Patients for Sale


The article below was written for the Socialist Voice in 1989 by Rae Hunter. The article shows she knew where the attacks on public health were leading if the workers’ socialist struggle did not stop them.

The Government launched its White Paper on the National Health Service on 1 February 1989. Margaret Thatcher called it “the most far reaching reform of the National Health Service in its forty-year history”. The Government declares it will extend patient care and reduce waiting lists. Yes! – for those with money it will provide these things, but for the poor, the old, the mentally disabled and the chronically ill the life-line will be severed.

The NHS was a product of the strength of the working class who had been through six bitter years of the Second World War and had made it plain they would not go back to the misery of the thirties.

The destruction of this Health Service is not a sudden thing. For years hospitals have been under attack. The process began under Labour Governments and is now being brought to fruition by the Tories.

Between 1969 and 1974, 121 hospitals were closed in England and Wales. Between 1976 and 1978, these figures leapt up. There were 143 closures or changes of use.

Up till 1983, the NHS administration was based on a team management concept. Districts and Regions were run by District and regional teams of officers drawn from the different areas of the Health Service – administration, nursing, finance and medicine. The teams I worked in took decisions by consensus of opinion.

In 1983, the Tory Government changed this method. They appointed Ray Griffiths, Managing Director of Sainsbury’s supermarket chain, to refashion the NHS. He wanted “business management” and was opposed to consensus. He recommended the appointment of General Managers.

This method was extended right through, even to hospital wards. Managers who increased performance to lower cost were give financial incentives.

One of the ways of saving money has been employment practices. Some 70 per cent of the Health Service budget goes on wages. In 1984, the number of NHS employees fell by more than 1,500 and in 1985 there was a further reduction of 3,300. Comparing 1987 with 1982, 25,000 jobs of ancillary workers went. Their jobs were lost in contracts to private enterprise.

The main proposals of the White Paper are as follows: major hospitals will be able to apply for a new self-governing status. They will be free to set rates of pay for their own staff. They will be able to offer their services to other parts of the NHS and to the private sector.

Because they will have an incentive to attract patients, it is evident that if the elderly, the chronically ill etc. have no money then they will not get a lookin. The free Health Service which working people fought for is going to be practically destroyed.

The other most important change will be for general practitioners. They can have a special budget to choose how the money is spent. The method can be exploited for gain by unprincipled GPs, but the majority would most likely feel like Dr Roland in the “Independent” of 31 January, 1989 “What will happen when the budget runs out?” he asked, and went on, “It would change the relationship with patients. At the moment, when you go to a doctor you assume he is making a judgement based on your need for medical care.

“With a budget, patients would know the GP is also influenced by how much money he has left that year. Many patients as well as doctors would feel that unacceptable.”

One of the worst aspects of the White Paper is the further rationing of prescriptions. If the GP’s allocation of money for drugs runs out, what then?

Involved in the movement of the hospital workers in 1988 was the question, should the NHS be carved up and run for profit or should it be for the benefit of the working class communities with decent conditions and wages for hospital workers?

In 1989 the Tory Government has made it clear what it thinks should be done with the NHS.

It is up to the health service unions and the labour movement to answer by building on the movement of last year and uniting more and more of the communities that will suffer under the Tory plans to defeat the attacks on our NHS.

Source: Journal Socialist Voice – nº 10 – Special March