Year 2000 No. 158, September 25, 2000
Labour Party Conference:
Workers' Daily Internet Edition : Article Index :
Labour Party Conference:
The Working Class Must Put Forward Its Own Alternative Programme
Workers' Weekly Health Group (WWHG)
The NHS Plan
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Labour Party Conference:
This year's Labour Party conference opened in Brighton yesterday, and will conclude on Thursday, September 28.
The conference is being heralded as possibly the last for the Labour government before the next election and is being held at a time of increasing opposition to the anti-social offensive, to globalisation and the marginalisation of the masses of the people from decision making. In the face of such wide-scale and growing opposition and with the possibility of an election looming, government ministers attending the conference have already been fighting amongst themselves, eager to show that they are now prepared to at least listen to people's concerns and hinting that more funding might be found for an increase in pensions, or a decrease in fuel taxes in the future. At the same time the media is attempting to resurrect the even more discredited Conservative Party, in an effort to persuade people that a credible alternative to New Labour might soon exist.
Whatever speeches, or promises, might be made this week during the Labour Party conference, the underlying message will remain the same, that there is no alternative to the old, that society must continue to be geared to paying the rich, the anti-social offensive continued, while the workers must join in "partnership" with their employers and accept their fate in the global market, where according to New Labour, Britain can become number one.
But what must be grasped is that there is an alternative. The working class itself holds the solution to all the problems confronting society and must increasingly take centre stage. It must reject the entire programme of New Labour and its marginalisation under the existing political system and put forward and fight for its own independent programme, Stop Paying the Rich! - Increase Investments in Social Programmes!
Workers' Weekly Health Group (WWHG) Commentary:
The NHS plan which was announced in July by Tony Blair as a plan "for the future of the NHS" has aroused serious concern amongst doctors, nurses and other health workers as to what direction the government is taking the NHS. Already, doctors, the BMA and other health workers organisations have expressed serious doubts whether the plan will work, whilst others have said that they think the plan is fine as far as it goes but criticised the government for continuing with the Private Finance Initiative (PFI) and called on the government to make further investments in health.
The plan, which is a plan for "investment" and "reform" of the NHS has been promoted by the government as containing the "most fundamental and far reaching reforms the NHS has seen since 1948." The plan admits that serious problems will continue, that waiting lists for treatment will persist for years to come and so on. With this same guilty conscious the plan also confesses that "NHS has suffered from decades of under investment." But to diffuse the issue it says; "In part the NHS is failing to deliver because over the years it has been underfunded. In particular there has been too few doctors and nurses and other key staff to carry out all the treatments required. But there have been other underlying problems as well. The NHS is a 1940's system operating in a 21st century world."
On the funding crisis in the NHS their plan is for the NHS to grow one half in cash terms and by one third in real terms in five years as a result of the budget announcement in March. But a plan to solve the problem of chronic underfunding cannot be based on predetermined budget announcements which themselves are based on a status quo where the financial oligarchy have first claim on the public finances in terms of national debt interest and so on. Even to get to the same level as the spending of other European countries will take 5 years according to this plan, but this will not solve the problem of chronic underfunding now.
The plan considers the method of funding for the NHS. It examines "boosting private health care insurance" by tax incentives, "charging" for health services, "continental social insurance" and "rationing to a core service". By subjecting each to its "efficiency test" and "equity test" the plan comes to the conclusion that the "way the NHS is financed continues to make sense". Finance is precisely the direction the government is taking the NHS using tax revenue not to fund the NHS but to finance private investment, using revenue not as a source of funding but as a source of huge profits for finance capital. If the government continues to commission new hospitals through the Private Finance Initiative (PFI) then such a "plan" for investment will increasingly go to finance the profits of big business and even less meet the crisis of underfunding in the NHS. With such a plan big business will continue to have first claim on these investments that the government is making in health and the crisis of underfunding in the NHS will intensify.
The government claims that the NHS plan will fund 7,000 new beds and over 100 new hospitals, 7.500 more consultants, 20,000 extra nurses and so on. But how will this come about to meet the investments needed in hospital beds, new medical schools and nurse training, when quite the opposite is occurring with increasing number of beds being cut back even as new hospitals replace old ones, with increasing numbers of doctors and nurses trained abroad being encouraged to come to Britain at the expense to the health services of many poor countries. So disgaceful is this situation that Britain as 4th richest country in the world does not invest in health care so as make the necessary number of beds available, train the necessary number of nurses and doctors that meet the basic health needs of the people here let alone training excess doctors and nurses without fees so as to assist developing countries.
In its Plan for the NHS the government analyses the "systematic problems". Blaming alleged "lack of national standards", "old fashioned demarcations between staff and a lack of national standards between services", "a lack of clear incentives and levers to improve performance" and "over-centralisation and disempowered patients" the government hopes to convince people that these are the problems that need to be solved in order to secure the NHS. Solving such "problems" will not bring about the development of a modern public health care system but these solutions are transposed and adapted from the manuals of big business. They do not address the real NHS, its history and development from its formation in 1947.
As a central theme of this NHS plan the government attempts to address the legacy of over a half century of a National Health Service by asserting that the NHS is a "1940's system operating in a 21st century." They say that the "relationship between central government and the NHS has veered between command-and-control and market fragmentation. Neither model works." Therefore the logic is that this justifies that "the NHS cannot be run from Whitehall" and a "new model is needed where intervention is inverse proportion to success". What this means is a "partnership" of health authorities, local authorities, business and voluntary organisations commissioning and running health care locally with the government only ensuring that there are "national standards" and intervening in organisations that "don't perform well". But there is no coherence in such a conclusion. Such a plan is reminiscent of the health service prior to the 1940's and proposals then to keep it in line with 19th century liberal values that instead of a national health service where the government takes reponsibility the health service should remain parochial, fragmented and subject to control of market forces and charitable organisations. This is not a "Third Way" between the NHS "being run from Whitehall" advocated by the "old left" or "market fragmentation" advocated by the "new right" but it is tinkered version of what the "new right" is saying that market forces should be paramount as long as there are so-called checks and balances. So what they are trying to do has no coherence. Coherence can only be brought about by the question of rights being applied to the NHS.
In 1947 irrespective of why the government sought to bring about a national health service, or that the capitalist class saw that it was in their interests for expanding production at that time, the masses of the people had an enlightened conception of public health, of a national health service as one which was available to all with out distinction as between those who could afford and those who could not afford to pay and at the highest level that society is capable of. Such a vision of the NHS recognised that society has a responsibility to care for its members. It is this right which is central to the modern conception of a national health service, and which people most passionately desire that the health service should be based on. With its analysis and solutions to the systematic problems the government has not taken this principle of a universal public health care system to its logical conclusion but has instead further used old conceptions such as business criteria to judge how the health service is being run and is further putting profitabitly in command. Of course this has all been done under a smokescreen of "defending core principles" and declaring that its plan is "designed around the needs of the patient."
The present government does everything to avoid the conclusion that modernising the NHS means creating the conditions so that the rights of all are fullfulled, which is the real legacy of 1947. Neither does the plan even restore the rights people previously had in 1947, such as the hundreds of thousands of elderly people who are now excluded from NHS long term hospital care and who now have to pay for private nursing homes. Instead, New Labour pretends that it is the greatest moderniser of a "new NHS" since the 1940's by repeating the post war declaration on human rights that "health care is a basic human right". For the people such a legacy can only lead to the conclusion that universal public health care must be recognised as an inviolable right and investments must be made in the NHS to ensure that the concrete conditions are provided to allow the satisfaction of this right.
The issue is not one of whether the plan can be made to work, or whether it solves some problems, or goes far enough, because the issue is that the solutions the government is putting forward will not safeguard and guarantee the future of the NHS. Neither is it just a question of a plan for the NHS with more public control versus the drive for private control. For the working class and people modern society is more and more revealing that it is they that have first claim on the economy and the public finances and in the health service the starting point of their demands for a plan for health is the claim that the people have for a health service provided for at the highest level as of right.
It is up to health workers and all working people discuss there own alternative plan to safeguard and guarantee the future of the NHS and to fight for a new society that recognises in words and deeds such a modern health care system as of right.
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