Government in difficulty over the NHS

Photo: Chris Beckett

By Nicky Dempsey

The first serious political difficulty for the current government rose from the student mobilisation against rising tuition fees and the abolition of the Education Maintenance Allowance. The government pressed on regardless – and produced a collapse in the vote for the LibDems at the recent local elections largely because they have been seen to betray a specific pre-election promise.

Similarly the pre-general elections claims from the Tories that the ‘NHS is safe in our hands’ and that spending on the health service would be ring-fenced are now widely seen as flagrant lies and are now the second major difficulty for the Tory-led government. The health budget is being reduced by at least £20bn in real terms over 4 years despite increasing needs – which could be higher if inflation exceeds official forecasts. In addition the reforms of the NHS include a vastly increased role for the private sector which the British Medical Association vehemently opposes – even though the plan relies on implementation by GPs, who are nearly all BMA members.

Crucially in both education and health funding, the government’s difficulties have only arisen after significant mass mobilisations. Students led the way with demonstrations around the turn of the year and the government’s announcement of a ‘pause’ before implementing the NHS privatisation has arisen directly after the 500,000-strong demonstration organised against the cuts by the TUC. The ongoing campaigns in both these areas should be supported both to increase the pressure on the government and to increase the political price to be paid for ignoring popular sentiment on these issues.

The May 17th Save the NHS march to Whitehall helped maintain that pressure. If the TUC is casting around for focus for another major notional demonstration with the potential to bring even greater numbers out into the streets there is no more unifying issue than defence of the NHS. A major, weekend national demonstration in London opposing the changes and cuts to the NHS has that potential.

Cameron, buoyed by the Tory vote holding up in the election has mounted a defence of Tory plans which shows little sign that the pause has been used to listen to the widespread opposition to his plans. Instead he seeks to create an entirely bogus crisis in healthcare which only current plans can resolve. The reality is that after Labour’s decision to correct some of the chronic underfunding of the NHS from 1979 to 2002 public satisfaction is at a record high.

The crisis is actually one of the profit rate with the government acting to increase it by systematically privatising key parts of publicly-owned service provision in order to provide new areas for generating profits. A key provision of the legislation is that NHS work must be tendered to ‘Any Qualified Provider’, including the private sector. Yet while the publicly-run NHS must fund the training of all health care professionals as well as undertake all the most complex, chronic or emergency procedures, the private sector will be free to cherry-pick which profitable services it cares to provide – and NHS funding will be cut accordingly.

In fact, Britain spends too little on health care. Life expectancy at birth in Britain is only just above the EU average, which includes a host of much poorer countries. Only Slovenia, Romania, Poland and Turkey have a lower per capita number of practising physicians than Britain.
Despite this, the NHS is a much more efficient system of healthcare than those dominated by private provision, with a large number of countries pending more per capita on health but achieving worse outcomes because of the inherent wastefulness of the private sector, which claims a proportion of profits at every level of input.

The NHS remains one of the most prized institutions in Britain. In common with the rest of Western Europe it was created at the end of the Second World War in response to the radical upsurge caused by the defeat of fascism, in a successful attempt to prevent that radicalisation moving beyond boundaries set by capitalism. The struggle to prevent it being dismantled is likely to be a prolonged one.