healthworkers fighting agaunst hospitals opting out and other aspects of the Bill, the division and demoralisation of management gives new hope. A renewed offensive now to underline the scale of opposition to the changes could yet tip the balance, and force a retreat.
Step up the fight: build the Hands Off campaigns in each district! It's up to us to defend our NHS! Page 4
UPDATE Health workers in - the firing line The NHS & Community Care Act has now completed its progress through Parliament: it amounts to a root and branch onslaught on the NHS and the health unions that will:
• cut the size of district health authorities and hand half the remaining seats to management;
• encourage major hospitals and units to opt out" of local health authority control to become self-contained businesses as "Self Governing Trusts';
• break up existing arrangements for funding and planning services, replacing them with a complex, untested "internal market mechanism that will compel hospitals to compete against each other for patients (and thus for funding), with the "losers" possibly facing closures;
• smash up national bargaining arrangements with the unions;
al generate a new round of competitive tendering and privatisation of services:
force management into new moves to impose 'flexibility' of labour and pay scales;
I undermine union recognition and existing agreements on staffing levels and conditions;
• threaten the viability of whole departments and units which are deemed less
NE OPT
NO NOT SELINO WHITE PARRI TO OPT OFF GAT! "profitable":
• accelerate the closure of long-stay NHS beds for the elderly and the privatisation of community care services under the management of local authorities;
threaten the jobs of thousands of health workers in long-stay psychiatric hospitals;
endanger the jobs of thousands more NHS employees in the community sector.
Every branch of every health union will be affected, and needs to be made aware of these sweeping, potentially devastating changes - and other plans by management to undermine or sweep away existing Whitley Council agreements and procedures - if they are to prepare to defend vital services and jobs as well as the hard-won pay and conditions of their members.
Yet there has been little campaigning against it by the labour movement. The early resistance was left up to the "professionals" of the BMA and the Royal Col leges, whose campaigns faded away as the White Paper became the Bill.
Many NHS union activists and members have yet to discover how great is the threat to services and to their jobs, pay and conditions. Others, building local campaigns on the ground opposing the 'opting out" of local hospitals
or other aspects of the Bill have found themselves battling in isolation against a tide of ig norance.
There is little time left: this autumn, after a brief charade of "consultation". Kenneth Clarke will announce his initial list of hospitals that will opt out under the new legislation: and District Health Authorities will soon be purged of local authority nominees and trade union reps, and slimmed down to 11- person "business-style" bodies on which half the seats are allocated to management. The full force of the Act will take effect next April.
This is not all: management documents reviewing Whitley Council conditions for NHS staff already make clear that their objective is also to tear up a whole series of agreements, conditions and procedures in the Directly Managed Units.
It's no use health workers in NALGO, NUPE and COHSE waiting for the possibility of a mega-merger in 1993 to solve these problems: by then irreparable damage could have been done. The fightback must begin now!
What must be done?
The new situation will force more staff than ever to think about defending their jobs, pay and conditions - which for decades have been assumed to be more or less "safe". The only way to do this is for them to join a trade union and play an active role within it.
Every health union branch should be energetically stressing this point to all sections of staff, SOCIALIST OUTLOOK no 26, July-August 1990
stocking upon recruit- ment literature, looking for new additional shop stewards and reps, hold- ing more regular meet- ings, and ensuring that is every opportunity taken to expand and strengthen their or- ganisation. This is the best pos- sible of fore- means stalling any management attempts to withhold or limit recognition: the stronger the union base, the less likely is a swift management onslaught or any victimisation of any section that might take action. As we have seen, every section of staff is affected and in some way threatened by the proposals and reforms that are coming in the wake of the Bill. Nobody is safe. While some managements, especially in the opted-out hospi- tals, will try to use differential pay rises and other techniques to divide one section of staff from another, there is a better than ever opportunity for the unions to build a fighting unity in defence of all their members. This should especially be the case in the present period of merger talks between NALGO, NUPE and COHSE: what better way to test out the level of cooperation and agreement - and prove the case for merger to the membership - than in a common fight against the employer and the govemment's proposals? At the same time the switch to the "internal market", with its "business-style* of funding through contracts and its self- contained businesses (the opted- out hospitals), gives the health unions for the first time the weapon their colleagues in the private sector have always been able to use: an economic lever against management. Union action can - if management refuse to back down - potentially jeopardise "contracts", and even threaten the profitability of a Self Governing Trust. The greater complexity and SOCIALIST OUTLOOK no 26, July-August 1990
U ALGO CAPE Acaring union for those who care WE Nurses face the loss of their pay review body bureaucracy intro- duced to the NHS by the Bill also of- fers staff more op- portunities to dis- rupt management without necessari- ly hitting patients at all. The new in- formation systems and the entire mechanism for costing. pricing and billing of for treatment patients from other districts, all re- quire considerable cooperation from many sections of Clarke: given an easy ride by unions staff. They are severely vulnerable to even the "guerrilla'-style most irregular action by one section or another refusing to carry out additional duties and working to pre-NHS Bill pattems. Nursing staff in particular have scope to cause in- temal havoc while still doing their jobs - if they simply insist on treating patients in their care rather than filling in additional forms or keying information into computers to assist the pricing and billing system. Another advantage for the unions is that many NHS are themselves far managers from convinced or happy with
PDATE CENTRAL FUNDING NEEDED John Harris the proposals in the Bill. Of course there are some headbangers who favour the whole government package; but some general managers have already resigned in demoralisation; others are reputedly discussing doing so, while others are hanging on and just hoping for the best It's by no means too late to prepare the fightback. All kinds of things can usefully done, including: • meetings of union members to explain the Bill and its implications (wherever possible joint meetings involving as many unions as possible in the unit or
HE CAR
HEALTH
CARE COSTS district):
• public meetings to sound the alarm for patients, relatives and other trade unions in the area - especially where the local hospital is likely to "opt out":
• producing or purchasing leaflets and other material against the Bill, and seeking to involve local Trades Councils, Labour Parties, pensioners" groups, women's and community organisations in campaigning.
• organising ballots of staff, and other means of demonstrating community opposition;
It is still not too late to Kill the Bill - before it kills our NHS!
There is already a campaign that has developed material analysing and explaining the White Paper and the Bill from the standpoint of the health unions and the users of the service.
The Hands Off Our NHS campaign, launched carly in 1989, has just published a new detailed 28-page pamphlet for health union activists, Lumbered with the Bill, price €1.80 per single copy (ine pop). Cheques with