basic services, as appled with a shortfall of over £230r Yet government spending figures for 1988-89 mean a further shortfall of al- most £400m. These cuts come on top of a cumulative shortfall (estimated by an all-party commons select committee) of NHS spending in advance of Nigel Lawson's 15 March budget, the Tories are stepping up the fight This is a tremendous strength. It means that only a substantial reverse in government policy — a decision to provide major new cash resources for the NHS — can defuse an escalating struggle which has and add the extra inflammatory factor of à battle over London weighting pay- ments (the government has offered a miserly £51 per year increase on the £950 London weighting, against an all- union demand for an extra £1000), and we have every reason to expect NHS struggles to continue and escalate. Naive outsiders might expect that the opportunity to lead a united trade union membership in a hugely popular crusade against a vicious government would ex- cite and delight trade union and Labour leaders. No such reaction can be seen from the same timid, spineless TUC and Parliamentary Labour Party team that Nurses from Homerton hospital, London on strike 3 February: the question is how we move from the present stage of struggle to create conditions for a general strike has brought an unbroken series of re- betrayals and sell-outs since treats, Thatcher took office. The enthusiastic mass upsurge of rank and file nurses, which led to the success of the 3 February day of action may have inspired most activists; but it was re- garded as an embarrassment by Neil Kinnock. It have also appears to
quire adamant bhais to tend to and nake no extra cash available for healt therefore launch a new round of cuts
more problems for nurses and the other sections of healthworkers who have already begun to fight back.
Thatcher's threatened 'review' of the NHS, which is almost certain to involve imposition of new, means-tested charges for treatment, is due to be unveiled by late summer — just as the 1988-89 cuts begin.
Add to this the strong likelihood that this year's NHS pay round will anger almost every section of healthworkers;
ship besotted with Tom Sawyer's defeatist 'new realism', and a TUC leadership
politically dominated by the hard right.
Apart from the Scottish TUC day of
action on 24 February, NUPE leaders have (with some honourable exceptions)
for the most part been working to pre-
vent or restrict further strikes, and have actively attempted to sabotage the call
March — the eve of the budget.
Instead of following the Scottish example and calling a TUC day of action, or pressing for other unions to back the COHSE call, the NUPE leaders, Norman Willis and the other TUC heavies called in COHSE's Hector McKenzie - and rapped his knuckles for having called on his own members to take action!
COHSE's rather different response to the NHS crisis arises partly from its less rigid bureaucratic control over the rank and file compared to NUPE, and partly from recognising an opportunity to recruit new members, especially dissidents from the no-strike Royal College of Nursing (RCN). It is ironic, after militants have argued for years against the inter-union rivalries in the NHS, that precisely these divisions have opened up the best possibilities for action: if NUPE leaders were in total control, there would be little strike action taking place!
The TUC's one initiative - decided only after an agonising five-hour debate (which began with a call for an indoor meeting) — was to call the 5 March national demonstration in defence of the NHS.
'health unions should boycott all work to implement cuts and
closures'
Clearly the task is to use this mobilisation, and the opportunity to build solidarity on the 14 March COHSE action, to build for escalating action to defend the NHS.
Simply to state the truism (as some do on the sectarian left) that what is needed to defend the NH$ is a general strike to defeat the Tories is to state the problem rather than the solution.
Given Thatcher's intransigence, a general strike is needed to win; and defence of the NHS is one of those issues around which, in the right conditions, a general strike could be achieved. Every previous major struggle by healthworkers has seen supporting strike action by industrial unions, and already we have seen Vauxhall workers, miners, local government and other workers take supporting action.
The question is how we move from the present stage of struggle to create conditions for a general strike. This can only develop if we take seriously the organisation and mobilisation of the health unions themselves: we must avoid empty propagandist sloganising, but also oppose the kind of 'grand old Duke of York' official tactics of endless single 'days of action' which led to demoralisa8 tion and defeat in the 1982 pay fight.
HEALTH 0.5 SEL TALINE ARAGE INDUSTRIAL ACTION TODAY MONE THe N.HIS 0F
Serious, sustained action is needed: but to achieve this, healthworkers must be convinced that there is no other way out, and that the short-term inconvenience it will mean to some NHS patients will be made good by the long-term defence of the NHS. At present, many of the nurses and other staff who have readily responded to one day token strikes remain reluctant to take any more prolonged action (even with emergency cover).
Some fear it would hurt patients; others recognise that an escalation to longer strikes would change the character of the dispute and end the unreal 'honeymoon' period of favourable press coverage: it could also cost them heavily in wages — and few have any savings to fall back on. In addition there is the problem of the active scabbing role of the
whose national leaders generally regard it as their job to attack the health unions rather than the government.
These problems could possibly be overcome by a firm and united official call for action by the health union leaders: but this is not likely in the short run. They could also be overcome by a process of organisation and escalation of the dispute which can create the conviction that only sustained strike action can win, and the confidence that the health unions are strong enough to undertake it.
The fact is that the mobilisation of healthworkers so far has to a large extent remained at a rank and file (therefore patchy and spontaneous) level: whole hospitals — and indeed whole unions — have lagged behind, with manual ancillary staff in particular less active this time than the nurses.
This is why it is essential that vigorous campaigns in each hospital and action against local level cuts and closures are combined with calls on national leaderships for more generalised action. • Health unions in each locality should
be linking up with each other, with trades councils, Labour parties and community organisations, to build campaigning health emergency-type organisations which set out to expose and combat every cut and closure in local hospital and community health services. • Local forms of industrial action, necessary short of all-out strikes, should be taken to combat management at* tacks. In Edinburgh a seven week workto-rule and overtime ban by nurses last autumn won 60 extra posts.
Since much nursing overtime is unpaid, and many nurses work unacceptably long hours, overtime bans can also help focus the fight for union organisation and win union members from the RCN. Management can be obliged to
staff to cover wards, often negating the 'savings' from cuts and closures. • Some unions still have formal 'nocover' policies for unfilled vacancies, which can be enforced to expose management's 'hidden' cuts. Other ways too can be found in each hospital to disrupt the workings of management while preserving patient care.
'the TUC should call an all-
union day of action in defence
Cof the NHS' • In particular health unions should boycott all work to implement cuts and closures — whether this be moving beds or patients, or clerical and other work. This policy can win widespread support from non-health unions. • Where hospitals or facilities are threatened with closure, the tested tactic of occupation (or 'work-in') has proved successful in Oxford and London, and has prolonged the life of other hospitals (sometimes for years). As long patients stay in the hospital (protected by pickets on the gates), management must ensure it is staffed — and pay those who work there! This form of action has proved ideal for building solidarity and supporting action. • Boycotts on private patients who queue-jump their way into NHS hospitals could also be considered as more managers look to step up the role of private blocks as a means of 'income genera• Publicity is vital for all these activities achieved through 'opening the books' of local management - revealing the real growth of waiting lists, financial incompetence, hidden losses on private treatment, secret plans for cuts, and horrendous 'options' being considered. Any-
SOCIALIST OUTLOOK nod March/April 1988
thing like this helps stoke up public anger and build local campaigns.
With a firm footing of local mobilisation, demands must be made for action at national level by the TUG - and by the Labour Party, whose scandalous inaction on the NHS helped Thatcher win her third term of office, and which is now missing the chance to build a massive grass-roots campaign reaching the whole working class (and deeper into the middle classes than any of Bryan Gould's loopy share schemes).
The Labour Party nationally should be working flat out on the issue, and urging local parties to build health campaigns and to leaflet wards — especially council estates — mobilising local support.
The TUC must be told to call an STUC-style day of action by all unions in defence of the NHS: this would alert the whole movement to the crisis and produce a one day general strike bigger than that over GCHO. We must also demand the Labour Party and TUC call a full-scale demonstration (or simultaneous regional events) in July to mark the fortieth anniversary of the NHS.
Healthworkers in NUPE must fight at branch, division and national level for resolutions demanding solidarity in action with COHSE; and healthworkers in NALGO, the GMB and TGWU must likewise demand that their unions join the mobilisation in defence of the NHS.
We should be calling on health unions to launch a national nurses' work-to-rule and overtime ban, with supporting action from ancillary staffs: they should also set a deadline for escalating this to strike action (with a call for support from the whole workers' movement) unless the government stumps up the £2.5 billion needed to restore the cuts it has made in the NHS.
A fight developed and escalated along these lines could revive the best traditions of working class solidarity from the miners' strike — on an even wider level. Over 90 per cent of voters (including over 80 per cent of Tories!) in opinion polls favour spending more tax revenue on the NHS: over 70 per cent support the nurses' strikes; 70 per cent say they would pay extra taxes at once for the NHS. Only the timidity of the union leaders stands in the way of tapping this support.
Combined with the evident rebirth of militancy at rank and file level in many unions, mass trade union action to defend the NHS could provide our best chance yet for a combined onslaught that could rock or even unseat the Thatcher government • SOCIALIST OUTLOOK nod March/April 1988
HEALTH Labour Labour JAN TURNER
GOVERNMENT COST cutting measures and the financial crisis they have ment inquiries and right wing think tanks jostling for position in the race to produce proposals which 'review' (i.e. fundamentally undermine) future NHS financing, 1988 is a crunch year for the NHS.
The public know there is a severe blame and they want it put right. They
*Labour has barely yet
managed to dent Thatcher's
Plead in the polls' may not necessarily know how, but in the short term they want more public money put into the NHS. Poll after poll shows continuing public support for decent funding for the health service -even if it means forgoing tax cuts or increasing the tax burden on the rich.
Of course the continuing action -On the picket line at Whittington hospital, London: the mobilisation of health workers has to a large extent remained at rank and file level
SITE STAND UP
FOR PATIENT CUT
CARE THATCHER NoT NHS Reflex
ary and other health service workers and
is Thatcher's greatest weakness
Labour's big chance.
Here, you might think, is Labour's
golden opportunity to make its case for
an alternative to the economics of
Thatcherism. A chance to argue for
socialism. Or at the very least to (re)state problem, they know who is ultimately to the principles of the limited commitment
to public ownership and provision that
the welfare state was built on. But no.
Apparently oblivious to the clear pol-
itical need, and tremendous opportun-
ity, to establish an alternative political
pole around which to build support for
Labour from this opposition to
Thatcher, off go Labour's leadership
trundling into the ground tried, tested
and failed by the SDP.
With superbly bad timing, at a
National Executive Committee (NEC)
meeting held just two days after the
successful first wave of NHS strike action
on 3 February, Kinnock and Hattersley including strike action by nurses, ancill- issued their 'aims and values' statement tongton Hospita Mang HOW
WHITING TON MANY FOR ACTION NURSES STRIKE MORE MUST LEx є?
TAKING MAI INDUSTPIAL ACTION TODAY IN DEFENCE OF THE N.HIS which rescues the market from the dustbin, where successive Labour Party conferences have attempted to throw it.
This dreary and defeatist document basically accepts the legitimacy of the role of 'market forces' and values, and de-prioritises Labour's commitment to public ownership and provision.
At this same meeting the party leadership also tabled a resolution giving little more than qualified recognition to the NHS strikes, in opposition to a position put by left members to fully support the current — and any further — strike action taken by healthworkers.
The leadership were supported, as they always are, by the trade union representatives on the NEC, who later accused the left of 'patronising' nurses by supporting them in this way and demanding Labour give a lead to their struggle — preferring their own brand of condescension (and cold feet) that tries to turn a grassroots strike movement into a 'protest'.
Small wonder then, that even with the Tories vulnerable on the health service, and with the SDP-Liberal merger fiasco fresh in the public's minds, that Labour has barely yet managed to dent Thatcher's lead in the polls, gaining only at the expense of the Alliance, and that Kinnock only manages to scrape level with Steel — a miserable 39 per cent of punters rate each as 'good' leaders.
Perhaps predictably for readers of this journal (but also unusual, and even reassuring insofar as it is confirmed by polls commissioned by the Daily Telegraph) it is clear that the problem for the labour movement comes down to the problem of the leadership of the trade unions and the Labour Party.
That there is a groundswell of support for the NHS is indisputable. The breadth and commitment of that support has been heartening. Much of it has come from outside the traditional confines of the labour movement: from patients, doctors, consultants and surgeons; well as from those professional organisations like the non-TUC and no-strike RCN, who have sometimes been almost as willing to attack the Tories 10 as they are to attack striking nurses.
HEALTH as challenge the government effectively over the NHS
-----