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Volume 41 Number 1, January 29, 2011 ARCHIVE HOME JBCENTRE SUBSCRIBE

No to the Health and Social Care Bill!
Health Care Is a Right! Fight for It!

Workers' Weekly Internet Edition: Article Index :

No to the Health and Social Care Bill! Health Care Is a Right! Fight for It!

Commentary:
The Economic Violence Done to Ireland’s Sovereignty

Building the Opposition to the Anti-Social Offensive:
Defending Oxfordshire’s Libraries

Workers' Movement:
March For the Alternative: Jobs - Growth - Justice

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No to the Health and Social Care Bill!
Health Care Is a Right! Fight for It!

March in Defence of NHS, 2007
March in defence of the NHS, November 3, 2007

The Health and Social Care Bill was published on January 19, and will receive its second reading on Monday, January 31.

It has been described as like “throwing a grenade into the NHS” or thrusting a knife into its heart. The former could be said to be more apt, in that the Bill’s purpose is to re-order the NHS as part of re-fashioning the health service in a society in which “austerity measures” for the people are contrasted with paying the rich on a grand scale, and which will lead to chaos as regards people’s health care but will benefit the European and US health monopolies.

It is not a Bill to safeguard the NHS but a Bill to further privatise it, and with the model of health care being purchased in the market place and under the banner of “giving patients great choice” runs directly counter to the principle that health care is a right.

This is not “liberating the NHS”, as the rhetoric of the White Paper on which the Bill is based proclaimed. Under the guise of “liberation”, the government is actually concentrating wide-ranging powers in its own hands regarding the direction of the health service.


Rally in defence of public services and against the cuts, September 2010

The Health Service Journal had this to say on January 27: “If the bill is passed in its current form Andrew Lansley and future health secretaries will have powers including the ability to direct the economic regulator Monitor and the NHS Commissioning Board and to decide what services should be commissioned by whom. And while Mr Lansley has preserved substantial powers over the Commissioning Board, the board itself has what lawyers called ‘draconian’ powers over consortia.”

The Health Service Journal went on: “The health secretary will be able to step in to the day to day running of the commissioning board if he considers it ‘is failing or has failed’ to discharge any of its functions. The minister will be able to direct the board to carry out the functions in a manner and a timescale he believes appropriate. If the board does not comply the health secretary can take over the discharge of the functions or make arrangements for someone else to discharge them on his behalf. Clause 59 of the bill gives the health secretary the power to ‘direct’ the regulator Monitor. Notes with the bill state that this power would be used in ‘cases of serious failure by Monitor to carry out its functions’, and argues it is similar to the powers the health secretary already has over the Care Quality Commission. Senior sources said the future role of Monitor as an economic regulator made it inappropriate for the health secretary to have such control and that an arm’s length relationship similar to those between government and other economic regulators such as the energy sector’s Ofgem were more appropriate models.”


All Together for Public Services rally in Central Hall, Westminster,
on the eve of the Coalition's Comprehensive Spending Review  

The point here is that not only is the government setting the agenda, but it has the powers to dictate how this agenda is carried through. It has been pointed out that the Health Secretary will be acting in a similar fashion to a CEO of one of the vast vertical monopolies. His powers could including licensing providers (in the purchaser/provider split), policing competition and setting prices (i.e., competition between the “providers” – i.e. the hospitals competing amongst themselves on “price”, and against the private health-care “providers”; under the Bill, private providers could be paid 14 per cent more than NHS “competitors”).

The Health Service Journal points out that the Department of Health’s “foundation trust financing facility would behave like a bank with respect to the £24bn taxpayer investment in foundation trusts and exert control through the use of regulations similar to bank covenants on commercial debt”.

Monitor, which is currently the regulator of NHS foundation trusts, will be transformed into the economic regulator of the health service, and for example could push for pensions to be reduced under the terms of the Bill.

These powers put in perspective the high-profile measures of the Bill, which are to give consortia of General Practitioners responsibility for commissioning the majority of health services, and create an independent NHS Commissioning Board. The measures include the abolition of Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) and transfer local health improvement functions from PCTs to local authorities. They would also give local authorities responsibilities for co-ordinating the commissioning of local NHS services, social care and health improvement. The Bill would introduce measures to provide for all NHS trusts which are not at present foundation trusts to become such trusts. Under this scenario, the Trusts “compete” and the GP consortia are supposed to do the shopping around. The Trusts would be able to take private patients and make commercial borrowings to finance their activities. Trusts could “fail” or merge.

It beggars belief that such measures are being put forward which so blatantly favour the private sector when the model on which they are based is in such dire economic crisis and the financiers are basking in government bail-outs. Yet at the same time, the aims of benefiting the health monopolies and slashing public expenditure on the health service stand out in stark relief.

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It is clear that if the Conservatives, not to mention the Lib Dems, had put forward their aims for the health service in such stark terms prior to last May’s election, then public opinion would have united against them. In fact, they made the opposite promise, which was to maintain the existing structure of the NHS. Even the “Programme for Government” which was the hastily drawn-up basis for the Con-Dem coalition, pledged: “We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.” One has to draw the conclusion that these words were part of the price of coalition. Cameron’s gloss on this pledge now is that it is rather a “bottom-up reorganisation”. But even this cannot square with the Programme’s categorical statement: “The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.”

In other words, the government has decided that a form of “shock and awe” reorganisation will best service its needs and to force through its programme of privatisation and cutting funding and investment in the NHS. This is in line with the changes that the government is making throughout society.

This is the significance of the “too far, too fast” complaint about the government’s “austerity” measures of its anti-social offensive. The “internal market” of providers and commissioners was introduced by the Conservative government in 1991. However, although Labour in opposition opposed the internal market, after a period of incoherence in its policy after coming to power in 1997, the New Labour government embraced this purchaser/provider split, and embarked on its own programme of so-called “investment with reform” in 1999 with the whole programme of PFI, and with the Strategic Health Authorities and PCTs emerging in 2002. A whole rhetoric of “efficiency”, “productivity”, “payment by results” and “budget deficits and surpluses” burgeoned. This rhetoric now rules the roost. There is a target of £20 billion in “efficiency savings” to be achieved by 2014, to be achieved under a “Quality, Innovation, Productive and Prevention” (QIPP) programme. In real terms, this will mean cutting tens of thousands of health workers and professionals, axing beds, wards and hospitals, and massively increasing the stress and workload of the remaining staff, against whom the culture of blame will be escalated.

The just demand of the people is that health care be provided at the highest standard as of right. But the government’s Health Bill is set to negate this principle and impose instead a system with a capital-centred thinking and aim. It must not pass! Workers’ Weekly calls on the working class and people to take up the fight to change the direction of the NHS to one which is based on the principle that health care is a right, and to build a Workers’ Opposition which will put a block on the government’s reorganisation and fight to safeguard the future of the National Health Service.

Whose NHS? Our NHS!
No to Privatisation and the Market Model!
Safeguard the Future of the NHS!
Health Care Is a Right!

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Commentary

The Economic Violence Done to Ireland’s Sovereignty

Following the withdrawal of the Green Party from the ruling Coalition on January 23, the Irish government reached an agreement with the opposition parties that after the passage of a finance bill through the Dáil Eireann by January 29, the Dáil will be immediately dissolved and an election must be held within 30 days. This puts the date of the Irish general election on or about Friday, February 25.

The political crisis in Ireland comes in the wake of the bailout package from the European Union and the IMF. On December 15, 2010, the British House of Commons had passed the Loans to Ireland Bill, rushing through the Second Reading, Committee stage and Third Reading in one day. This itself was the source of some disquiet, since even by recent parliamentary standards this represented legislation by decree. Her Majesty’s Opposition in the shape of the Labour Party supported the Coalition’s Bill. The Loans to Ireland Act received the Royal Assent on December 21.

The Loans to Ireland Act authorises the Treasury to loan up to £3.25 billion to Ireland, and contains an order-making power to increase this limit subject to affirmative procedure in the Commons. This loan represents Britain’s share of the €85 billion (£71 billion) international loan package agreed on November 29. This loan has been forced on Ireland by the IMF, plus two EU “mechanisms” and the governments of Britain, Denmark and Sweden. It should, however, be pointed out that the British government is itself financing the loan by borrowing from the financial institutions.

This loan has not been given out of the goodness of the hearts of the international financiers. It has come with strings attached, namely that the Irish government pushed through an “austerity” budget. The premise has been that the Irish cannot sort out their own affairs, or more to the point cannot be relied upon to guarantee the debts to the Irish banks’ creditors. This is the logic of the loan, and meanwhile the Irish government has been bludgeoned into carrying out the agenda of the European monopolies, financiers and owners of capital. In this scenario “the market” is key. It is all being done under the slogan that “there is no alternative”.

Britain has its own role to play in this scenario. In extending the loan, it too is acting according to the dictate of the European finance capitalists, including those in Britain. British, French and German banks are the beneficiaries. In addition, there are the interests of the British banks, which have £94 billion of outstanding loans to Ireland, including £20 billion to the banking sector. And, as a House of Commons research paper points out, Ireland is also Britain’s fourth largest overseas market, with exports to Ireland in 2009 worth £23.8 billion.

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The Irish working people themselves had been cautious about the splendours of the “Celtic Tiger” that had been hyped during the two decades to 2007. Although Ireland was a founding member of the euro in 1999, the Irish people rejected the Lisbon Treaty in June 2008, and only after a massive “yes” campaign and a re-run of the referendum did they agree to its ratification 16 months later. The issue of Irish sovereignty, political and economic, has been at the heart of the matter.

This is no small matter. The Irish people’s history has been one of struggle for its independence. The proclamation of the Irish Republic in 1916 was signed with the blood of the Irish people. Even the Irish Times had this to say: ‘‘It may seem strange to some that the Irish Times would ask whether this is what the men of 1916 died for: a bailout from the German chancellor with a few shillings of sympathy from the British chancellor on the side. There is the shame of it all.” The aim of the patriotic forces in recent times has been to reunify the country and build a self-reliant economy. Now everything is being done to protect the interests of the international financiers who are dictating terms to the Irish government, and the people of Ireland are paying the price. This was the significance of the “austerity budget” of December 7.

The bail-out package was not expected to “work” in the sense of averting any financial crisis, either in the eurozone or of preventing Ireland defaulting on some of its bank loans. The finance capitalists do not intend to stop until Ireland lays completely prostrate at their feet. The process which escalated with the economic penetration of international monopolies such as Intel, Kellog’s and GlaxoSmithkline, the finance capitalists wish to see taken to its ultimate conclusion. The Irish government’s bailout of its banks with state guarantees and the government’s buying up the banks “toxic assets” has not resolved the crisis, but has been a step along the way to entrenching it.

However, the Irish working class and people are determined that this should not pass! In this they have common cause with the British working class. The working people of both Ireland and Britain have been demonstrating and will continue to fight against the anti-social offensive which is the agenda of the European monopolies and financial oligarchy. These monopolies must stop the economic violence being done to Ireland’s sovereignty.

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Building the Opposition to the Anti-Social Offensive

Defending Oxfordshire’s Libraries

Opposition to the anti-social offensive is being organised with the perspective that There Is Alternative! A new direction has to be given to the economy, with the orientation that more has to be put into the economy than is taken out, and that instead of cuts in social programmes the opposite is necessary. The deficit is caused in essence not by the investment in social programmes, as the Westminster parties proclaim, but by the rich’s ownership of debt and by paying them in every possible way.

In this context, along with the opposition to the rise in tuition fees, the doing away with EMAs, the privatisation and dismantling of the NHS, there is a groundswell of opposition to the swathe of library closures that is sweeping the country. A successful public meeting to defend public libraries in Oxfordshire, the home of David Cameron’s own constituency, was held by Oxfordshire Anti-Cuts Alliance on Thursday, January 20. Hundreds of people packed into an Oxford Town Hall meeting room to give their views and hear speeches by “His Dark Materials” author Philip Pullman, who lives in Cumnor, local library campaigner Stephanie Kitchen, library worker and Unison representative Steve Squibbs and Oxford East MP Andrew Smith. Local television and other media were present filming and reporting on the meeting.

The meeting was advertised under the heading of “Stopping the Cultural Vandalism of Library Closures”, a sentiment that was certainly reflected in the speeches and contributions from the floor.

That twenty out of forty-three libraries are currently threatened with closure in Oxfordshire has come as a shock to many residents of the county. The symbolic importance of such sweeping closures of public libraries has brought people in the region face to face with the profundity of the anti-social offensive. Public libraries represent to people a mark of civilised society and progress; are we really to turn our back on that? The question on people’s minds is: which way society will go? The high road of civilisation or backward?

Steve Squibbs quoted the Somerset library campaign, which described the cuts as a “short-term dash towards cultural oblivion”. Philip Pullman portrayed the Dickensian nature of the government and told the council to leave libraries alone. “They are too precious to destroy,” he said.

In this vein, speakers described the social value of libraries, from promoting literacy and reading to playing a democratic role by assisting people in finding information. In particular, the need for local as opposed to a few big central, libraries was emphasised, as part of what Andrew Smith called “the essential part of fabric of local communities” and a place where social interaction takes place.

Many speakers from the floor gave their experiences of what libraries mean to people. As Steve Squibbs pointed out, these contributions are not easy to measure on a balance sheet, but they are no less real or valuable for this.

In this respect, Philip Pullman spoke about what he called the “greedy ghost of market fundamentalism” which simply cannot understand enterprises that do not exist for profit, such as public libraries, and that this market fundamentalism is driving the closures and bidding wars, in his view. The culture of bidding for funding, which is part of what is being introduced in the running of public libraries, sets one community against another, and must result in victory for one and defeat of the other. It is authority abandoning its responsibility, he said.

The unanimous view of all who spoke was the need for unity and to oppose either the setting of one library against another or the setting of all libraries against other public services. As one speaker from the floor said, for a community to even put forward a bid would be to accept defeat. Another spoke about how a decent, humane society must recognise the right to public services.

In this context, the whole logic of the cuts to libraries in particular and the cuts to social programmes in general was questioned. Stephanie Kitchen pointed out that the cuts to the libraries amounted to less than 2% of the cut in the County Council’s budget.

Steve Squibbs spoke about the scale of threats: nearly 400 public libraries are currently threatened in the country as a whole, and in some areas the proportion is much higher. He mentioned the Isle of Wight, where nine out of the eleven libraries are under threat. The cuts are not necessary, but driven by ideology, he said, and are about making ordinary working people pay or the crisis, and pointed to the huge bailouts of the banks and the billions being paid in bankers’ bonuses.

While Andrew Smith stated that the cuts are a deliberate choice of government, and that the national debt is best brought down gradually with sustainable growth and a proper contribution from the banks, Steve Squibbs questioned the whole alleged issue of the debt, which relative to GDP is not high by historical terms, and is not particularly high compared to other big economies.

Contributions from the floor raised the issue of the rich, tax avoidance and the tax system, and the need to oppose all cuts to public services. A speaker from Save Kennington Library in particular pointed out that getting people to travel to Oxfordshire with OAP passes, which costs the County Council money, is effectively handing public money to the bus companies.

The logic of volunteerism and Cameron’s “Big Society” was also questioned. Stephanie Kitchen explained how this involved transferring funding and management to voluntary organisations. She and others spoke about how this is not realistic, and about the need to maintain libraries as a publically owned service.

People spoke about the importance of paid staff and valuing the librarian. Philip Pullman in particular denounced the “patronising nonsense” of asserting that volunteers can do the whole job. “If anyone has the time and energy to work for nothing for a good cause, they are already doing it,” he said. “People who want to serve the public will be allowed to bid for a central pot, sit up and beg for it like little dogs and wag their tails when they get a bit.”

The meeting ended with a positive spirit, with speakers describing the campaigns springing up and the action being organised, such as the national day of read-ins, the national demonstration against cuts in March, and other local actions.

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Workers' Movement

March For the Alternative: Jobs - Growth - Justice

TUC Narch

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