The NHS protests around the country on 3 July should be the start of building a mass campaign for decent pay and to save the NHS. Well over a million people work in the NHS. Organised in trade unions, backed up by community campaigns, these workers have tremendous potential power.
NHS workers have campaigned for a 15% pay rise. The Tories proposed an insulting 1% to workers who have spent the last 16 months working themselves to exhaustion to save lives.
Following an NHS Pay Review Body recommendation, the Tories are due to announce what they will offer any day – potentially right at the end of the parliamentary term.
Any announcement which does not give NHS workers what they deserve should be met with immediate protests from the NHS trade unions, and they should make clear their intention to prepare for national coordinated strike action.
The rest of the public sector faces a pay freeze. With a bold lead from the tops of their respective unions, care workers, teachers, civil servants, council workers, and so on would respond to a call for joined-up action.
And it’s not only the question of pay. Despite batting away calls for a Covid inquiry, with the claim that it would be a distraction from fighting the pandemic, the Tories have nonetheless found time to produce a white paper on the future of the NHS in England.
A new health and care bill could be published at any time (see opposite page). Even if it is delayed by the resignation of former Health Secretary Matt Hancock, the Tories’ aims remain clear.
If it is based on the white paper, the bill will be a blueprint for further privatisation, a reduction in democratic checks, and the further break-up of national service. It must be opposed.
There should be protests at Parliament when the bill is debated and a national NHS demonstration, all of which would help prepare the ground for the necessary strike action.
The potential to build a fightback is clear. Workers in a whole number of workplaces and sectors, from construction and buses to housing and schools, have recently been on strike, some achieving important victories. Members of the Royal College of Nursing and GMB union voted to reject the 4% pay rise offered by the Scottish government.
Importantly, members of Unison, the biggest public sector union, and the biggest union in the NHS, voted for change in the national executive elections.
The left, including four Socialist Party members, now has a majority on the National Executive Council (NEC), surrounding recently elected right-wing general secretary Christine McAnea.
Disgracefully, Unison’s Health Service Group Executive, still dominated by the right-wing, refused to back the 3 July NHS protests.
Socialist Party members will appeal to others on the NEC to ensure a fighting stance and plan of action is laid out urgently, to make it clear to members in the NHS and the wider public sector that the new union executive will live up to the expectations placed on it by members desperate for a fight.
Hancock’s resignation is just the latest in a series of events that expose the weakness and divisions in the Tories.
A serious campaign on the NHS can be instrumental in the fight to kick them all out. It means part of the struggle has to be to fight for an alternative: a new mass working-class party that can articulate workers’ anger; campaign for a programme of a 15% pay rise, full funding and to end the privatisation of the NHS; and fight for a socialist government that can implement such a programme.
- Fight the health and care bill
- 15% pay rise now for all NHS and social care staff
- Reverse all privatisation within the NHS. Abolish the Private Finance Initiative and cancel all debts
- Bring all outsourced workers and services in-house on a permanent contract
- Nationalise the private healthcare sector, care homes, the medical supply industry and the pharmaceutical companies – integrate them into the NHS
- A fully publicly funded and democratically controlled NHS and care system free at the point of use
Fight the health and care bill
Steve Score, Leicester NHS campaigner
The future of the NHS hangs in the balance. Nearly five million people are waiting for treatment. Covid has pushed our health services to the limit, but years of underfunding meant it was already in crisis before the pandemic. Waiting lists were already rising, as were the huge staff shortages.
But rather than addressing these problems as a priority, the government is proposing a more drastic reorganisation of the NHS.
In February, plans were leaked and then published in a white paper. Inaccurate headlines suggested the government was planning to reverse previous privatisation and to properly integrate health and social care.
This was wrong. The white paper did not propose reversing privatisation nor deal with the crisis in social care. The government would divide the NHS in England into separate areas runs by boards called ‘integrated care systems’ (ICS). NHS England is already three-quarters of the way through its plan to create 42 ICS in advance of legislation to empower them.
The market mechanism first introduced under Thatcher, including its split between ‘purchasers’ and ‘providers’, will remain.
A new health and care bill is expected to be published shortly, having been flagged up in the Queen’s speech in May. But that was vague on the detail. If the bill includes much of what was in the white paper, it will be a further threat to the NHS and must be opposed.
What confused the press was the suggestion in the white paper that the compulsory competitive tendering rules would be scrapped. However, it does not mean privatisation being abolished – just that companies would no longer have to compete! Throughout the pandemic the government handed out private contracts worth billions for test and trace, PPE, and to private hospitals. These have been without competition or transparency, and with a heavy element of cronyism – and that’s the model they want to continue.
NHS England has already created an approved list of private companies to fast-track the outsourcing of contracts. ICS with commissioning powers will be able to include private companies on their boards. So not only can private profiteers continue to carve out bits of the NHS, they can also now be part of running it!
In fact, companies like Virgin are already being invited onto the existing fledgling ICS, like the one in Bath, Swindon, and Wiltshire. Of course, these bodies will not be democratic, with members being appointed not elected.
It is also proposed to remove the current requirement for the government’s plans for the NHS to be debated annually in parliament.
Local councils, which would have their scrutiny over the NHS weakened in the white paper, are one of the ‘partners’ who will have representatives on the boards. But the current power of local authority Health Scrutiny Committees to refer bad local NHS decisions to the secretary of state would be removed.
On some occasions, local campaigners in the past have succeeded in getting decisions to close services reversed by putting pressure on councillors.
In fact, rather than simplifying the structure of the NHS, the plans create two tiers of ICS in every area – one with the real commissioning powers and the other (also including private companies) which appears to be intended to act like the already existing ‘health and wellbeing’ boards.
Each ICS will have its own separate budget – bringing pressures to make cuts resulting from underfunding, and increasing the potential for regional inequalities in service. It also raises concerns about whether it would be used to weaken NHS workers’ current national pay bargaining powers by replacing them with local bargaining.
All of this is of course not clear until the government publishes its bill. But one aspect that was mentioned in the Queen’s Speech was to “innovate and embrace technology” and that “patients will receive more tailored and preventative care.” Bland statements in isolation.
But the intention is to continue a process, begun with the pandemic as an excuse, of fewer face-to-face appointments with specialised staff, replacing them with more digital services, which will cause difficulties for those not able to access computers or smartphones.
In addition, there is the danger of faster discharge from hospital, but without the back up in community services.
Campaign groups such as Health Campaigns Together and Keep Our NHS Public are opposing this bill. Despite quotes from Labour’s Shadow Health Secretary, Jon Ashworth, saying that the white paper proposals meant “little accountability to the public, allowing contracts to be handed out to private interests with no challenge”, Labour has shown no real fight against these proposals. If Labour was a real opposition, Starmer would be hammering it in every speech!
Trade unions and campaigners will have to take up the battle to save the NHS. Stop and reverse privatisation, fully fund the NHS and pay the workers the 15% they need!
We don’t want a USA-style healthcare system
Mick Griffiths, Wakefield and Pontefract Socialist Party
The health scrutiny committee on Labour-led Wakefield Council returned on 24 June for its first physical meeting since the Covid outbreak.
A report was received from the local clinical commissioning group (CCG) to update on progress made towards implementation of the government’s NHS white paper proposals to create new ‘integrated care systems’ (ICS) by April 2022.
NHS campaigners have concerns that these vague proposals could lead to an entrenchment of private companies sitting on ICS boards. In reality, this is already happening.
Wakefield’s health scrutiny committee agreed to write to the secretary of state for health raising concerns over the proposal to end scrutiny powers to refer objections to the secretary of state. But not a single councillor questioned increasing involvement of the private sector!
The CCG representative did state that it was a contract condition that private service providers pay employees the living wage. However, the commissioners apparently have no influence or control to enforce it!
The new local integrated care system is to cover Bradford, Calderdale, Kirklees and Wakefield.
ICS contracts may become commercially confidential trade secrets servicing private profiteering interests. Local democratic accountability – tame as it is – will be lost altogether.
Wakefield council’s health scrutiny committee has only raised concerns about the perceived weakening of its role, while not raising any objections to the very real threat of a fundamental break-up of the founding principles of the NHS.
We will not sit back and rely on councillors who timidly acquiesce to the Tories’ attempts to dismantle the NHS and move it into the direction of a USA-style healthcare system.
Healthcare trade unions and community campaigners need to build a mass rank-and-file movement to expose, resist and defeat the NHS white paper, and build a fully funded and publicly owned and controlled alternative.