Nurses' pay battle
Tories put the
boot in
Another 'winter of discontent' seems a real possibility in the NHS. Has the government miscalculated? HARRY SLOAN argues that the Tories may be deliberately stoking up the conflict in order to attack the National Health Service. At first sight, the Tory strategy is crazy. Health Secretary Kenneth Clarke has embarked what seems on another unwinnable confrontation with the nurses. By inflaming new levels of militancy among previously inactive and poorlyunionised sections of the workforce, who enjoy massive public support, be appears to be on a hiding to nothing.
Short of an unexpected about-tum by the govemment - putting much more money onto the table to fund a fair and proper implementation of the regrading of nurses pay ahrupt and massive betrayal by the health unions, which have again been propelled by their rank and file into action, the dispute over grading seems set to run and run.
As this issue of Socialist Owlook goes lo press, union militancy, (work-to-grading action, sometimes coupled with overtime bans, and token or even all out strike action) is spreading through every region of the NHS. The no. strike Royal College of Nursing, which has opposc any form of collective action to challenge contested gradings, is losing members in large numbers to TUC-affiliated unions.
Management, who in many cases were un happy at being obliged by rigid cash limits to limit the numbers of nurses they could afford to put onto higher grades, are hecoming increas ingly cheesed off as Clarke deliherately winds up the nurses and forbids any local concessions. Indeed the threat of disciplinary action does not only apply to militant norses but also to managers who step out of line.
Meanwhile ministers have begun to step up the media propaganda offensive against the health unions, exploiting events such as the temporary closure of the intensive care unit at Birmingham Children's Hospital and patients sleeping on foorrat Leavesden Hospital. Some staff have already heen suspended for working strictly to the grades imposed on them by management: others have defied management threats and forced limited concessions. Others have taken the individual course of resigning in disgust. The scene seems set for a winter of discontent" created by deliberate goverment policy.
However a closer look at the way Clarke has provoked the current escalating dispute with tens of thousands of nurses suggests there may be a degree of method in his madness. The
FEA - m Tones would not be too unhappy to be able to tum the tables for the first time on the nurses, who have been able to enlist public sympathy lo repeated concessions and holding back on their real plans. They may have decided this is their chance to use the media to attack 'militant" nurse action.
We must remember that the Tory government is not simply looking towards short-tem questions: it still holds a long-term ambition to reform' the National Health Service and massively provision of health care:
Thatcher knows well enough that to attempt such a project at present would be politically unacceptable. It would antagonise not only the public at large, but also big sections of the Tory electoral base, who are also dependent on the
The top level review' of the NHS. promised by Thatcher at the beginning of the year (after the govemment had been pressurised into conceding additional funding for hospital services), has still not appeared, and no date has yet been named for publication of its findings.
It seems certain that the cabinet now want first to do some preparatory work on softening public opinion to weaken support for the NHS and create conditions where brutally reacLionary "radical" proposals could get a hearing. We have already seen this procedure appliedto education policies, before the government moved in for the kill with Kenneth Baker's 'reform' proposals.
The straw in the wind demoostrating that the Tories are still determined to press home their attack on the NHS was Clarke's dogged Fight to impose swingeing new charges for eye tests and for dental check-ups, despite Tory hackbench opposition. The amounts of money in volved (£150m a year) are puny compared to the E20 billion NHS budget; the motive is not economic but to register a political declaration
Significantly the row over the new charges was followed by Nigel Lawson's kite-flying
Nurses - now facing threats of injunctions exercise on new means-testing for pensioners. The same philosophy of targeting' is arcady making itself felt in discusrions on the future of some NHS serviceR.
Waiting in the wings, and apparently being strongly promoted by Health Minister David Mellor, are far-reaching plans to ditch NHS responsibility for much long-term care of the ciderly, mentally ill and mentally handicapped.
These plans have been drawn up by Thatcher's chief advisor on NHS matters, Sainsbury chief Sir Roy Griffiths as a strategy for 'community care" services - especially those to the elderly. Griffics proposes that all such services should be removed from the NHS, and run by local goverment, levying charges under a system of means-testing Rigorous central govemment control would also ensure that all such community care services were put out to competitive tender.
The result could he hundreds of thousands more elderly people being forced to plunder their life-savings or sell their houses in order to finance their own care. Yet this policy has actually been welcomed, hailed as "bold' and "radical", hy academics and naive elements in local government: a lobby grouping called "Griffiths now! has been formed headed by Labour boroughs. Though NALGO has recently published a heavy crique of the Griffiths Report, other health unions have been slow off the mark and reluctant to reject it outright.
The Tories have not yet announced an offcial government response to Griffiths: but his plan offery them a series of advantages. It simultaneously enables the NHS to shed the hurden of providing costly free care to tens of thousands of elderly patients; lands increased,