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Workers' Weekly Internet Edition: Article Index : ShareThis
International Women’s Day 2016:
Women at the Forefront of the Fight to Safeguard the Future of Society
No to the EU of the Monpolies!
Stampeding the “Yes” Vote to Continue Britain's Membership of the EU
The Battle for the Future Direction of the NHS
NHS In Crisis – Save Lewisham Hospital Campaign Conference and Discussion Day
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On the occasion of International Women's Day 2016, RCPB(ML) sends its revolutionary greetings to women throughout the world who are affirming their rights, who are front and centre of the struggle against imperialism, war, oppression and exploitation, and who are rightfully at the forefront of the project to build a new world, a new society without the exploitation of persons by persons and where the rights of all are recognised simply by virtue that all are human. Women’s dignity, security and future lies in the fight for the rights of all.
Today’s society attempts to downgrade women as human beings, to put them in subordination to men, to reduce their participation to so-called women’s roles. And yet despite this, and in direct contradiction to this promoted view, women are very much at the forefront of all the struggles going on in society. In fact, women as a collective are a force in society who are taking up and leading the fight to defend the rights of all. Women lead the fight to defend the NHS, women are at the forefront of the anti-war movement and in fighting for an anti-war government, andwomen are demanding that social programmes be defended and placed centre stage. Women are showing what it means to be political by being at the forefront of the various struggles being waged. Women are at the forefront and the centre in all aspects, and women are taking their place as second to none.
Women are fighting for a just society and in all areas they are taking a just stand. Women are showing what their right to be actually is, and are showing that it is consistent with opening the door to progress, to a new society.
Those that are exercising the dictate over society in imposing the anti-social offensive, which is today expressed in the form of the fraudulent austerity programme, are mouthing words that they are listening to women, or are concerned about the violence and abuse against women and young girls. Yet these forces stand for escalating the conditions which give rise to all the abuses against women. In fact, women are bearing the brunt of this anti-social offensive.
Women are giving the lie to this propaganda through their very actions in fighting for the rights of the whole society. They are taking a courageous stand against the perspective which is being pushed that the issue is to realise individual women’s ambitions to break the “glass ceiling” and take their place as equal partners in the exploitation of society by the big monopolies and the warmongers. Women are taking a crucial stand that No means No! not just on the abuse and exploitation of women and women workers, but on all attacks on society and the public good. The fact is that all over Britain women are taking up leading positions in the struggles of the people against the anti-social offensive and for the victory of a pro-social programme.
In a modern age and a modern society, the most enlightened thinking is needed and this enlightenment demands that women are at the forefront of solving the problems of society alongside everyone else. What is needed is democratic renewal where the new conditions bringcommensurately new arrangements. It is wishful thinking to think that societal change can be made without resisting the neo-liberal agenda; and this is why the affirmation of all the struggles to fight this agenda and to take up the building of the new is so important. And this is why, within this context, the affirmation of the fight of women to take up their place in the fight for an anti-war government and in the fight for the rights of all, is so important.
The conclusion is that women must create the conditions for them to take their place in all spheres of society, and in practice, against all the odds that the status quo of capitalist exploitation places on them, they are doing so. And in taking up these struggles, women are also fighting for a change in the direction of society, they are demanding a decisive say in the running of society.
There Is a
Necessity in Women Playing the Leading Role in Transforming Society,
Looking at What is Central not Peripheral, What is Proactive not just Reactive
The present period is one of retreat of revolution. However, it cannot be said that there is no alternative to the retrogression being imposed on society. Far from it. As Lenin said on this day in 1920, “Capitalism combines formal equality with economic and, consequently, social inequality. This is one of the principal distinguishing features of capitalism, one that is mendaciously screened by the supporters of the bourgeois, the liberals, and that is not understood by the petty-bourgeois democrats. Out of this distinguishing feature of capitalism by the way, the necessity arises while fighting resolutely for economic equality, openly to recognise capitalist inequality […] But capitalism cannot be consistent even with regard to formal equality (equality before the law, 'equality' between the well-fed and the hungry, between the property-owner and the property-less). And one of the most flagrant manifestations of this inconsistency is the inferior position of woman compared with man. Not a single bourgeois state, not even the most progressive, republican democratic state, has brought about complete equality of rights.”
Our stand is that the complete emancipation of women is inescapably connected with the emancipation of the working class and the whole of society, that in the act of emancipating itself, the working class emancipates the whole of society. Our call, therefore, in the context of the necessity for the transformation of society under the leadership of the working class, is for working women to join in working out and implementing the independent programme of the working class, which is necessary for this transformation, for democratic renewal, and build the organisations of the class which are indispensable for this transformation.
Our experience in this regard also is that if not consciously participating in this struggle for the emancipation of women as part of safeguarding the future of the whole of society, then the pressure is for women to get overwhelmed, along with all other sections of the working people. Our call is to recognise the necessity of consciously adopting the road of the line of march to a new society, discuss this with everyone, so as to make the act of emancipation that of the women themselves.
Women workers must raise their own demands within the struggle for the emancipation of the entire working class. Only in this way can all women be emancipated. We call on class-conscious women to join RCPB(ML), take an advanced position and become leaders of society. This is a crucial problem of our times, to oppose getting diverted into what is known as “identity politics”, or movements which do not serve the cause of ending the enslavement of peoples, or worse that call for regime change under the illusory banners of “defence of human rights” or that serve a pro-war agenda. In this way the voice of women can be genuinely heard alongside and as part of the voice of the working class.
We can in this way set the sights of all of humanity on the future. As Lenin concluded, “It is a long struggle, requiring a radical remaking both of social technique and of customs. But this struggle will end with the complete triumph of communism.”
The fact that David Cameron has had to declare that his current tour of the country in the referendum for a “Yes” vote to remain in European Union (EU) is “Project Fact” rather than “Project Fear” rather underlines his desperation to stop any serious discussion on how people should vote and reveals his true aim to stampede through a “Yes” vote in the referendum in June. The EU referendum was called on February 20, just hours after Cameron claimed to have achieved radical reshaping of Britain's place in the EU, and a “special status” for the UK. The choice of June was opposed by many including those who support the “Yes” campaign as coming too close to the Scottish Parliament and Welsh and Northern Ireland Assembly elections. Nicola Sturgeon First Minister of the Scottish Parliament, Carwyn Jones First Minister of Welsh Assembly and Arlene Foster First Minister of the Northern Ireland Assembly wrote to David Cameron to urge him to defer the date. Cameron ignored their concerns that a June date will confuse the process and it would not give any time for people to consider such an important matter as whether Britain should remain in, or withdraw from the EU.
David Cameron's referendum campaign is indeed a “Project of Fear” designed to gloss over the serious issues and is just as shallow as is his claim to have achieved Britain's “special status” in the EU. Whilst Cameron tries to give the illusion that he is achieving advantages against the other European powers by threatening them with the referendum he also wants to make sure that their interests are also served by stampeding through the “Yes” vote to continue Britain's membership of this elite club of the monopolies in the EU.
On Sunday, the Cabinet Office published a “detailed document” which has already been reportedly described by some in his own cabinet as another “dodgy dossier”. The warning was of what the Prime Minister called a “decade of uncertainty” if Britain leaves the EU, ridiculously citing negotiations with other European and non-European countries over the terms of “access to their markets” as the reason Britain cannot leave its membership of the EU. But what the Prime Minster also wants to hide in this fear campaign is that far from being a victim of Brussels, where he claims he had to “negotiate” a new deal, Britain as one of the old colonial powers along with Germany and France has always dominated the European Union and all its member countries on behalf of the monopolies and financial oligarchy he represents. The British monopolies and financial elite are in rivalry to dominate Europe and this is his aim, an aim he shares with the other members of his cabinet that want a “No” vote and who think the interests of the monopolies can be better served outside the EU. All of their concerns have nothing to do with the interests of the people of Britain, and Europe and their future.
Rather that submitting to this climate of fear and the aim of the Prime Minster to stampede through a “Yes” vote the working class and people should look to their own interests and aspirations in this referendum to inform themselves of how they should vote. Having time for people to properly evaluate the issues would enable people to see that a European Union dominated by the European powers and their monopolies is a block to the progress of the working class and people to defeat the pro-austerity and pro-war agenda of the dominant powers in the EU. In deepening the discussion people would see that the EU of the monopolies has imposed extreme measures of impoverishment on Greece as well as other European countries overriding the sovereign governments of those countries. The EU bloc is also an alliance with the US implementing so-called “free trade” agreements such as TTIP (the Transatlantic Trade and Investment Partnership) to further allow the penetration of US and European monopolies to privatise public services and interfere in the affairs of European countries, overriding the sovereignty of the people and their governments. The EU as a bloc also seeks to weld EU countries to the warmongering NATO alliance and the inter-imperialist rivalry on the side of Anglo-US imperialists aim of world domination regardless of the wars, illegal invasions, proxy interference, devastation, death and mayhem they create.
To have this proper debate would mean that more and more people would see the EU for what it is. A block and hindrance not only to the sovereignty of European countries but also a factor for compromising the sovereignty of the peoples of Scotland, Wales and England. Such a discussion would reveal that leaving the EU of the monopolies would remove another major block to progress. It would enable the working class and people to go for sovereign states on a new basis, where the working class and people, if they so desire, can decide on a free and equal union between them which will put the English ruling elite at Westminster in their place. This would support the same struggle for the working class and people of other EU countries and further enable all to embark on a line of march to establish modern sovereign socialist states. Britain leaving on this basis indeed would start to end the anachronism of a Europe of the monopolies dominated by the big powers and open the possibility for genuinely uniting the peoples and countries of Europe on a new equal basis that serves the interests of all the peoples of Europe and the world.
The current debates in the monopoly controlled media concerning the future of Britain’s membership of the EU are presented from the perspective of falsifying its essential character. The EU remains the organisation of the big monopolies and financial institutions of Europe, especially those of Britain, France and Germany, and acts on the basis of the requirements of these interests not those of the peoples of Europe nor those in other parts of the world.
The EU has, for example, established a neo-colonial relationship with the counties of Africa. This is based on the unequal relationship that was established historically, first during the centuries when African men, women and children were trafficked across the Atlantic Ocean and which was continued when the leading European nations, such as Britain, France, Germany, Portugal, Spain and Italy invaded and divided the African continent in the period leading up to the First World War. For much of the twentieth century Britain and the other major European powers militarily occupied the African continent and argued that it was their right to exercise colonial rule. In many cases this relationship between Europe and Africa was only ended by armed struggle national liberation struggles. Yet Britain and the other countries that dominate the EU have accepted no responsibility for the crimes committed over centuries relating to Africa and Africans, refuse to accept demands for reparations and continue to interfere in Africa’s affairs. Indeed, further crimes are being carried out both by individual EU countries but by the EU as a body, such as sanctions against Zimbabwe, the actions of the EU towards African migrants and the recent military intervention in the Central African Republic.
Today the EU claims that it is in “partnership” with the the African Union (AU), the organisation of African states that was first established in 1999 precisely to address the many problems caused by neo-liberal globalisation. This “partnership” has been consolidated by various agreements and mechanisms and yet there can be no real partnership of those that are not equal, or when one party dictates to the other. This unequal “partnership” was formally established by the Cotonou Agreement of 2000 which governs the EU’s relations not only with the African continent but also with other former countries of the Caribbean and the Pacific (ACP) until 2020. This agreement is based on the Eurocentric values enshrined in the Paris Charter and facilitates the intervention of some of the world’s wealthiest and most powerful countries in the affairs of some of the poorest.
Although refusing to accept that wealth accumulated in the EU is in part a product of the exploitation of Africa over many centuries, the EU uses this wealth to continue its intervention in the continent. The EU countries are the main source of foreign direct investment in Africa, despite competition from China and the US. From 2007-2013 the EU provided €141 billion in “development assistance” to Africa and it remains the major financial contributor to the AU, providing 80% of the AU Commission programme budget. Through such means both individual African countries and the AU remain in a dependent relationship with the EU which continues to give itself the right to intervene in Africa’s economic affairs.
The nature of the EU’s intervention in Africa can also be judged by the free trade agreements, or Economic Partnership Agreements (EPA), established with individual African countries, or regions such as the Economic Community of West African States (ECOWAS), which also form part of the Cotonou Agreement. Since these “agreements” are not between equals they are designed to open up Africa’s economies to the big EU monopolies. Countries that refuse to sign, such as Kenya, are pressured to do so by the threat of the imposition of tariff barriers. The EPAs were widely opposed by the workers’ movement in Africa and other ACP countries and by the TUC and other trade union centres in Europe, nevertheless they constitute the main basis for the economic relationship between the EU and the AU as well as other ACP countries.
The relationship established between the EU, Africa and other ACP countries is one of neo-colonial domination and imperialist intervention and must be ended. The demand of all democratic people must be that Britain withdraws from the EU which remains the organisation established in order to serve the interests of the big monopolies of Europe.
In the autumn of 1988 Jacques Delors, the then President of the European Commission, addressed the British Trade Union Congress, promising that the Commission would be a force to require governments to introduce pro-labour legislation. Delors also at that time attempted to influence the trade union movements in Denmark and Ireland to the effect that “Social Europe” was a reality they should support.
Prime Minister Margaret Thatcher responded with her infamous “Bruges Speech” on September 20, 1988, in which she said that she had not “rolled back the frontiers of the state in Britain only to see them reimposed by a Brussels superstate”. In so doing, she was asserting the interests of British monopoly capital to impose its will in an unfettered manner not only in Britain but globally, and demonstrating that there were not only common interests throughout international finance capital but also the most cut-throat contention.
In these circumstances, the ETUC (European TUC) offered “partnership” with the monopolies as a trade-off for survival agreeing discussions with the “Round Table of Industrialists” to limit class struggle and agreeing support for the European Union.
Various protocols of the “Social Chapter” and “Social Charter” were drawn up along with the various ideas of “limiting working time” and later produced directives. The aim here was to make the European monopolies the most competitive in the global market and encourage the workers of the EU states to get behind these aims in contention with the US and other blocs. It was also a time when there was euphoria among the ruling circles that the workers' movement with its independent programme and thinking was finished, and the end of history had come with the triumph of neo-liberalism. The EU became the embodiment of that euphoria on a Europe-wide scale. It seems a far cry from the problems that are today racking the EU, the contradictions between “old” and “new” Europe, and the self-created threats to the very existence of the EU as an entity.
The issue really is that the workers' movement should not get embroiled in these dog-fights of the monopolies but should develop their own independent programme, the alternative. In this connection, it cannot be said that workers' rights are given by the EU or guaranteed by its legislation. This is first of all untrue on a theoretical and political level. Workers' rights are inalienable and belong to them by virtue of their concrete conditions of existence, of their being. The struggle of the workers' movement has been and is to provide these rights with a guarantee. But on a practical level, it is at best questionable that the EU directives have done so.
It is said that workers’ rights in the UK are “underpinned by EU rules”. This could be called a fraud. The same EU promulgates rules and directives that enforce the neo-liberal agenda of privatisation, capitalist competition, dictate of the monopolies and scrapping of regulations that safeguard the rights of all. The question can be asked, for example: is remaining within the EU going to nullify the Trade Union Bill? Where is the guarantee of workers' rights here? It is true that, as TUC General Secretary Frances O'Grady said only recently: “[Workers'] rights can't be taken for granted.” But what must be recognised is that is the case with or without the EU. It is extremely myopic to ignore the destruction of the manufacturing base, the destruction of jobs, the shackling of workers' ability to resist the anti-social offensive, the dismantling of public services, and then claim that the EU is the guarantor of the “workers' hard-won benefits and protections”, in Frances O'Grady's words.
There are many workers across the EU who are having to live with the attacks on hard won, hard fought for paid leave, many workers on zero hour contracts and temporary contracts. Many have reduced leave and many witness the discrepancies across the EU. There have been no “guarantees” with discrepancies even across industries with discrimination still operating against women who become pregnant and whose employment or conditions or progression is threatened. Male parental concessions are not equally distributed in firms across the country and other European countries. Part-time workers are in no-way in a state of equal treatment.
The right to not be forced to work longer than 48 hours a week on average is regularly challenged in wage negotiations by employers, with forced overtime and lack of premium pay. The Junior Doctors are the obvious case in point today and the British government, with no such protection available or invoked, directly enforces their conditions and contracts.
Eighteen weeks' parental leave per child and to time off for urgent family reasons simply does not exist for many workers or is made difficult or unavailable to claim.
The right to equal pay for work of equal value between men and women is nonsense in many circumstances. Job descriptions, job evaluations and benchmarks are unrealistic or uncategorised in many circumstances. Hard fought for women's equality amongst production workers, gained by milestone struggles such as by Ford women workers, has still not got the recognition of establishing new criteria to measure equal pay even though established outside of the EU.
The battle for the right to equal treatment for part-time, fixed-term and agency workers with other employees is still an ongoing struggle.
The right for workers' representatives to be informed and consulted on significant changes that could affect jobs, changes in contracts of employment is still arbitrarily implemented and not conformed with in many consultations.
The right to high standards of health and safety at work have seriously been undermined in recent years leading to increased accidents and industrial injury reported in the press on a daily basis.
There are still no protections for workers affected by outsourcing or business buy-outs. Even when labour is supposed to be “tuped” across (Transfer of Undertakings ; Protection of Employment Regulations, 1981) at local authority level when services are outsourced along with jobs, it is undermined or not carried out.
To intimate that protections from discrimination in the workplace on grounds of sexual orientation, gender reassignment, age, and religion or belief is an EU prerogative is totally misleading and to indicate that it will not persist in or out of the EU or would be weaker is erroneous.
WWIE calls on the working class movement to examine the preconceptions promoted about the EU and workers' rights, and to reject the illusions being created that the European Union is there for the benefit of the working class, which is a cruel joke being played on working people. In actual fact, the ruling elite is in such crisis in part precisely because it does not recognise workers' rights, and this is playing havoc with the economy, and is creating problems for the EU states that they had not foreseen nor can deal with. The power of the working class has always been in their own organisation and numbers. This remains true today, and it is these factors which are crucial in being brought to bear in the struggle against the anti-social austerity agenda and for the guarantee of the rights of the workers.
For Your Information:
Collective Bargaining in Europe
The 2013 publication “Reconstruction after the crisis: a manifesto for collective bargaining” by K D Ewing and John Hendy QC, published by The Institute of Employment Rights, carries a chapter “Collective Bargaining in Europe”.
Keith Ewing is Professor of Public Law at King's College London. He is President of the Institute of Employment Rights and Legal editor of the journal International Union Rights. He is also a Vice President of the Campaign for Trade Union Freedom. John Hendy is a QC specialising in trade union law at Old Square Chambers. He is Chair of the Institute of Employment Rights, President of the International Centre for Trade Union Rights and a Vice President of the Campaign for Trade Union Freedom.
The authors point out in this chapter that it can be said that “there are two 'Europes': the first is the Europe of the Council of Europe and the European Court of Human Rights; and the other is the Europe of the European Union and the European Court of Justice”. They say that it is one of the great tragedies of the modern era that while the Council of Europe is moving, via the European Court of Human Rights, to strengthen the right to collective bargaining, the European Union is moving just as quickly to dismantle it in many of the different states of the Union. They say: “As a result, collective bargaining coverage in much of the EU is in decline, and although not as low as in the United Kingdom, the collapse to British levels cannot be ruled out as institutions and structures are dismantled. This is no coincidence, with the decline in collective bargaining coverage now being carefully orchestrated from Brussels by the European Commission.”
Ewing and Hendy point out that on average across the EU, 62% of workers remain covered by collective bargaining. However, the UK, with 23% of workers covered, is second to bottom with only Lithuania (15%) below it. Industry-wide bargaining has largely disappeared, at least in the private sector, and bargaining occurs at company level if it occurs at all.
In detailing the attack on collective bargaining, the authors write: “The Troika [the European Central Bank (ECB), the European Commission (EC), and the International Monetary Fund (IMF)] sees radical decentralisation as the blueprint for reconstructing collective bargaining systems in Europe.” The word “reconstructing” in this context could be read as “deconstructing”. The authors cite the examples of the termination or abolition of national level collective agreements; the extension of the scope for workplace derogation from industry-level collective agreements; the introduction of more stringent preconditions for extending collective agreements by legislative means to non-signatory employers; and finally the dismantlement of the trade union monopoly over negotiating on terms and conditions and the granting of scope for non-union employee organisations and employee groups to conclude workplace collective agreements.
Ewing and Hendy describe these as “a sustained attack”. They say: “The crisis in the Eurozone has plainly provided an opportunity for many of these developments to be driven through.” They point to the Posted Workers' Directive (which is a 1996 EU directive concerned with the free movement of labour within the EU) and litigation allowing contractors to undercut collective agreements in the name of business freedom. They write: “It now became impossible for trade unions in Member States to protect collective bargaining arrangements and to protect collective agreements from being undercut by contractors posting workers from countries with lower wages. Nor could Member States insist that contractors complied with collective agreements.”
Secondly, there has been the impact of austerity with the dismantling of collective bargaining structures now demanded by the Troika. “The demands of the Troika cannot be under-estimated,” Ewing and Hendy write. “They trample on the constitutional guarantees of countries like Greece and Portugal, with the constitution in the case of Greece providing that 'General working conditions shall be determined by law, supplemented by collective labour agreements contracted through free negotiations and, in case of the failure of such, by rules determined by arbitration'.”
Thirdly, the authors point to growing pressure from within the European Commission for a growing decentralisation of collective bargaining from the level of the sector to the level of the enterprise. “This appears to be a demand for a dilution in the role of trade unionism and collective bargaining,” they say. The authors continue: “It also appears to mark the eclipse of the idea of 'Social Europe' and the triumph – at least for the time being – within the corridors of Brussels of neo-liberal ideology at the expense of the social democratic ideology of an earlier generation of politicians.”
Fourthly, Ewing and Hendy point out, there is a new threat on the horizon in the shape of TTIP, which “could have a potentially devastating impact on collective bargaining arrangements in Europe”. They stress that the US has not ratified either of the freedom of association conventions and now has collective bargaining density of 7% in the private sector. They conclude: “In the absence of any likely levelling up by the USA, the most likely consequence of the free trade agreement for freedom of association will be the levelling down by EU member states, with more pressure from employers to adopt US practices with US levels of bargaining coverage.” It is, they say, a grim prospect.
On Saturday, December 5, at Goldsmiths College, South London, the Save Lewisham Hospital Campaign (SLHC) held a very successful and significant day-long conference entitled “NHS In Crisis – Why is our NHS under threat and what can we do to defend it?” Over a hundred people – health workers, NHS campaigners including some from other parts of London and beyond, patients, interested and concerned local people attended the conference.
The conference was opened by Heidi Alexander, Shadow Secretary of State for Health and Lewisham East MP. Heidi Alexander paid tribute to the SLHC saying that if it were not for the SLHC she would not have been given the job of Health Secretary. She pointed, “We saved our hospital, now we have to save the NHS” which was “on the brink of its biggest crisis for a generation”. Heidi Alexander paid tribute to the Junior Doctors saying that they were “the front line for the NHS”. She opposed the scrapping of bursaries for student nurses and again praised the SLHC saying that “it is still needed”.
The Chair of the SLHC, Louise Irvine, gave an introductory keynote talk: The NHS in Crisis. We give some of the main points of her speech:
This conference has been organised by the Save Lewisham Hospital Campaign to help to raise the general understanding of what is happening to the NHS just now, and to arm the participants with information, arguments and ideas to enable them to organise and campaign effectively in defence of the NHS. The Save Lewisham Hospital Campaign has continued as an active campaign. The hospital was saved, but there can be no illusions that the victory is secure for all time and Lewisham must fully expect further attempts at downgrading the hospital. Furthermore, the campaign to save Lewisham hospital taught everyone that no one service can be safe unless all the NHS is safe. Lewisham does not exist in isolation and all the pressures on the NHS nationally also affect Lewisham. So it can be said that the local is national and the national is local. That is why the conference has invited speakers from other parts of London and beyond. The English NHS is facing attacks on many fronts that undermine its fundamental nature as a public service, free, equitable, comprehensive. But there has also been resistance to those attacks – which have led to some successes or are managing to hold the line – and strength and inspiration should be drawn from those campaigns. Today’s conference will hear from campaigners in north west London and also in Leicester where they are facing major reconfigurations of services and hospital and bed closures. The threats to the NHS are in four main areas: funding, privatisation, attacks on staff, and reconfiguration of services leading to cuts and closures.
As regards NHS funding, despite government rhetoric, funding is not protected as it does not match rising need due to changing demographics and increased costs of health and medical technology. Rising health care needs would require a 4% annual real terms funding increase – the same as in other developed countries – but there has only been and will only be a 0.9% annual real terms increase so that means inadequate funding in relation to need and reduced spending in real terms per capita. George Osborne’s fanfare announcement of another £3.8 billion for the NHS in his Autumn Statement is “front loading” of the promised extra £8 billion by 2020. Such “front loading” was vital in the face of a £2 billion hospital deficit and impending winter crisis like last year. However, over the next five years the annual increase will be less and overall, adjusted for inflation, it is only 0.9% annual increase – no different from the past five years, and not nearly enough to meet growing health care needs. In addition, cuts to social care will exacerbate the problems in the NHS as inadequate social care leaves many older and disabled people vulnerable and at risk of deterioration in their health or unable to be discharged from hospital, and at least £1.5 billion being taken out to shore up social care as the Better Care Fund. The NHS budget is no longer ring fenced and non clinical services have seen big cuts with £1.5 billion removed from the public health and the education and training budgets to contribute to the £3.8 billion “increase” for front line care. Moving money around from one section of the NHS to another is not a genuine funding increase. It is short- termism to cut public health and training and education budgets.
Despite government boasts to the contrary, this is the lowest average annual change of any decade, contrasting with average annual increases of 5.7 per cent under the Labour administrations between 1997/8 and 2009/10 and 3.2 per cent under the Conservative administration between 1979/80 and 1996/7. This represents the largest ever sustained reduction in NHS spending as a percentage of GDP. Compared to others, the United Kingdom (for which figures are given by the Organisation for Economic Co-operation and Development) has slipped further into the bottom half of the OECD health spending league – overtaken by Finland and Slovenia. But even with the promised £8 billion by 2020 the NHS must find £22bn efficiency savings by 2020 that nearly all informed opinion believes is highly unlikely. Around three quarters of savings found in the last five years in the NHS have come through cuts to tariffs (the price paid to hospitals for treatments) and capping NHS workers' pay. But neither are sustainable going forward, with hospitals in open revolt over tariff reductions and NHS staff increasingly voting with their feet.
Regarding local authority spending on social care for older people, since 2009/10 this has fallen in real terms by 17 per cent; over the same period, the number of older people aged 85 and over rose by almost 9 per cent. It has become much more difficult for people to get publicly funded social care and that numbers had fallen by 25 per cent since 2009 (from 1.7 million to 1.3 million) and in 90 per cent of local authorities only those with “substantial” or “critical” needs will get publicly funded services. Social care is often neglected, and just trotting out statistics does not do justice to what is really happening. Health and social care must both be properly funded. It is a political choice, and the austerity argument that there is no more money is unsustainable when there is money for bombs, but that for health care is denied. So much money is being wasted on the market, management consultants and so on. Abolishing the market in the NHS would liberate resources for front line care. Yet, the amount of contracting and privatisation has increased steadily throughout the last government and into this one. This was accelerated by the Health and Social Care Act 2012.
This Act also created new structures which changed the NHS from being a public service with a duty on the part of the government to provide a comprehensive health service to a marketised system with groups of GPs in clinical commissioning groups (CCGs) allocating resources by contracting services out to the market, allowing private companies to bid for contracts and to compete with NHS providers. The government claimed last year that only 6% of clinical services had been privatised but that was before 2013, before the section 75 regulations kicked in. According to the NHS Support Federation, which monitors contracting, between April 2013 and October 2014, £18.3 billion worth of contracts to run or manage clinically related NHS services were advertised in the first 18 months since the Health and Social Care Act came in to effect in April 2013. In the same period £5 billion worth of contracts were awarded through the market. Non-NHS providers have won two thirds of these clinical contracts. The value of NHS contracts being awarded through the market is rising significantly. In the first six months after the Health and Social Care Act came into effect (April-September 2013) over £400m of NHS contracts were awarded. A year later the number of awards in the same six-month period (April-September 2014) had doubled and their value was over seven times higher, at £3bn. She said that 10% of General Practice was owned by companies like Virgin and that spending on private firms to provide 999 ambulances has doubled in the last three years from £24m to £56m.
In the sphere of community care, Virgin Care was awarded a £130 million contract from March 2013 in Devon to run children’s services and services for people with learning difficulties and adolescents with mental health problems. It has a £450 million contract to run a range of community services in Surrey, and recently won the contract for community child health in Wiltshire. In the sphere of elderly care, an £800 million contract in Cambridgeshire was tendered out at a cost of £1 million for the tendering process itself. The contract was won by two NHS Trusts who have, after just eight months, handed it back to commissioners as it was not “financially viable”. As regards cancer care, in July 2014, four NHS GP-led clinical commissioning group areas in Staffordshire tendered for a £687 million, 10-year contract, the first such contract in this area opened up to private companies. The four CCGs involved are also seeking bidders for a separate £340 million 10-year contract to provide end-of-life care. Together the contracts are worth £1.04 billion. Health care planning and management has been privatised. Recently a £6 billion, 5-year contract for commissioning support was given to a private company. Capita won a £6 billion contract to provide back office functions for general practice, pharmacies and opticians. £600 million a year is spent on management consultants like Deloitte, Ernst and Young, Price Waterhouse Cooper and McKinsey’s.
PFI repayments are having a devastating effect on many hospitals, costing nearly twice the amount of a publicly funded scheme. In 2013-14, nine out of the 15 most indebted Trusts had PFI schemes.
Attacks on staff
Over the past five years NHS staff have suffered a pay freeze that amounts to a 15% pay cut in real terms. The overall problems of NHS staff, including the Junior Doctors who are currently waging the fight against the imposition by Jeremy Hunt of a new contract, have been caused by the relentless attacks on their pay and conditions by this government, resulting in low morale, staff shortages, cuts in training places and reliance on agency nurses. Staff shortages were the main cause of the Mid Staffs scandal where staffing levels had been cut to save £10 million a year in an attempt to show financial balance to secure status as a Foundation Trust.
Reconfiguration of services
Having promised no top-down reorganisation and no closure of A&Es and maternity units in the 2010 election, the Coalition and now the Tories have been carrying on relentlessly with so-called reconfiguration plans. These are aimed at closing district general hospitals but are dressed up as bringing care closer to home and improving specialist services. The SLHC was born out of a campaign to prevent our hospital being closed as part of a reconfiguration of hospital services in south east London – the TSA (Trust Special Administrator) process. This followed on one about five years ago called “A Picture of Health”. And now the OHSEL (Our Healthier South-East London) process – strangely reminiscent of the language of previous attempts – is all about bringing care closer to home. This is coded language for downgrading hospitals.
The OHSEL Report is a 5-year plan currently being developed by the six south east London Clinical Commissioning Groups for redesigning local health services. The report uses language that is worryingly reminiscent of the TSA arguments for cutting hospital beds by “improving” community care in their plan to downgrade Lewisham Hospital. The SLHC lobbied OHSEL for clarification about whether proposals would include the possibility of closing Lewisham A&E and had received reassurances that future plans would not mean downgrading or closure of Lewisham Hospital. We are certain that it is due to our lobbying that we have been given these assurances. At the same time we don’t trust the process and will remain vigilant, asking questions about where they will make £1.1 billion funding cuts, while properly funding good community care. The role of the SLHC in this is a proud one. It flexed its muscles again and forced the announcement that the two A&Es are protected, with a promise of a similar announcement about maternity services. Genuine plans to improve community services cannot be implemented at the expense of acute services.
As regards devolving healthcare to the local council in the Manchester area, known as “Devo Manc”, it is a continuation of the process of government divesting itself of responsibility or accountability for its health and social care decisions.
What of the future?
This conference is to equip its participants with deeper understanding of the many and varied ways our NHS is under attack but also the ways that this is being resisted. Let us discuss how we work together better and what strategies we should employ to do this. In this way, both local and national campaigning efforts can be strengthened.
The Junior Doctors' Dispute
Louise Irvine’s opening speech was followed by two talks on the Junior Doctors' dispute.
The first talk was given by Dr Helen Fidler, a consultant in the Lewisham and Greenwich Trust. Dr Helen Fidler spoke of the importance of the dispute, praising the Junior Doctors as being “the vanguard of our NHS”. Dr Fidler talked about her experience when a Junior Doctor herself: of the very long unregulated hours they had to work and how it was not safe for patients because of the problem of lack of sleep. She said that the Junior Doctor’s fight was against the removal of the restrictions of working long hours and how crucial it was for the Junior Doctors to win, not just for themselves but for the whole future of the NHS.
Dr Shruti Patel, a Junior Doctor at Lewisham Hospital then spoke. She said that the reason why Junior Doctors were so angry was that Jeremy Hunt’s plan represented “the wholesale destruction of our working practice”. Hunt’s plans would result in “financial hits” for the very people who provide a 24/7 NHS service and that the Junior Doctors hardest hit would be in A&E, Paediatrics and Intensive Care. Dr Patel pointed out they already work anti-social hours, she herself working every other weekend. The new contract would further penalise Junior Doctors taking time off for necessary research, for example in new cures for cancer, as well as those taking time off to have children. The dispute is not about a pay rise. Hunt’s plan involves an actual 40% pay cut, so that Hunt’s much publicised 11% “offer” would still amount to an overall 30% pay cut.
Dr Patel said that the decision to go on strike was a hard one to take yet 98% of those voting favoured strike action. The November/December period is a time when traditionally Junior Doctors apply for speciality training, but there has been a huge dip in numbers applying to train. “We would like to show Hunt that we are making a stand for our patients, we are also doing something positive in our community.”
(to be continued)
North East Workers & Politics*, March 7, 2016
On Saturday, February 13, a rally took place to call on people to stand up against the cuts to council, care home and mental health services at Gateshead Civic Centre. One of the speakers, Stephen Luke, who represents the many families whose loved ones suffer from mental illness, spoke to raise awareness of the present changes to Mental Health Services. He started by saying these are not only the biggest changes in recent years but probably overall the most damaging to Mental Health Services in Gateshead and Newcastle. He said that over the last five years Northumberland Tyne Wear NHS Trust “have already closed 459 mental health beds, which has contributed to all the remaining wards being full and over capacity”. He pointed out from statistics he had investigated there had been “a 62% increase in violence towards staff, carers and family members and an increase in suicides, murder, restricted access to inpatient services and a reduction in recovery rates”. He said that there had also been a “63% national increase of inpatient referrals under the Section 3 of the Mental Health Act, which means they must be hospitalised by law”.
He condemned the fact that there is now “a national crisis where mental health inpatients are not only sent hundreds of miles from their locality but at times can no longer get a bed anywhere in the UK both in the NHS, or with private services. There are also more mentally ill people being detained in police cells and more being imprisoned.” He pointed out that in spite of these severe and critical conditions Gateshead and Newcastle Commissioning Groups are proposing the potential closure of a further 40% of the remaining acute mental health beds and proposing to remove the remaining beds to out of locality areas in Sunderland and Morpeth. He called on people to oppose the closures and stop this decision being made by the Gateshead CCG on May 24.
As we pointed out in NEWP in the last issue supplement, the fraudulent austerity arguments that the health care of the people is too costly must be rejected. The people must assert their claim that health care is a right in a modern society and must be funded as a priority over the schemes of the rich. The people must continue to strengthen their organised resistance and expose further this whole assault on the mental well being of the people, defend public authority and bring the inhuman perpetrators of theses criminal plans at the heart of government and elsewhere to account. The people must continue their fight to safeguard mental health services.
* North East Workers & Politics is a publication of the Northern Region of RCPB(ML).
North East Workers & Politics, March 7, 2016
On February 29, the South Tyneside NHS Foundation Trust (STFT) announced to its staff that it was developing its partnership with City Hospitals Sunderland (CHS) into an “Alliance”. The statements issued were that there was urgent need to “rebalance” the services with South Tyneside “moving away” from providing complex acute services and in future “leading on” out of hospital rehabilitation and diagnostic and screening services. The claim is this will lead to “high quality and sustainable hospital and community services”.
The claim is also that this is not a merger, or takeover by one Trust of another, although a new Board South of Tyne Healthcare Group has been set up with a Chief Executive from CHS and Chair from STFT. It is also clearly indicated that this will lead to and “alignment towards one Group Executive Team over time”. Already, prior to the announcement staff have been informed that the award winning acute stroke services at STFT will move to CHS and under review are most of the acute services at STFT, if not all, for transfer to CHS, whilst out-of-hospital rehabilitation and diagnostic and screening services are transferred from CHS to STFT. The Trusts have also refused to invoke a consultation process claiming that this was a “management re-organisation” and therefore there was no need for public consultation.
In the letter to staff, the Chief Executive admitted that many Trusts were being encouraged by the Department of Health to create “planning footprints for Trusts to work together”. However, although the Trusts mention the “financial climate” in their statements, what they don’t acknowledge is the deliberate government underfunding of NHS acute and community services which is the real reason behind the moves of STFT and CHS. The government’s refusal to properly resource our health service has led to the scandalous situation where CHS and STFT are £50 million + short in their budget for 2016/2017. This is what is driving the closure of acute services for patients at STFT which they hope will safeguard acute services at CHS. However, both the acute services at STFT and CHS are overstretched now, so how will drastic reduction in these services for patients help? The increasing pressure and crisis in Urgent Care Centres (A&Es) is now the increasing lack of acute beds and services at our District Hospitals added to which is the government's deliberate underfunding for training, over decades, of the doctors and nurses required by the NHS.
The government’s call for Trusts to “work together” is not to develop “high quality and sustainable hospital and community services” but to desperately try and paper over this chronic underfunding and fragmentation they have caused by their purchaser/provider split. They want all these Trusts that have been competing with each other to now engage in takeovers and mergers. Cynically, the government is using this underfunding and competition to provide services to speed up the process of privatising health and support services and attacking the pay and conditions of health workers to wreck the universal health care system built up over generations. For this purpose and for decades governments have continued to make cuts to the budgets of Trusts and other providers each year under so-called “efficiency savings”. They then use the threat of “unsustainable provider” if health services and hospitals are unable “live within their means”.
It is this whole direction that the NHS is being driven that is at fault. The people of South Tyne and Wear should not accept that their hospitals and health services be subjected to this financial dictate and serious irrational consequences for their health service. The people should demand that they should decide the future of their health care system based on the needs of the population in each district, region and nationally. These are not decisions that can be left to the accountants of a so-called market in health, or to the dictate of the neo-liberal anti-social agenda of governments. In the modern world health care is a human right. No community should be subject to the arbitrary closure of their acute, community or rehabilitation health services. It is our NHS – We decide!
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