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Volume 53 Number 25, August 19, 2023 ARCHIVE HOME JBCENTRE SUBSCRIBE

The struggle for the future of the NHS

Junior Doctors Hold Four Further Days of Strike Action, Rejecting Sunak's "Final Offer"

Workers' Weekly Internet Edition: Article Index : ShareThis

The struggle for the future of the NHS :
Junior Doctors Hold Four Further Days of Strike Action, Rejecting Sunak's "Final Offer"

The Integrated Care System and the Elective Recovery Taskforce:
Further Distancing Decisions from the People on Health Care Intensifies the Crisis

Hands Off Niger!:
No to Foreign Interference in the Affairs of Niger and Its People! US, France, Britain and European Union Out of Africa!

The struggle for the future of the NHS

Junior Doctors Hold Four Further Days of Strike Action, Rejecting Sunak's "Final Offer"

Junior doctors on strike in August - Photo: Personnel Today

In the latest escalation of their campaign for a meaningful pay rise in the face of government intransigence, junior doctors in England staged a 4-day full walkout from August 11-15, continuing a wave of action involving various sections of staff across the NHS that began in December last year.

Junior doctors striking at Arrowe Park Hospital, Wirral, Merseyside - Photo: John Brace

Most unionised junior doctors are organised in the BMA. However, those belonging to the smaller Hospital Consultants and Specialists Association also took part in the strike.

On the first day of the strike, over 100 doctors gathered outside Downing Street, holding placards and BMA flags. The union points out that F1 doctors, the newest medical recruits, were among those attending, whose very first action as doctors was being forced to strike for their pay and working conditions [1].

The doctors are demanding a 35% pay rise, having suffered a 26% real-term pay cuts since 2008, which has led to a crisis in recruitment and retention, with dire consequences for the future of the health service.

In the lead-up to the action, Prime Minister Rishi Sunak had announced his "final offer" of a mere 6% increase in 2023-24, together with a £1,250 consolidated payment, stating strike action will not alter the decision.

NHS workers have been making themselves felt through their actions, which have resulted in over 820,000 cancellations of operations and hospital appointments since last year, with 7.5 million people now awaiting non-urgent treatment [2].


NHS chief executive Sir Julian Hartley had claimed the strikes have cost over £1 billion. He estimated 1 million appointments to be cancelled and rearranged by the end of this round of action. [3]

The BMA is currently balloting for further action.

The junior doctors' strike coincided with a 2-day walkout of radiographers, and consultants in England will begin another round of strike action on August 24.

NHS England last week also set out plans to prepare this winter for unusually high levels respiratory diseases, including Covid, flu, and RSV.

"Junior Doctors and their patients need change now. While workload and waiting lists are at record highs, junior doctors' pay has been cut by more than a quarter since 2008," explains the BMA.

"A crippling cost-of-living crisis, burnout and well below inflation pay rises risk driving hard working doctors out of their profession at a time when we need them more than ever. To protect the NHS, the Government must engage and address doctors' concerns. But so far, they have refused to meet with us. This has left doctors with no other option but to vote on whether to take industrial action. If junior doctors are forced out of the NHS because of poor pay and conditions, the services we all rely on to look after our loved ones will suffer".

Their campaign aims to:

  1. Achieve full pay restoration to reverse the steep decline in pay faced by junior doctors since 2008/9.
  2. Agree on a mechanism with the Government to prevent any future declines against the cost of living and inflation.
  3. Reform the DDRB (Doctors' and Dentists' Review Body) process so pay increases can be recommended independently and fairly to safeguard the recruitment and retention of junior doctors.

At the rally, BMA Junior Doctors Committee co-chairs Rob Laurenson and Vivek Trivedi told the assembled doctors:

Photo: SSTHC

"We're here yet again to fight for what we're worth, to show this government that we will not roll over... Sunak has the audacity to suggest that this 'final offer' ends our dispute but make no mistake, our dispute is far from over. He wants you to give up and accept another pay cut. He wants you to think that he has the power and not you as doctors."

Writing for the Daily Mail in a rabid attack, Health Secretary Steve Barclay defended the Government's pay offer and said: "Yet, the BMA continues to act recklessly by going ahead with further unnecessary strike action this week, which serves only to harm patients and put further pressure on their own colleagues." [4]

The struggle appears as government intransigence versus the persistence of the junior doctors.

On the one side is the government and Sunak himself, who pledged in January that waiting "lists will fall and people will get the care they need more quickly". This is a government that has only its failed "deliverology", blind to real human beings and their relations.

Government intransigence only masks their real weakness. It has been reduced to introducing anti-strike laws, trying to use the courts over ballots to offset actions. Yet even the judiciary can see what is at stake, and now a High Court ruling has blocked NHS England from using agency staff to undermine the strikes.

The government also crudely attempts to divide and rule by concocting disinformation, resorting to blackmail and scaremongering. Yet the public have seen through the deceit, and they support their doctors, nurses, paramedics, ambulance drivers, and all who work in the NHS.

All of which brings us to the "final" offer. How can such "finality" be reconciled with the fact that there is an existential crisis without health for all citizens? If the government continues to dig in, this will only sharpen the struggle around the aims of defending the rights of all, and conflicts with the popular will, which is for the NHS to be maintained and funded to the maximum, including those working for it.

Sunak himself points to the essence of the matter: Who decides? He declares that this is his decision, and that no amount of strike action will alter his decision. But as Laurenson and Trivedi counter, it is "not for... Sunak to decide that negotiations are over before he has even stepped in the room."

Sunak's stance, arbitrariness backed by naked police powers, serves the private interests he represents that demand every aspect of society pay tribute, regardless of the consequences. It is the doctors and other health professionals, and public opinion on their side, who represent the general interests of society. The issue is, whose will will prevail?

1. "Junior doctors' rally descends on Downing Street", Tim Tonkin, BMA, 14 August 14, 2023
2. "Junior doctors in England to strike for four days in August", Financial Times, July 26, 2023
3. "Barclay claims strike action by doctors causes 'harm' to patients", Richard Wheeler, The Independent, August 11, 2023
4. "Our offers to doctors are fair and final. This strike only serves to harm patients" Steve Barclay, Daily Mail, August 10, 2023

Article Index

The Integrated Care System and the Elective Recovery Taskforce

Further Distancing Decisions from the People on Health Care Intensifies the Crisis

Keep Our NHS Public (KONP) protest in Birmingham

Mass opposition to the Health and Care Act 2022 [1] which was imposed by the government and given the Royal Assent in April 2022 continues to this day. The Act applies to England, but regulations made by Welsh Ministers bring the Act into force in Wales also. Scotland's NHS remains a separate body from the other public health systems in the UK.

The so-called Integrated Care System (ICS), which was heralded by the Westminster government, further distanced decision-making from local communities. It was seen then and now by community campaigns as a desperate attempt by government to push the interests of a US-style dominated privatised health care system even further in England by making decisions far away from their communities by unelected and remote Integrated Care Boards (ICBs) and sub-committees under government control. Yet 18 months later, the publication on August 4 of the long-awaited report of Rishi Sunak's 17-strong "Elective recovery taskforce: implementation plan" [2] is another example of the government's complete failure with this corporate-led ICS system to solve the deepening crisis in the NHS. It does not bode well for yet another dangerous escalation of the crisis this coming winter.

There is no surprise that the focus of the report is on ways of maximising the use of private hospitals and of getting private providers to run new Community and Hospital Diagnostic Centres. This is the whole direction that the ICS was set up to increasingly implement. The taskforce plan is backed by no extra funding at all for the NHS and is simply diverting more existing NHS funds into contracts with the "independent sector". Yet this sector's accomplishments are small scale and of little scope viewed in terms of what is needed to resolve the crisis in the NHS.

The main headlines on the report were grabbed by the announcement of 13 new "community diagnostic centres" (CDCs), eight of which are to be run by the private sector. Five of these in the South West (on permanent sites in Redruth, Bristol, Torbay, Yeovil and Weston-Super-Mare) are to be run by one company, In Health, which hit headlines back in 2019 when they landed a controversial 7-year contract to provider PET scan services in Oxfordshire. They also run a CT scanner in Sunderland. Alliance Medical runs a PET scanner and other scanners in South Tyneside in rivalry to the NHS scanning service. However, disgraceful and scandalous that it is that NHS funds get diverted to make profits for these private companies, unless the government invests in the state sector this can never be a solution to the crisis in the NHS.

The new CDCs announced case studies which show that "currently over 200 Independent Sector Providers (ISPs) provide over 10,000 diagnostic procedures per week to the NHS". Yet this is a tiny figure when compared to the "479,000 diagnostic tests and procedures the NHS delivers every day". And, on the recommendation to use private beds, the data so far underlines what a minor and insignificant role the private sector has played in delivering such patient care. This while they make huge profits and charge more with payments diverted from public health care. In fact, the data shows that in the year to April 4, 2023, private hospitals treated just 105,000 NHS-funded elective in-patients and 650,000 day cases, and delivered 665,000 diagnostic tests and procedures. By contrast England's NHS in the most recent statistics (2021-22) treated 7.9 million elective in-patients, 6.8 million day cases, 6.2 million in-patient emergencies and 17 million diagnostic tests.

Protest outside South Tyneside Hospital against the closure of the midwife-led birthing unit in 2022

One of the 17 members of the "taskforce" was Independent Healthcare Provider Network (IHPN) boss David Hare. The Lowdown, a publication linked to Health Campaigns Together, and written by HCT campaigner John Lister comments; "In an article on the 75th Anniversary of the NHS [IHPN boss David Hare] tried to justify a greater role for the private sector. But he admitted (as the Lowdown has shown from ICB Board papers) many NHS managers, facing tight financial constraints, have been looking for ways to reduce rather than increase their reliance on the private sector".

John Lister quotes Hare where he complains that; "IHPN recently conducted a survey among our members, looking at engagement with the NHS planning process for 2023/24. 60% of respondents reported being asked by their local NHS to do the same or less activity as in 2022/23."

Hare goes on: "I understand the reasons. Of course it's understandable that NHS trusts - themselves under extraordinary financial pressures - want to retain work. However, we also need to ask - with 7.4m people on the waiting list - and with more than 300,000 people having waited more than a year - are we pulling out all the stops? Are we doing everything we possibly can?"

John Lister comments that; "Mr Hare, of course, wants us to ignore the costs and consequences of NHS reliance on private hospitals:

"In other words using apparently "empty" or "spare" capacity from the private sector not only lines the pockets of their shareholders, but comes at a heavy price to the NHS."

He concludes; "The most logical and efficient way to expand capacity in health care in England is to expand the NHS, not divert vital resources, staff and funding, into small-scale, profit-seeking private businesses." [emphasis in original]

Thus the opposition of health workers, their trade unions and health campaigns is about speaking out and continuing to expose this fraudulent direction for the NHS and social care in Britain, which is only aimed at paying the rich. The call of the times is for people to speak out everywhere for the new. Everyone must gain the confidence to speak out and take a stand against their own unethical governments on health matters as well as on everything to do with the health and well-being of the people. People must empower themselves, especially health workers when it comes to the NHS, and recognise that to do so is part of bringing about a new situation.

Emphasising this point, in an interview with Nursing Times on August 1 [4], the chief nursing officer of the World Health Organisation (WHO), Dr Amelia Latu Afuhaamango Tuipulotu, called on national governments to listen to the voice of nurses, amid the pay disputes that are currently taking place across the globe. She explained that now was the right time "for empowerment, recognition, value and respect for nurses and midwives". She spoke about WHO's warnings that many high-income countries, including the UK, continue to fill vacancies with nurses from countries on the red listwhere active recruitment should not be used. Currently, the WHO has a red list comprising 55 countries that have been identified as facing the most pressing workforce shortages and should, therefore, not be targeted for systematic recruitment by international employers. She added: "If our actions are unethical, which may solve a short-term problem for now, it will not be the best solution for us in the long term."

The government's further distancing of decisions from the people on health care is only intensifying the crisis. People require new public health authorities which are human-centred. These must be new democratic authorities that involve health staff and the people in the communities that they serve in speaking directly about their requirements for health and social care services and participate in making the decisions. Such a direction for society must be to fully fund a public health and social care system that is free to all humans as of right regardless of any other consideration. For example, the latest inhuman treatment of charging immigrants and visitors to England must stop, as all residents in the country should have access regardless of their citizenship status. Health and social care is a human right in a modern society and must be upheld by all.

1. "Health Care Bill: Imposing the Path of Privatisation and Cronyism in the NHS" Workers' Weekly, April 16, 2022
2. Elective recovery taskforce: implementation plan. The Task force was set up with great fanfare by the Prime Minister, Rishi Sunak at Downing Street in December 2022 to solve the backlog of operations. The report itself has been delayed and only published on August 9, 2023.
3. "Task force packed with privateers backs outsourcing plan for NHS recovery" The Lowdown August 9, 2023
4. "WHO chief nurse urges governments to 'listen to nurses'" Nursing Times, August 1, 2023

Article Index

Hands Off Niger!

No to Foreign Interference in the Affairs of Niger and Its People!
US, France, Britain and European Union Out of Africa!

On July 26, General Tchiani, a former chief of the Niger presidential guard, and other members of the Niger armed forces deposed President Mohamed Bazoum and seized power. Tchiani stated that he wanted to avert "the gradual and inevitable demise" of Niger. The coup leaders have since organised the National Council for the Safeguard of the Homeland (CNSP).

The Economic Community of West African States (ECOWAS), a regional group of 15 countries, currently chaired by President Bola Tinubu of Nigeria, threatened military intervention by August 6 if Bazoum was not freed and restored to office by then. However the deadline passed without event and there is not unanimous support for military action among ECOWAS members. Senegal, Mali and Burkina-Faso have stated that they are firmly opposed to any military intervention in Niger. Even Nigeria's own Senate has opposed military intervention and encouraged the bloc to "strengthen political and diplomatic options" to deal with the situation. Nigeria's constitution requires Senate approval before any troops can be deployed externally or internally unless the President deems national security is under threat. An ECOWAS summit in Accra, Ghana on August 10 that was to review the "best options" for military intervention was postponed indefinitely, purportedly for technical reasons.

Map shows Sahel region

Niger is a landlocked country in West Africa, bordered by Libya to the northeast, Chad to the east, Nigeria to the south, Benin and Burkina Faso to the southwest, Mali to the west, and Algeria to the northwest. It is referred to as the gateway to the Sahel, a 3,670-mile-long region that runs from the Atlantic Ocean to the Red Sea and spans parts of northern Senegal, southern Mauritania, central Mali, northern Burkina Faso, the extreme south of Algeria, southern Niger, the extreme north of Nigeria, Cameroon and Central African Republic, central Chad, central and southern Sudan, the extreme north of South Sudan, Eritrea, and the extreme north of Ethiopia. The Western Sahel, including Niger, was colonised by France in the late 19th century, and later decolonised in 1960. The Eastern Sahel was annexed by Egypt in 1820, eventually coming under British control as part of the Sultanate of Egypt in 1914.

Niger produces seven per cent of the world's supply of uranium, extracted mainly by French mining companies which have been mining uranium in Niger since 1957. The Madaouela Uranium Project is one of the largest uranium resources in the world. While foreign multinationals are pillaging the wealth of Niger, the people have one of the lowest standards of living in the world and the per capita income is less than £480 per year.

The government of Mohamed Bazoum was known for working closely with the militaries of the US and the former colonial power France. The US State Department has described Niger as "important as a linchpin for stability in the Sahel" and a "reliable counter-terrorism partner" against various Islamist groups. The US and France maintain air bases in the country's capital Niamey. Reuters says, "France has between 1,000 and 1,500 troops in Niger, with support from drones and warplanes." Among other actions, the CNSP has revoked five military co-operation agreements and suspended broadcasts of French international news outlets France 24 and RFI. A statement by the French foreign ministry referred to Bazoum as the country's sole leader, adding that France "does not recognise the authorities resulting from the putsch led by General Tchiani" and that France "reaffirmed in the strongest terms the clear demands of the international community calling for the immediate restoration of constitution al order and democratically-elected civilian government in Niger". France has conducted military operations throughout West Africa in the recent period.

As concerns the US, "There are about 1,100 US troops in Niger, where the US military operates out of two bases. In 2017, the government of Niger approved the use of armed American drones to target militants," Reuters informs. "The US Embassy in Niamey in 2021 said the Pentagon and State Department had provided Niger more than $500 million in equipment and training since 2012," it adds. The US opposes the coup only because it does not serve US interests, but has not called it a coup, because under US law, doing so would require it to cease military and economic assistance, and the US does not want to give up the strategic position of its troops and bases in Niger. In 2020, a map from the US Command in Africa (AFRICOM) indicated that the US has 29 military bases across the continent.

Victoria Nuland, Acting US Deputy Secretary of State - who organised the 2014 coup in Ukraine that set off the events that led to the current US/NATO proxy war in Ukraine - is in Niamey, in talks with the coup leaders. Nuland stated that "if there is a desire on the part of the people who are responsible for this to return to the constitutional order" the US is offering its "help".

Italy's Defence Ministry says there are some 300 Italian troops in Niger. The EU "has 50-100 troops for a three-year military training mission it set up in Niger in December to help the country improve its logistics and infrastructure. Germany said in April it would deploy up to 60 soldiers to the mission."

For its part, the British government said in a statement on July 30: "The UK condemns in the strongest possible terms attempts to undermine democracy, peace and stability in Niger. The Communique agreed at the Fifty First Extraordinary Summit on the Socio-Political Situation in the Republic of Niger, held by the Economic Community of West African States (ECOWAS) on July 30 sets out a strong and clear response to this infringement of the democratic rights of the people of Niger. We continue to stand by ECOWAS and their efforts to ensure a return to democracy in Niger."

Minister for Development and Africa Andrew Mitchell said: "The UK wholly supports the immediate political and economic measures announced today by ECOWAS and will suspend long-term development assistance to Niger. We will however continue to provide critical humanitarian assistance to the people of Niger. The UK is a committed partner of Niger's democratically elected government and calls for President Bazoum to be immediately reinstated to restore constitutional order."

A further statement from the Foreign, Commonwealth and Development Office (FCDO) on August 11 said: "The United Kingdom supports the Economic Community of West African States (ECOWAS) in calling for the restoration of constitutional order and democracy in Niger. We welcome the determination of ECOWAS to pursue all means to bring about a peaceful resolution. We stand in support of democracy in Niger.

"We stand with ECOWAS in condemnation of the illegal detention of President Mohamed Bazoum, his family, and members of the government, as well as the unacceptable conditions under which they are being held, and call for their immediate release."

A rally was held in Niamey on August 6 attended by 30,000 people in support of the CNSP. Addressing the gathering, General Mohamed Toumba, one of the CNSP leaders, denounced those "lurking in the shadows" who were "plotting subversion" against "the forward march of Niger". "We are aware of their Machiavellian plans," Toumba said.

Absent from all the statements and media reports is the fact that the destabilisation and increased terrorist activity in the Sahel is directly the result of NATO's illegal 2011 intervention in Libya to depose Muammar Ghaddafi, in which Britain was a close partner of the US in this military aggression. The British government itself operated an "open door" policy allowing British-trained Libyan exiles and British-Libyan citizens to enter Libya to take part in the overthrow. While NATO's jets bombed Libya from above, it poured weapons into Libya to foment civil war. These weapons and those groups armed by NATO, including Britain, in 2011 have gone on to destabilise the Sahel, providing justification for further foreign intervention in the name of providing "stability".

Military intervention would be a dangerous development for Niger and Africa as a whole and must be opposed.

Article Index

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