Tories aim double blow at health service By HARRY SLOAN National union officials complain privately that a "settlement' of the ambulance dispute was within reach in secret talks, and was only broken up by the outbreak of strike action in West Sussex, on the eve of the TUC January 13 demonstration.
We can only speculate: but to judge from every recent pronouncement from Health Secretary Kenneth Clarke, including the most recent (January 19) Department of Health press release - ("There is no more money on offer. There can be no question of a formula for the pay of ambulancemen and women. No talks will resume until the unions accept this") - any such settlement must have represented a substantial retreat by the unions.
Press speculation has focussed on pos sibities ranging from a pitifully small cash increase above the 9 per cent over 18 months, through localised deals that would threaten the national pay structure, to the possible acceptance of a two-tier pay structure dividing emergency crews from lower-paid non-emergency workers, who may also face the lingering threat of privatisation.
National officials know that much of the rank and file pressure centres on perhaps the hardest demand for them to negotiate with Clarke: the call for a long-term pay formula linking ambulance pay with other emergency services. But in their efforts to get off the hook it is not unlikely that they are biding their time, waiting for a drop in morale that might enable them to ditch this in the search for a scitlement.
The five-month dispute has seen NUPE's Roger Poole and other union chiefs, along with private lobby consultants and PRadvisors, acting as arch-exponents of 'new realism. They have won all the media and public relations battles, but failed to dent the arrogant, class-war Tory cabinet. Their tactics have allowed the dispute to drag on to their SOCIALIST OUTLOOK no 21, February 1990
UPDATE own disadvantage, and now the angry calls for strike action from many who have bome the brunt of the action reflect the frustration of the rank and file.
Seldom in the history of the British workers" movement has an industrial action been as overwhelmingly popular as that of the ambulance workers. With opinion polls for Tory papers showing over 80 per cent backing for their fight, and an all-time record 4.5 million signature petition. the ambulance crews have been able to tap the rich vein of public support for the NHS as well as a growing reservoir of anti-Tory sentiment.
The large 40-50,000 tumout on the TUC's poorly publicised and divisively organised January 13 demonstration was also the tip of a vast iceberg of potential support. Had the demonstration itself been open to all trade unionists and supporters, headed by uniformed staff, and not designed to reduce supporters to the role of passive spectators in Trafalgar Square, the tumout could easily have been doubled or trebled.
Lobbying Tories
Unfortunately these vivid indications of public support and even the inveigling of a handful of renegade Tory backbenchers into backing the ambulance workers' cause (after weeks of grovelling by union lobbyists) have not been enough to shake the government's hard line. After failing to win a ballot endorsement of their original proposed 6.5 percent settlement, and being forced into a fight, the national officials have consistently allowed management to set the pace, insisting only on one thing even as they have attempted to whit-
YOURS! Huge pubile support for the ambulance crews: but no move from the Torles tie down the claim: that of all the tactics available, the only one to be excluded was strike action.
The gradual and piecemeal escalation of sanctions on non-emergency services and then on the emergency service took place so slowly - and are still applied so patchily - that the goverment and local management have been given the maximum opportunity to prepare and deploy alternative scab 'emergency" services from the army, police and St John's ambulance.
Millions have been spent in a relentless effort to crush the ambulance militancy: in London alone, figures just released by the Regional health authority which manages the London Ambulance Service (LAS) show that the cost of using police in the dispute has sent the LAS £5m into the red this financial year.
Far from being crushed, the normally conservative ambulance rank and file has, despite the blandishments of Poole and co, become increasingly radicalised in the course of the struggle, with more and more districts voting on strike action, and several stations going it alone unofficially. Strike calls come not only from a desire to step up the pressure on Clarke, but also from confusion on how to implement the often contradictory official guidelines on escalating the dispute, which have instructed ambulance staff still in their stations to refuse to take emergency calls from non-suspended controllers, while Roger Poole
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repeatedly pops up on radio and television insisting that the unions are still answering emergency calls. Even the less militant convenors are saying that where management have not suspended staff, strike action - putting ambulance crews out of earshot of emergency calls - would be easier to carry out than refusing to answer the red phones.
That management is not in the least concered to preserve the emergency service was best demonstrated in Oxfordshire, where a High Court injunction was obtained, naming every ambulance worker and union official, preventing them from using any of the county's ambulances - a prohibition far more draconian than any strike call: as one worker put it If we even put a bandage on someone we could face court action and even the sequestration of the union's assets'.
The bitter reality, however, is that the longer the unions keep on trying as they have done to minimise the impact on patients and turning the other cheek management provocations, the more ruthlessly will Health Secretary Kenneth Clarke stick to his no compromise position, regardless of public opinion.
Much more than
cash
Why, then, are the Tories so determined to defeat the ambulance staff? The answer cannot be an economic one: there are only some 20,000 ambulance crew, and even to concede their pay claim in full (winning public applause) would make only a marginal difference to an NHS budget of £25 bilbion.
The way the dispute has dragged on has certainly increased the importance of one factor which was not strong when the action began: the impact of a union victory on the current pay round. Last autumn, Clarke could have quietly conceded much of the ambulance claim - in the aftermath of government concessions to rail unions and NALGO local government staff - with little public attention.
However the rising public profile of the dispute has coincided with the new year's round of industrial pay negotiations, not least those in the car industry, headed by the Ford 'double figures and shorter hours" claim. which have now swung into the headlines.
The eventual deal will also now influence the 1990 pay demands from other groups of health workers, many of whom were fobbed off early last year with settlements well below inflation. NHS admin and clerical staff, whose low-paid jobs are notoriously hard to fill, had already raised their demands in the wake of last summer's partial victories by fellow Page 6
FEATURES NALGO members in local govemment.
However Clarke also has a wider political purpose in seeking to wind up ambulance staff - with his cynical and derogatory references to "professional drivers' - and defeat their industrial action.
The Tory government is determined to confont the still powerful unions in the public sector, and the relatively small, highly visible, rather elitist and (until now) largely conservative ambulance workforce has traditionally been seen as a strong section of NHS union organisation.
To inflict a defeat upon them in the teeth of massive public support would offer the government a double prize - simultaneously AMBULANCE deterring pay battles in the public sector, and softening up the NHS unions prior to the implementation in the next 18 months or so of Clarke's wildly unpopular NHS and Community Care Bill, now at its committee stage in the Commons and due for the Royal Assent
Smokescreen for Bill
An added bonus for Clarke has been the way in which the pay dispute has grabbed the headlines in the last few months, acting as a smokescreen to give the Tories a virtually free run to push the Bill unnoticed through parliament, while few health workers or voters are even vaguely aware of its contents or how soon it will be imposed.
The frightening public ignorance on the Bill is a direct consequence of the refusal of the health union leaderships to carry through conference decisions from last year calling for campaigns to be built against what was then the White Paper. With almost no information, leaflets or campaign activity being produced for use in the hospitals, the Labour Party's limp 'new model' campaign of press advertising linked to the half-baked "post a postcard' initiative was also directed away from building local, active campaigns against the Tory plans.
The result after three months was a miserable 100,000 signatures (a third of these
from Scotland) - embarrassingly short of Robin Cook's rash pledge to deliver 'a sackful of cards from each health authority' (there are 200). Labour's fiasco, let off surprisingly lightly by Kenneth Clarke (who must have been laughing all the way to the bar) was another reminder of the ineffectiveness of half-hearted petitions on an issue such as the NHS, where the opposition to the Tory plans commands 70-80 percent support: this should mean a petition of 30-40 million!
While Cook waged his pointless, passive bid for "hearts and minds", health unions not only ignored conference calls for a national demonstration against the White Paper, but, in the case of COHSE, actually opposed any
form of activity as a national focus of opposition to the Tory proposals when this was discussed on the TUC's ineffective and bureaucratic Health Services Committee. Even in those 70-80 hospitals shortlisted in the autumn by Clarke as likely candidates to 'opt out' of health authority control, local union activists were left to their own devices on whether or not to build campaigns, without any help, information or encouragement from officials at national level. The small, Londonbased Hands Off Our NHS campaign emerged as virtually the only source of campaign material against the White Paper, sending consignments of leaflets, pamphlets, stickers, badges and T-shirts to isolated unions and community campaigns all over the country.
In November, the Tories decided to take advantage of the elbow-room they had been given, and published the NHS and Community Care Bill, announcing that it would be forced through parliament in double-quick time and implemented from the autumn of this year, with opted-out "NHS Trusts" fully operational from April 1991.
Groundwork for privatisation
The Bill's proposals are far-reaching. laying the basic groundwork for a possible fourth-term Tory government to press for extensive privatisation of health care - either through imposing more means- testing and charges for treatment (compelling most workers to take out medical insurance) or through floating off more and more NHS Trusts' as fully-fledged private concerns.
Its main proposals can be summarised as follows:
• It abandons any attempt to plan for more equal access to local health services, and instead establishes the beginnings of an internal market" in health care, setting every hospital and health authority in competition with each other, and requiring the establishment of a vast new administrative apparatus for the costSOCIALIST OUTLOOK no 20, Dec-Jan 1989-90
Moves towards privatising non-emergency ambulance services are just part of the attack on the NHS
ing, pricing and billing of treatment for each patient, as well as drawing up complex "contracts" governing hospital services. The government admits that their 'reforms" will re- quire at least another 1,000 account- ants and several thousand additional clerical staff to administer, at a cost of over £200m. From the patients' point of view the new system means it is more likely that they will have to travel to another health district to obtain treatment, and that districts already poorly provided with health services will fall even further behind, with the least "successful' departments and hospitals losing out in the com- petition for patients, being starved of cash and forced to close. • Within the internal market system, an initial list of up to 80 hospitals are being encouraged to "opt out of local health authority control and become 'NHS Trusts' self-contained businesses (public corporations") dependent entirely upon income from attracting suffi- cient patients, and required to generate a profit of up to six per cent per year on the capital assets of the hospital. The opted-out hospitals would be run by Boards of Directors, half of whom would be full-time managers, and the remainder hand- picked by Kenneth Clarke. They would con- duct their meetings in secret (only one public meeting each year), and would be exempt from any requirement to plan services with health authorities or local authorities. They would be free to reallocate NHS beds to private use, to sell assets of the hospital, and to tear up national pay and conditions agreements for any and all grades of staff, or even to withdraw trade union recognition al- together. The Bill specifically excludes any require- ment or provision for a ballot of staff or the local community on proposals for hospitals to opt out: the decision on whether an opt-out bid drawn up by a handful of managers and top consultants should go ahead is solely in the hands of Kenneth Clarke as Secretary of State. • Family doctor (GP) services are to be subjected for the first time to cash limits, whether voluntarily (large GP practices are being invited to apply to become independent "budget holders", with a rigidly limited budget averaging a mere £60 per head) or as part of a general move to fund the Family Practitioner Service from (cash- limited) Regional Health Authorities. Clarke's assurances to the BMA that this will not limit doctors' ability to treat patients are not worth the paper they are writ- ten on. Cash limits in the GP service will work most fiercely against the elderly and chronic sick who are more costly to care for, and who may well find it increasingly difficult to get on SOCIALIST OUTLOOK no 21, February 1990
FEATURES THE NEXT LIFE IN OUR HANDS COULD BE YOURS! to a GP list: there are already complaints in some areas that some seriously ill patients are being squeezed out by cash-conscious GPs. Towards the end of the financial year, when practice cash allocations will be running low, the probability is that waiting lists will be transferred from hospital departments to GP surgeries, where patients will be waiting for referral as outpatients before even getting as far as waiting for operations.
• The Bill also sets out to squeeze more and more of the frail eldedy out of NHS beds (provided free at point of use, funded from taxation) into the means-tested area of local government social services, forcing more and more elderly people to pay (again) - from savings or even the sale of their houses - for their own health care.
• To prevent these proposals leading to an increase in local goverment services, the Bill also insists that every aspect of community care provision - from home help services right through to residential care - should be subject to competitive tendering, opening the threat of cheapskate cowboy firms employing teams of low- paid, grudging staff who would then provide a miserable standard of service in the homes of the vulnerable elderly.
Councils are particularly to be penalised if they seek to provide residential care themselves rather than send elderly people to private or voluntary residential accomodation: they will have to foot the whole bill for any patients accomodated in their own directlymanaged homes, but will be eligible for subsidies on those sent into privately-run homes, which are already proving themselves a 'nice little carer" not only for individual
JUS IMBU WOr proprietors but also for quite large companies.
• Health authorities are to be reduced in size, partly by kicking off the present local authority representatives (the only members ever to be elected in any capacity by the local community, abandoning the pretence of joint planning with local authorities. Also axed will be the token trade union representative. Instead new 'business-style" health authorities, half of them full-time managers, the rest handpicked by Kenneth Clarke, and completely remote from the local community, will take over - making it virtually impossible for unions to maintain their present disciplinary and appeals procedures.
• The Bill as a whole increases bureaucracy while eliminating any coherent planning. There is no guarantee that any health authority will continue to offer the less glamourous and profitable specialities, espocially those needed by the elderly and chronic sick.
As management in West Berkshire has said, the specialities most hospitals will offer on the 'interal market" will be "those which do not require substantial support services or long-term continuity of care". But there is also nothing in the Bill to prevent a surplus of health authorities all deciding to compete for any particular speciality - for example orthopaedics - at the expense of another - say gynaecology.
Chaos
The chaos will be compounded by the opted-out hospitals seeking to win patients from other health authorities and to maximise income any way they can. There can be no long-term guarantee that such hospitals will
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Research Bill, currenly before parliament. JANE KELLY explores the
continue to offer any particular service to local people: they may find it more profitable to admit no local people at all, but to focus instead on private patients. Harefields Hospital has already spelled out its expectation that NHS demand will not increase, but that after opting-out it will expand its private beds.
The NHS Bill is indeed a looming disaster for our health service: but the left cannot simply pile the blame for the lack of a campaign on to the Labour and union leaders. The rank and file of the Socialist Movement, the left in the Labour Party itself and the revolutionary left have for the most part been conspicuous by their almost complete indifference and inactivity on health campaigns, except on those occasions - such as the nurses' and now the ambulance dispute - where a wages struggle erupts. The concept of a serious labour movement political campaign to defend the NHS is almost completely lacking.
The fact is that even if the Tories' majority is sufficient to push it through parliament, the implementation of the Bill can be seriously disrupted by the health unions if a campaign is built now to fight back. The complex systems for monitoring, costing, pricing and billing for treatment of each patient can only work with the cooperation of the NHS workforce at each level: and in many cases the new system imposes extra, unpaid and unwanted tasks on staff, such as nurses being required to key information into computers.
Campaign
There must be a campaign now inside and outside the health unions around the clear policy of boycotting all work on the new information/computer systems, refusing to cover for additional work created by these systems and for vacancies created in admin and clerical staffs by the recruitment of extra staff to implement the White Paper, and fighting to expose the squandering of cash and human resources on the bureaucratic madness of the Bill - resources that should be devoted to patient care.
This must be backed up with fim decisions of health unions for strike action in defence of any member of staff victimised for imposing such a boycott, and in opposition to any attempt by management to scrap or undermine existing trade union recognition and Whitley council conditions.
This campaign should already have been well underway: it can't now wait until after the ambulance dispute.
Side by side with our fight for solidarity action with the ambulance crews and an escalation of their fight we must begin the political fightback to defend the very fabric of our NHS against this deadly eamest attack by the Tories. Page 8
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