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Proletarian issue 63 (December 2014)
Public health care – a vanishing commodity?
The following resolution was passed at the recent CPGB-ML party congress.
This congress notes that the founding principles of the 1948 NHS charter – to promote health and provide universal and high-quality medical care, free at the point of use, from the cradle to the grave – remains the deeply-held desire of the overwhelming majority of the people of Britain, is in the immediate interest of all working people, and in the long-term interest of humanity as a whole. Yet from the 1980s onward – under Thatcher, Major, Blair, Brown and Cameron – we have seen a steady and inexorable undermining of the NHS through marketisation and privatisation.

Congress realises that the NHS was the product of a particular set of social conditions, and that, although the health service never fully attained its target, created as it was from a pre-existing patchwork of private and charitable services, it was a massive step in the right direction, and has made an incalculable contribution to the welfare of British people, and served as a model, after the Soviet Union, for many public-health systems worldwide, including, for example, the socialist health system in Cuba.

This congress understands that the NHS was put together at a time, after the second world war, when hundreds of thousands of British workers had laid down their lives to defeat fascism. Returning soldiers and civilians alike demanded a better quality of life and a more humane existence. They had, moreover, realised that free and universal provision of health services, and a decent and cultured life, was the norm in the Soviet Union, and had witnessed the heroic Red Armies of the young Soviet republic vanquish fascism, in order to defend workers’ control over their own fate, and the freedom of all peoples to determine their own destiny.

Congress therefore appreciates that the NHS, like social housing, welfare and education, was a concession granted by the British ruling class to the militant demands of workers, backed by the real or perceived threat of the revolutionary overthrow of the capitalist system of exploitation itself, and the weakened position of imperialism following the spread of socialist democracy to one-third of the world’s population.

This congress realises fully, however, that the capitalist class was careful to maintain the role of private medicine, like the market in general, which continued to exist – servicing a wealthy elite, and allowing them to bypass queues and obstacles. The fury of private interest waited, like a bacillus, within the predominantly nationally-funded and accountable body of the health system, for the recurrence of ideal conditions in which to become active and virulent, and to re-conquer the host organism for capital.

Congress notes that with the retreat and outright counter-revolutions within the people’s democracies – due to gross revisionist mismanagement of the ascendant communist and anti-imperialist block – global finance capital found its time to strike. Having again lost all fetter and apparent scruple, the capitalists are undermining the public-health system with successive legislative acts. Gains once taken for granted by British workers look increasingly transitory, ephemeral and illusory.

Congress notes that Britain’s medical professionals, struggling to keep the NHS afloat, are increasingly concerned about the continued existence and quality of universal health provision. Professor Allison Pollock has written that:

The NHS, which established health care as a right, has been progressively dismantled and privatised by successive governments over the past quarter-century. The story is of course not unique to Britain. Universal health care systems are being dismantled and privatised across the world. Making health care once again a commodity to be bought, rather than a right, has become the standard prescription of the World Bank, the International Monetary Fund, the World Trade Organisation, and even the World Health Organisation ...

The dismantling process and its consequences are profoundly anti-democratic and opaque. The catchphrases of ‘Public-Private Partnership’, ‘modernisation’, ‘value for money’, ‘local ownership’ and the rest conceal the extent and real nature of what is happening; moreover the complexity of health care allows the reality of its transformation into a market to be buried under a thousand half-truths.”[1]

This congress asserts that, contrary to the all-pervasive free-market fundamentalist dogma peddled by the capitalists, the two aims of maximum profitability and excellence of care are usually mutually exclusive, when the patient – reborn as the ‘health consumer’ – is working class.

Congress notes that the Health and Social Care Bill 2011 is widely perceived for what it really is: the final outright privatisation of the NHS, which will make it compulsory for GPs to open up all areas of health provision to private companies. But anyone who attempts to paint this attack on the NHS as a purely Tory or ConDem phenomenon need only look as far as the last Labour government’s record on the NHS to see that the social democrats are equally complicit.

Congress notes further that, while NHS funding doubled between 1999 (£49bn) and 2009 (£110bn), much of the increase went directly into private coffers of drug companies (£20bn a year), private contractors for cleaning, catering and maintenance contracts (formerly supplied by NHS workers), health technology companies and building contractors – particularly with the Labour government’s massive introduction of Private Finance Initiative (PFI) from 1999 onwards, which sought easy profit opportunities for big business by mortgaging NHS assets to private banking consortia.

Congress notes that, having bailed out private finance capital – the city bankers – to the tune of £1.5tr, the government is looking to balance its books by cutting social provision to the working people of Britain. Truly “the capitalists are our implacable enemies – their wealth is built upon our poverty; their joy is built upon our misery!” (Stalin)[2] This is the rationale behind the ongoing so-called ‘Nicholson Challenge’ for the NHS to make £20bn-worth of cuts in ‘efficiency savings’ by 2015. It is not a chance occurrence that Sir Chris Nicholson is from the ‘old Labour’ school, and was a long-term member of the CPB. Neither do we forget that this target of £20bn was announced to leading NHS doctors before the ConDem government was elected – ie, by the last Labour government.[3]

This congress realises that the PFI repayment burden for the NHS is increasing year-on-year. Standing at £459m in 2009/10, it increased to £628.7m in 2011/12 (these amounts only apply to NHS trusts in England). Details of the contracts compiled by the Treasury make clear that some NHS organisations will end up paying almost 12 times the initial sum paid to build their premises, over what is usually a 30-year (but up to 60-year) contract.

For example, congress notes that while the capital cost of rebuilding Calderdale Royal Hospital in Yorkshire is £64.6m, the scheme will end up costing Calderdale and Huddersfield NHS Foundation Trust a total of £773.2m. Similarly, the cost of building the new Walsgrave district general hospital in Coventry will jump from an initial £379m to an eventual £4bn.

Congress further notes that the cost of PFI will continue to soar for another five years and end up costing taxpayers more than £300bn in total. The 717 PFI contracts currently under way across the UK are funding new schools, hospitals and other public facilities with a total capital value of £54.7bn, but the overall ultimate cost will reach £301bn by the time they have been paid off over the coming decades.[4]

Congress notes that most of the 717 contracts were agreed under Labour, although a number have been signed recently and were agreed by the coalition. In 2007/8, the total annual repayment cost of all PFI schemes in the UK was £5.78bn, but by 2017/18 that will have almost doubled to £10.1bn, and repayments will cost at least £9bn a year for the decade after that.[4]

Congress further notes that PFI contracts have very high interest rates and that they often include expensive maintenance and service contracts, which charge the public purse vastly-inflated fees for performing simple tasks (one PFI hospital was apparently charged £333 to have a new light bulb installed under the terms of their maintenance contract, for example).[5]

Congress realises that Trusts with PFI contracts are often in serious financial difficulty, jeopardising the future of the hospitals that they were supposed to help improve. In England, there are several Trusts where PFI repayments account for more than 5 percent of total revenue:

• Dartford and Gravesham NHS Trust (7.9 percent of spending)

• Sherwood Forest Hospitals NHS Foundation Trust (7 percent)

• South London Healthcare NHS Trust (6 percent)

• Norfolk and Norwich University Hospitals NHS Foundation Trust (5.8 percent)

• Barking, Havering and Redbridge University Hospitals NHS Trust (5.6 percent)

• Peterborough and Stamford Hospitals NHS Foundation Trust (5.6 percent)

• St Helens and Knowsley Hospitals NHS Trust (5.3 percent)[5]

This congress believes that it will remain the case that the most politically disenfranchised workers will bear the brunt of the cuts and the recession. Thus when South London NHS Trust went into administration, it was the nearby Lewisham hospital – not a member of the failing trust – that was singled out for closure of its A&E, and financial penalties to bail out its giant neighbour.

Congress applauds the people of Lewisham, who showed that a strong community-based campaign is the only way to safeguard services, and notes that Labour, with breath-taking hypocrisy, have tried to jump on the anti-cuts bandwagon, attempting to make some cheap political capital by sending the notorious Frank Dobson – the Labour health minister who introduced PFI funding into the NHS – to speak at Keep our NHS Public (KONP) meetings to demand that Jeremy Hunt save Lewisham hospital! The truth is that successive administrations – Labour, Tory and and ConDem – are in the business of privatising the NHS together.

This congress notes that Sir David Nicholson, NHS Chief Executive – and former member of the CPB – has been at the heart of implementing cuts across the NHS. In his 2014 report to parliament, he called for national, local and service-driven cuts to make up a total of £20bn by 2015. His 2014 report made uneasy reading for all who cherish the NHS:

While nationally-driven initiatives have certainly produced some short-term cost savings [£12bn] and may have produced some sustainable efficiency gains, the response to the Nicholson Challenge necessarily involves large-scale transformational change. The committee believes that the case for this transformational change needs to be better made and better understood.”[6]

Congress further notes that the commitment to ‘transformational change’ needs, therefore, to embrace every aspect of the QIPP programme (Quality, Innovation, Productivity and Prevention – the brand name given to the current programme of massive budget cuts) including – in particular, the major existing providers.

Congress thus appreciates that Sir David Nicholson’s ‘challenge’ of saving £20bn through ‘efficiency savings’ is being used as the shock therapy on the back of which to deliver up public-health provision wholesale to the private sector, in order to maintain the unsustainable level of cuts. Threatening that the NHS could face a funding gap of £30bn by 2020/21 as a result of the growing gulf between flat funding and rising demand driven by an ageing population living with a growing burden of chronic disease, in a statement on the NHS England website, he says this gap “cannot be solved from the public purse” and that the NHS and the public will instead have to accept radical changes, “freeing up NHS services and staff from old style practices and buildings”.[7]

This congress notes that the British Medical Association (BMA) response to recent ‘reforms’ has been emphatic:

The BMA has not supported the direction taken in the NHS in England in recent years, which is continued, and indeed accelerated, by the proposals set out in the White Paper [‘Liberating the NHS’], despite evidence showing that increased commercialisation has not been beneficial for the NHS or patients. Research has found that Independent Sector Treatment Centres (ISTCs) could damage the local health economy, profiting from NHS funding by explicitly choosing to treat only less risky patients while being paid the same rate as publicly-funded hospitals. In addition, a 2010 National Audit Office report questioned the long-term value for money of PFI hospital contracts and found that the lack of flexibility in repaying debts could make it difficult for trusts to make savings without cutting back on services.

The BMA supports meaningful choices for patients, free from political targets, but we do not believe that the patient choice agenda of recent years, which is continued in the White Paper, has improved clinical outcomes or offers patients the choices they actually want. We would suggest that most of all, patients want high-quality providers close to where they live and to receive timely, competent diagnosis and treatment and ongoing support when necessary.

The BMA notes that a large amount of money is being spent to make the changes proposed in the White Paper, whilst at the same time attempts are being made to release £15-20bn of efficiency savings over the next four years. This is a very difficult climate in which to make substantial service changes and reconfigurations. We would question the value for money of such changes and whether a less disruptive, more cost-effective process could have been proposed to achieve similar aims of reducing bureaucracy and empowering clinicians. We are aware that cuts are already being planned or implemented that will have an adverse impact on doctors’ ability to care for their patients.”[8]

This congress realises that the value of all the above-cited changes to established practice lies precisely in implementing the ruling class’s goal of privatisation of the NHS – nothing more or less.

Congress believes that the lesson to be drawn from the above is clear: the problem is not merely the HASC Bill and subsequent regulations, to be resolved simply by getting rid of Lansley, Hunt or Cameron, or – God forbid – by voting Labour at the next election, but the whole rotten capitalist system, which, in its insatiable desire for profit, will continue its merciless attack on the living standards of working-class people until it is overthrown.

Congress therefore resolves to continue the party’s policy to:

1. Oppose all privatisation of services – ‘core’ or ‘peripheral’ – and to campaign for the renationalisation of all privatised aspects of NHS provision, working towards a health service that provides nationally-funded, universal and comprehensive care, free at the point of use, that fulfils its original charter.

2. Oppose private provision of health care, and the internal market in health care within the NHS.

3. Campaign for the scrapping of all PFI debt.

4. Oppose the forced conversion of the NHS into Foundation Trusts, which will act as businesses first, and health providers second.

5. Oppose pay freezes and ‘restraint’, and the movement of Foundation Trusts to disband national employment contracts and frameworks.

6. Demand the nationalisation of drug and medical technology companies. It has long been the case that while public debt is social, profitable enterprises are private. This is one source of inequality under capitalism, and the source of much of the NHS debt also.

7. Join fully in the campaign to defend the NHS.

8. Encourage broad participation of workers, patients and healthcare professionals within a single, vibrant movement to defend the interests of the NHS – learning from examples such as the Save Lewisham Hospital Campaign how to involve the local community in the fight for their NHS services.

9. Point out within this campaign, and to British workers generally, that NHS cuts and privatisation are being smuggled in under the banners of ‘choice’, ‘efficiency’ and ‘excellence’.

10. Refuse to accept the legitimacy or necessity of cuts to the NHS and social provision. If these cuts are due to the direction of the state by the capitalist class, and the economic and financial crisis that is of their making, then they prove themselves bankrupt and unable to rule in the interests of the vast majority.

11. Campaign for the reintroduction of integrated health planning, commissioning and provision on a national and regional level, by the NHS itself.

12. Oppose the proposed GP commissioning groups, which are too small to plan adequately, and are simply the vehicles of distributing tax-payers’ money to private health corporations, or of ‘purchasing services’ – increasingly from private rather than NHS providers.

13. Point out to British workers that Labour governments, as much as Tory and ConDem administrations, have sought to privatise and destroy the NHS. Our party must use this fact to demonstrate that capitalism seeks nothing more than maximum profit – which means privatisation of health care, and decreased provision to the mass of the working class. And, in the last analysis, we must show that the welfare of workers cannot be achieved and maintained without putting in place a socialist system of economy, controlled and administered by the working people themselves.

1. A Pollock, NHS Plc: The Privatisation of Our Health Care, 2005
2. ‘ The bourgeoisie is laying a trap ’ by JV Stalin, October 1905
3. 20 billion to be cut from the NHS budget , Lalkar
4. PFI will ultimately cost 300bn, The Guardian
5. New figures reveal weight of PFI burden on NHS trust, Intergrational Foundation
6. New Meeting the Nicholson Challenge to 2015 and beyond,
7. Nicholson says mind the 30billion gap,
8. Equality and excellence - Liberating the NHS BMA Response, BMA

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