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Proletarian issue 50 (October 2012)
Dismantling the NHS
Our sick children deserve better!
The gradual dismantling of the NHS has been amply illustrated by hundreds and thousands of examples, not just in Lalkar and Proletarian but also by many other journals, activists and organisations across the country, and even across the political spectrum.

Deleterious effect of cost-cutting

One of the latest examples has been delivered in a report from the foundation trust regulator, Monitor, which found that “One in three NHS foundation trusts are predicting a deterioration in their finances over the next year with small general hospitals and those with large private finance initiatives warning of the greatest problems ...

The reports said specifically that the four-hour waiting time in A&E and the 18-week target from GP referral to hospital treatment ‘may come under increasing pressure’.” For patients with heart disease or cancer, which are Britain’s biggest killers, even an 18-week wait to be seen by an appropriate specialist can already mean the difference between life and death. (‘NHS waiting times may increase at one in three flagship hospitals’ by Rebecca Smith, Telegraph, 23 August 2012)

The point, however, is not merely that we should recognise the problem, although even arriving at that recognition has been a great journey for some. No, the point is to understand what needs to be done in order to deliver a top-quality health service to everyone, no matter where they live, that is comprehensive, easily accessible and free.

The first thing to realise is that health care does not exist in a bubble untouched by the rest of life. Britain is a bourgeois democracy, which means that all the important rights and decisions are in the hands of the capitalist ruling class and its loyal servants. Every sphere of our lives is run according to capitalist norms, which dictate that everything is a commodity produced for sale, and that the sole reason for all production is the realisation of maximum profit for the bourgeoisie.

This mentality pervades in every area of society, whether it be the stock market or the supermarket, the primary school or the local hospital. The real worth (ie, our need or use for a thing) of everything comes a miserable second when balanced against the need of our ruling class to extract the maximum profit.

As privatisation accelerates within the NHS, and the profit motive takes the place of the service ethos, we are seeing the increasing polarisation of skills and services at fewer and fewer locations in order to cut down on costs in equipment, staff and real estate. Smaller hospitals and clinics have closed in their thousands over the last few years, to be replaced by one or two larger hospitals in a given area. The promise, especially under the previous Labour governments from 1997 onwards, was that these would constitute ‘super-hospitals’, paid for by the PFI scheme.

The reality of PFI, however, has long come back to bite the simple souls who believed the sugary promises of the Labour party in power. The new hospitals, mostly scaled down from the original ‘super’ plans, have turned out to be financial millstones as the associated costs involved with the PFI con trick (see Lalkar, March 2012) have caused brand new wards to be mothballed because it costs too much to use them, while even not using them at all incurs a large cost that cannot be escaped.

The NHS is in crisis, and those who manage this vital service are now forced to do so using no other logic than that of capitalism, with the result that services that have already been sub-contracted to breaking point are being contracted further still.

Proposed closure of gold standard children’s heart unit in Leeds

It was announced in November 2009 that a national review of all 11 (yes there are only 11!) children’s heart centres could lead to closures and mergers as ‘experts’ waxed lyrical about the merits to patients of fewer, bigger units. Rumour and leak followed rumour and leak, and the children’s heart unit at Leeds General Infirmary (LGI) was said to be definitely in the frame for closure.

Local MPs and councillors from all the bourgeois parties rushed out press statements and selflessly threw themselves in front of ‘news’ cameras and suitably sombre-looking TV interviewers. Local unions held meetings, and even Leeds United football club players were mobilised for support, along with many hundreds of thousands of people across Yorkshire, who were attending meetings and signing petitions against a closure that will definitely cost young lives if it goes ahead.

As a result, the decision to close has now been referred to the Secretary of State for Health. So isn’t all that activity a good thing? The problem is that, even if the Leeds campaign succeeds in saving this particular centre for the time being, the constantly pressing demands of capitalism will ensure that this is the exception that proves the rule.

The reader may feel at this point that we are being very harsh on people who worked hard to save a unit with a very good (gold standard, apparently) record and highly-trained staff, and we have to say that it is right that people should want to defend the NHS. What we object to, however, is seeing our union and community ‘leaders’ allow the whole campaign to be hijacked by the political lickspittles of the bourgeoisie, whose demands are causing the whole problem in the first place.

In the main, these bandwagon-jumpers consist of local Labour party politicians and assorted hangers on, plus a handful of Tory and LibDem councillors and MPs. Hilary Benn, for example, battled valiantly against the closure by putting down an Early Day Motion (EDM) in the House of Commons, which was dutifully signed by some Yorkshire MPs, and he has spoken at rallies in the city to tell the masses of his efforts on their behalf (neglecting to mention that an EDM isn’t worth the paper it’s written on, naturally).

Conservative Pudsey MP Stuart Andrew said told one recent rally: “We’re here to show our support for all the families and the staff at the unit who are clearly wanting to make their voices heard ... Everybody is determined to do what they can. People have actually taken the day off work to come here today, which shows how committed they are.”

As fine an example of empty rhetoric as one could wish for. But committed to what Mr Andrew? Where the campaign ‘leaders’ are concerned, it would seem that they are primarily committed to the needs of capitalism, since their best ‘arguments’ run along the lines of accepting in principle the needs for swingeing cuts, and merely asking for them to be effected elsewhere.

For example, the director of the ‘Children’s Heart Surgery Fund’, Sharon Cheng, while pointing out that the campaign had run for a full 18 months and that 600,000 local people had signed the petitions opposing the removal of children’s heart surgery from Leeds, said: “We understand why larger, fewer centres would make sense, but you have to put them where the population is.”

Does Ms Cheng really understand why fewer units would make sense? We don’t think she ever explained to those hundreds of thousands opposing this closure that she and her charity ‘understood’ why fewer and bigger was better. Isn’t this, in fact, simply asking the government to close someone else’s unit instead?!

If we look at where the Yorkshire and Lincolnshire people will have to take their critically-ill children if the closure goes ahead, we see that the three nearest centres after Leeds are Liverpool, Newcastle and Birmingham. Ms Cheng doesn’t say which of those units she thinks should take the bullet in order to save the unit at LGI. But any argument that can be put for not having to take very ill children to Newcastle, Birmingham or Newcastle – and there are many good arguments – can be just as easily put by parents in those localities against bringing their children to Leeds.

Moreover, the same arguments can be made by many people within LGI’s current orbit in Yorkshire and Lincolnshire. It was for financial reasons that children’s heart surgery was pulled into Leeds and away from the rest of Yorkshire and Lincolnshire, and it is for financial reasons that it is now being proposed to concentrate this vital service in even more distant locations! It is, after all, most important that money should be saved on patient care because of the urgent need of PFI financiers, drug companies and private service providers to enhance their profits at NHS expense!

Professor Sir Roger Boyle, former clinical director for heart disease and strokes, and advisor to the Joint Committee of Primary Care Trusts, said in the Yorkshire Evening Post that “pooling surgical expertise means the clinical community can work together, develop new techniques and deliver improved care to keep more children with complex heart conditions alive”. But does it really make sense to anyone that, in this age of digital communication, we cannot develop new techniques in heart surgery without having all the surgeons working in the same place?

Healthcare under socialism

In 2010 a delegation from our party visited University Hospital in Pyongyang, capital of north Korea. While at the hospital, we watched a heart operation being carried out many miles away. We sat in a room with professors and top heart surgeons who were linked by computer with the surgeon carrying out the operation, able to see his incisions from many angles and talking to him all the time. They all had copies of the patient’s notes and they all took part in a successful operation.

Afterwards, they explained to us that it is stupid to haul a patient across the country before operating when time is often of the essence in heart surgery. This way, the patient got the best service possible and the knowledge was shared, as not only we in Pyongyang had been watching and listening, but many other surgeons in other hospitals around the country had been participating too.

And what of Cuba? This small, besieged Caribbean island has a wealth of trained doctors and health workers. So much so that they can and do send teams of them all over the world to help others. They do not say ‘We have a splendid unit here in Havana, so if the various patients from disaster zones around the world could just make their way here we will treat them.’ No; they go to the patients! And, in spite of this, the cost of providing health care of the highest standard in Cuba and north Korea is a fraction of the cost of NHS provision – solely because there are no capitalist vultures to feed.

So why is it that the DPRK and Cuba can treat people where they are, but here in capitalist Britain we can only offer help if those who are ill can travel miles first? It is not the commitment or expertise of the doctors and other health workers; the difference is the political system, and the fact that in Cuba and the DPRK, the managers and/or committees who look after the affairs of hospitals and medical units have the same commitment to the patients as the doctors, nurses and all other staff.

By contrast, those in charge of British hospitals, whether they want to or not, have to keep looking for services they can cut and cash that can be saved to try to keep the whole thing going against all the odds. Ms Cheng was right about one thing: children’s heart surgery (and every other medical service) should be where the people are – but that doesn’t mean saving a unit in Leeds at the expense of others elsewhere.

Only when all the campaigns join up and start fighting for the whole of the NHS rather than merely for the bits on their own doorstep will they achieve anything. In addition, we must stop allowing the agents of the bourgeoisie in the working class – the Labour party, and other apologists for capitalism – to take the lead in campaigns to save our services, since they are bound to lead us down blind alleys of pointless activity and diversionary ‘busywork’ that has no concrete effect at all other than to waste our time and leave us feeling demoralised and impotent.

World capitalism is experiencing its deepest crisis ever. Deeper than the one that led to the all-out destruction of the great depression and the second world war. The good times that the welfare state delivered for a majority of workers in Britain were all too brief, and they are over now. There is no way ‘back’ to the post WW2 days. Ultimately, if we want to secure a decent, universal health service for ourselves and our children, we need to tie the fight for the NHS to the struggle for the revolutionary overthrow of capitalism and the establishment of socialism.

If the capitalists cannot provide a decent level of care to everyone in Britain, our comrades in the socialist countries have proved that we are quite capable of removing such useless parasites from power and providing one for ourselves.


:: Save the NHS from capitalist greed , Leaflet (March 2012)
:: Last chance to save the NHS , Proletarian issue 46 (February 2012)
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