broadside
AS THE TORIES congratu- late themselves on forcing the NHS Bill in double quick time through the Commons (under cover of the am- bulance dispute) they faces more serious problems in im- plementing its provsions.
Labour MPs and union leaders may have given the government little or no cause for alarm with their half-baked or non-existent campaign against the White Paper and the Bill, but even the £3m propaganda blitz from Kenneth Clarke's depart- ment has failed to swing opinion in favour of the kemel of the Bill -the internal market and the top ting out of major hospitals as self-contained NHS Trusts'.
Wherever they get the chance to express their views, hospital workers are registering 9-1 op position to the opt-out proposals. The most recent proof of this (and politically the most damag- ing to the goverment) was the ballot conducted by the Hands
Off Guys! campaign in the flag- ship of a prospective fleet of op ting out hospitals.
Despite extensive manage- ment harassment of campaigners, a union-organised ballot of staff produced a 30%-plus participa- tion and a huge 93% vote to reject opting out. The result is consistent with other unofficial ballots of staff at the Central Middlesex and North Middlesex Hospitals and St George's in London and at St George's in Mid Staffordshire. It should also be echoed on a larger turnout by the official ballot which West Lambeth health authority has or- dered management to conduct under the auspices of the Elec- toral Reform Society at St Thomas's Hospital, right op- posite parliament.
Nor is it only health workers who reject Clarke's plans: BMA survey of consultants in the 74 hospitals on Clarke's hit list for opting out showed that a majority in less than ten hospitals
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were in favour, while in no less than 50 hospitals most consult- ants were against opting out or undecided. In 19 hospitals the opt-out bid is proceeding against the express opposition of most consultants.
There could be an even big- ger problem for Clarke: behind the press focus on the ambulance dispute, the financial plight of health authorities, brought about by deliberate govemment under- funding of pay awards and infla- tion, has been lurching (as predicted by campaigners) from disastrous to catastrophic. A BBC national survey has shown over a third of health authorities overspent, with many already closing wards and cutting ser- vices this year. But with cash limits for 1990-91 already fixed, and the allowance for pay and in- flation pegged at an absurdly low 5%, every health authority faces a major squeeze in the next 12 months. This is intensified by the changes embodied in the Bill,
which call for the elimination of all accumulated deficits - often amounting to millions of pounds - to create a "level playing field" for the internal market from April 1991.
Among the heaviest losers in all this will be the districts with opting out hospitals which - at least in London - are among the heaviest overspenders. Worst of all is St Thomas's, hit by the worst-ever deficit in the history of the NHS - and some E8.9 mil lion in the red.
With his flagships holed and much of the fleet severely damaged. Captain Clarke may yet decide to sail on towards op ting out: but it is clear that some traditional Tory supporters will be among those keen to make him walk the plank. There will be plenty of chances yet for the trade union and Jabour move- ment (and even the left if it ever wakes up to the issuel) to play a role in leading the mutineers.
Harry Sloan
SOCIALIST OUTLOOK no 22, March 1990
UPDATE
Poll Tax: