to bottom—who refuses to carry out a fight NUPE must not simply put such resolutions to the for the implémentation of working class policies. The Labour Party conference, it must be prepared to support recall of the TUC and Labour Party conferences, to and mobilise for demonstrations such as that organised organise a fight for the implementation of the Labour by thé National Co-ordinating Committee Against the Party conference resolution and to force a break with Cuts in the NHS. Similarly those ‘left’ MP's who abstathe governments policies, must be supported and camined on the governments White Paper must be prepared paigned for by all the ‘left’ MP’s-and trade union to speak at public meetings in the localities in support leaders who verbally claim to be in favour of fighting of workers taking action in the hospitals against the cuts for working class policies. on private practice, and calling for solidarity action from It is in this way, by beginning to build a class other sections of the trade union movement. struggle copposition inside the workers movement In short, unity of the left around the policies passed and uniting all forces. prepared to fight for the impleby the Labour Party conference means more than mentation of these policies passed at the Labour Party stating agreement with those policies, it means a comconference, thal we can begin to construct a classmitment to building a campaign of mass action, of demwide response to the crisis in the health service capable onstrations, pickets and where possible strike action, of defending the health care of the working class, which can force the implementation of these policies.

The IMG will consistently fight to drag the SMA and the Tribunites:in such a united front, demanding that No amount of delegations sent by the SMA, to the they support and build actions of the working clasa DHSS will persuade David Ennals to change his mind, such as demonstrations pickets and strikes, and thal however eloquent and persuasive that delegation may they help build action committees in the localities be. Nowhere is this more clearly shown than in his to organise and strengthen those actions. At the same predecessor—Barbara Castle's handling of the dispute time we say that this struggle to defend the health with the consultants over pay-beds. It was the militant service can only be successfully carried through by launchaction of workers at such hospitals as Westminster, Christie ing a fight for workers control of the health service. and Charing Cross in blacking pay-beds, coupled with the

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