Healthworkers lead challenge to
BRITAIN five of these at any one time because of a shortage of skilled nursing staff. This lack of intensive care beds has brought a horrific backlog of over 100 children needing urgent heart surgery but forced to wait weeks or months — and often finding their operations cancelled at the last moment. One baby, who eventually died, had his urgent operation postponed five times because there was no intensive care bed available. As this article is being written, the hospital has announced it can no longer take emergency heart cases, and will divert desper-
THEIR DETERMINATION to force through a root-and-branch attack on Britain's tax-funded National Health Service (NHS)
could yet prove the undoing of Margaret Thatcher's Tory government.
Already, the resistance to government spending cuts has mobilized tens of thousands of health workers in protest strikes and demonstrations, forcing a reluctant Trades Union
Congress (TUC) to call the first national demonstration for years on March 5. And on March 14 — on the eve of
Chancellor Nigel Lawson's annual budget speech — mass strike action is likely from health workers with supporting action from many other workers following a call from the
250,000-strong Confederation of Health Service Employees
(COHSE).
The fight to defend the NHS strikes a chord with millions of
British workers. Thatcher's attack on the service (which this year marks its 40th anniversary) has caused serious unrest among many of her own supporters.
HARRY SLOAN
INCE LAST AUTUMN, ministers have faced a hostile barrage of me.
tail the effects of cutbacks in NHS provision across the country. At the root of all these cutbacks is systematic Tory underfunding of the NHS, and the chronic low pay of one million (largely women) health service workers.
An All-Party Parliamentary Committee has just revealed that government spending on the NHS lagged behind increased costs by a total of at least £1,800,000 million between 1980-87. In the current financial year the shortfall was at least £235 million;
next year spending is set to decline in real terms by almost £400 million. The result has been a growing crisis, with enforced of beds, wards and whole hospitals, heavy cuts in pay and jobs for the lowest paid ancillary staffs, and growing of patients unable to obtain queues treatment.
In the years 1979-86, Thatcher's ministers axed almost 19,000 hospital beds.
These cuts have been heaviest in London, where 6,500 acute beds closed in the same period - 21% of the 1979 total. The rate of loss is accelerating, however, as the financial squeeze is tightened: in the four years from 1982-86 London lost 4,563 acute beds. In 1987 alone another 1,400 London beds closed, out of a national total of over 3,500 beds axed.
The crisis is biting all over the country. One of the most emotive and persistent examples in the press has been that of the Birmingham Children's Hospital. This covers a catchment area of five million people in the giant West Midlands region, but has only seven intensive care beds available, and is only able to use four or ately sick children 100 miles to London or Liverpool for treatment.
It is not just the big cities that have been hit. Rural Shropshire (on the Welsh border) faces the closure of five hospitals, and has seen a huge local resistance mobilizing mass meetings 1,000-strong in small market towns.
A massive mood of public anger
Countless appalling local examples of the crisis have helped build a massive mood of public anger, and fuelled a new militancy among healthworkers. Significantly, this militancy has spread to the normally more conservative 500,000-strong nursing workforce, who have for the first time taken the lead in challenging government spending policies.
Nurses began to move into action last autumn. October and November brought a successful seven-week overtime ban and work-to-rule by 600 Scottish nurses in Edinburgh, who not only won their demand for 60 extra staff at the Royal Edinburgh Psychiatric Hospital, but began to put industrial action back on the agenda for NHS workers.
The same period saw nurses, and junior doctors, organize mass walkouts and lobbies of Tower Hamlets health authority in East London to defeat the closure of a large casualty unit. In November came a one-day strike by all grades of staff against the threatened closure of four major hospitals in London's Riverside district. By this time, healthworkers and campaigners across the country were mobilizing hundreds of supporters to lobbies of local health authorities against bed closures and
March 7, 1988 • International Viewpoint
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BRITAIN service reductions forced on them by government cash cuts.
Even the conservative 250,000-strong Royal College of Nursing (RCN) — which poses as a union but has a rigid "no-strike" policy — began to stage protests, including disruptive meetings in working hours of up to 300 nurses at a time at the giant St Thomas's Hospital (opposite the Houses of Parliament) where 137 acute beds (20%) had been closed.
The normally Tory-leaning medical profession also emerged to challenge government spending policies on the NHS, with strong criticisms from the British Medical Association, with even the heads of the three most prestigious medical Royal Colleges penning an open letter to Margaret Thatcher.
A doctors' petition, launched from scratch by two campaigns - London Health Emergency and Hospital Alert — attracted 1,200 signatures from 160 hospitals around the country in just a few weeks, among them over 550 consultants and 20 professors. It was presented to Thatcher in a fanfare of press coverage by a group of five consultants, one of whom had appeared only months earlier on Tory election platforms endorsing Thatcher's claim that the NHS was "safe in our hands"!
There is little doubt that the depth and momentum of the fightback against NHS cuts has caught the Thatcher cabinet by surprise. Other equally vicious attacks not least on Social Security payments (to take effect on April 1) and on the education system — have sailed through parliament without difficulty, rubber-stamped by the giant Tory majority.
### Tories pursuing contradictory policies
Caught off-guard, the Tories at first found themselves pursuing contradictory policies. On the one hand they tried to appeal to the more conservative nurses, hinting at pay rises in the pipeline through a "restructuring" exercise. Yet at the same time ministers inflamed anger to new peaks by suggesting that the costs of restructuring pay be largely covered by slashing the present Special Duty Payments for night shift and other duties. This could cut some nurses' pay by up to f40 per week (basic pay for qualified nurses is less than £8,000 per year before tax - around
Another contradiction was on funding. The Tory line throughout last June's general election campaign and up until this winter had been to quote partial and misleading statistics to "prove" that there was no financial crisis, the NHS was booming and "there are no cuts". Yet within days of the doctors' petition to Downing Street the government suddenly announced that an extra £100 million would be given to the 6 of which represented nearmoney for local NHS for the current financial year, £70m International Viewpoint • March 7, 1988 through - Let Me inAl accountan
This new money fell far short of the £170m needed to cover pay and inflation costs this year alone, and did nothing to defuse the anger of healthworkers, doctors and campaigners. Rather, it represented a retreat under pressure, which encouraged campaigners to press for more. Thatcher's own backbenchers began calling for an extra £2,500 thousand million to restore the NHS, pointing out that this is the equivalent of just 2% on the basic rate of income tax, which Chancellor Lawson has been boasting he will cut in the March
The situation remained at boiling point over the holiday period, hogging news headlines into the New Year, when a wellpublicized 24-hour protest strike by 37 night nurses in Manchester opened a new phase in the struggle. The nurses, organized by the National Union of Public Employees (NUPE), walked out in protest at the Tory attacks on Special Duty Payments. Their action became national news and had immediate effects:
• within days, health minister Tony Newton had been forced to withdraw the plan to cut the special payments;
• also within days, nurses in London hospitals, in Scotland and other parts of the country began organizing to follow the Manchester example and take strike action - this time to show their disgust at the cuts
In London, where an evening trade-union rally (sponsored by COHSE and the whitecollar unions ASTMS (technicians) and NALGO (clerical staff) had already been called and publicized by London Health Emergency for February 3, strike decisions tended to focus on that date. Some hospitals varied the timing. The giant Maudsley psychiatric hospital in South London began their 24-hour strike on February 2, while in Ealing, West London, a very successful day of action backed by local busworkers took place on February 4.
The movement for strike action was a genuine brushfire spread of rank and file anger, with no particular political leadership. Many of the nurses who demanded meetings of previously inactive union branches, made militant speeches, and helped carry votes for strike action, had themselves only just become active in their unions. While many local union officials responded well to this new upsurge, others at higher levels were immediately hostile and suspicious, seeking to put the lid on a movement they did not expect and could
The London example spread to other parts of the country, with February 3 the most common date for action at hospitals in Yorkshire and the Midlands. Being a rank-and-file movement, the results were patchy: some hospitals did nothing; some saw only a few activists take action. In Yorkshire, miners from one local colliery walked out in support of the nurses.
It seems that as many as 10,000 nurses and healthworkers, including ancillary staff, 1,500 technicians and thousands of clerical workers were involved in some form of protest action on February 3, with over 40 London hospitals affected. The evening rally organized by London Health Emergency saw an enthusiastic packed hall of 1,000 militant trade unionists, including
Other regions held back, with the North
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West opting to follow a regional TUC day of action later in the month (which was supported by strike action from 2,000 Vauxhall carworkers), and Wales planning protests on March 1. By far the most advanced was Scotland, where the Scottish TUC called for a day of action on February 24, to involve industrial as well as NHS unions; local hospitals in Scotland have meanwhile been staging their own, smaller scale, activities.
While the union rank and file have been demanding more action, union chiefs and timid Labour leaders have been divided on how to proceed. TUC policy has until now been largely dominated by the cowardly line of "new realism", avoiding confrontation with the Tories at the expense of members" jobs and conditions.
Union and LP leaders under pressure from base
However, the union leaders do not want to fall too far behind their own members, especially in the NHS where there is continual rivalry for recruitment between COHSE and NUPE. This rivalry can produce bizarre results. For example, on February 3, COHE's right-wing leader Hector McKenzie was keen to be seen on picket lines, while NUPE's supposedly more "left wing" leadership, still in the clutches of "new realism", strikes, and news coverage of NUPE leader Rodney Bickerstaffe showed him wandering around with a bunch of flowers!
Similar problems confront the Labour Party leadership. Party boss Neil Kinnock ignored the huge public support for the February 3 strikes, and roundly attacked the picketing for giving the party a "bad name", while the LP's spokesperson on health, Robin Cook, toured the picket lines.
Under this kind of pressure the TUC has been forced to call a national demonstration in London on March 5, which promises to be one of the biggest marches ever held in the capital. But they have shied away from following the Scottish example and ignored calls to organize a day of strike action in defence of the NHS. Indeed, COHSE chiefs have been reprimanded for issuing their call for action on March 14, and NUPE leaders have declared their intention to obstruct any move for strike action that day. Meanwhile, there is no sign that this rising movement will be placated or subdued. Thatcher appears to have decided to "take on" the healthworkers just as her government did with the steelworkers, miners and other sections of the working class. Already ministers are leaking plans to impose new charges for NHS treatment which will be fiercely contested. Among the issues that will keep anger at boiling point in 1988 are:
• the NHS pay review in April, in which Tory proposals have already suggested no more than a 3% basic increase in nurses' pay. In London, nurses are already bitter at management's offer of only f51 per year increase in their £950 "London weighting" payments, against a union claim for an
• also in April, health authorities will begin a new round of closures and service reductions to meet their reduced cash limits;
• late spring is also the threatened time for Thatcher's "review" of the NHS, in which its very existence as a comprehensive, tax-funded system, free at point of use is to be thrown into question.
Thatcher knows she is living dangerously - she has no mandate for any such changes. So great is the emotional and political attachment of the vast majority of the electorate to the NHS that the Tory manifesto avoided any mention of radical changes to come. Many Tory voters were partly persuaded by this, especially in the absence of any serious Labour Party focus on this po-
Opinion polls show a massive 81% of Tory voters favour spending more tax money on the NHS (compared to 91% of the whole electorate). This is no surprise. With only 9% of the British population covered by any form of private medical insurance, the rest - including most Tory
- have a vested interest in defend-
Seven out of 10 voters would prefer to pay more tax to improve the NHS rather than opt for the Tory plan of tax cuts on March 15. This is why the nurses and other healthworkers who have been picketing, protesting and petitioning feel such a weight of support behind them. The defence of the NHS, unlike the miners' strike, does not polarize society, but unites all but a tiny handful in opposition to Thatcher's
To take advantage of this, a national campaign is needed to unite the potential
•• ••
BRITAIN forces that must fight for the NHS. Supporters of Socialist Outlook and Labour
Briefing have been prominent in the struggle for such a campaigning unity between the health unions and the wider labour movement. It is vital to draw in the support of the wide spectrum of community organizations — pensioners, tenants, hospital patients, black community organizations, women's groups — even health charities
— which should be mobilizing to defend
One "local" campaign that has developed along these lines is the local governmentfunded London Health Emergency, with
16,000 copies of its tabloid newspaper distributed through more than 220 affiliated trade union, labour movement and community groups - including many outside
London. In January, LHE convened a national meeting of 150 activists from over 70 campaigns and organizations to take the first steps towards a National Health Emergency network.
Despite the witch-hunting attacks against the new campaign that can be expected from some sections of the union bureaucracy, this is by far the most advanced national initiative towards the kind of concerted campaign that is needed. The mood is developing strongly for action on the NHS right across the trade union movement, overlapping with other struggles and disputes involving local government, teachers, car workers and many others.
As Thatcher sharpens the knife for major surgery on the NHS, the fightback against these attacks could yet be the catalyst that unites the workers' movement in mass general strike action to confront her hated, dictatorial government. * AL-MITRAQA number 5 is now available. This journal is produced by Fourth Internationalist organizations in the Arab region (Lebanon, Tunisia and the Israeli state). This issue includes: * The Palestinian uprising * Political and social contradictions in the Israeli state * Lebanon: towards the abyss * Syria: solidarity with the PAC * Tunisia: The November 7 coup * Imperialism and the Gulf war * Gorbachev's speech on history (Statement of the United Secretariat of the Fl
March 7, 1988 • International Viewpoint
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