HAVING TRIED and failed to rid themselves of the Poll Tax, John Major's crisis-wracked Tory government is now embroiled with another embarrassing legacy of the Thatcher years- the NHS and Community Care Act.
Best-known for its creation of opted-out hospitals, the Act also creates a new 'internal market' which is now wreaking havoc in health authorities across the country.
The crisis blew into the headlines in the run-up to the local elections, and cost the Tories heavily in lost votes.
But with even the British Medical Association once more aroused to angry protests, and shock revelations emerging almost daily, nothing short of a policy U-tum can prevent the issue becoming a huge liability to Major in the General Election.
After a decade of Thatcherism has starved the NHS funding, the Tory 'reforms' go much further: they are destabilising and could potentially wreck the entire NHS.
Within days of the Act taking effect, a barrage of scandals began to rock Ministers: there were cuts, closures, announcements of almost 1,500 redundancies, patients refused treatment, and the explicit emeractivist about town!
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I'd like to know more about Socialist Outlook • Name Address THE N.H.S. WOULD BE SO MUCH MORE EFFICIENT WITHOUT THE PATIENIO. gence of a two-tier service in major hospitals. Many who had ignored the passage of the NHS Bill have begun to wake up to the damage that has been done.
Competition
Dreamed up by Thatcher with a tiny handful of extreme right wing ideologues, the Act was intended to bring 'competition' into health care. The undeclared objective was to prepare the most popular of the public services for eventual US-style The Tories set out to create an 'internal market by ending the system whereby local health authorities were responsible for planning and providing a balance of services in their locally-run hospitals. Now smaller, even less accountable health authorities are simply , Subscribe to the new Socialist Outlook Ensure your copy of Socialist Outlook. An essential accessory for the well-dressed Yes! I want to subscribe to the new Socialist Outlook. Please send me: 1 years subscription (24 issues): £13 • Six months subscription (12 issues): £7 • Please return to Socialist Outlook, PO Box 1109. London N4 2UU "purchasers', using their cash-limited budgets to buy health care for their resident population from separately-managed or opted-out hospital 'provider units', locally or further afield. This completely untested new system needs prices. and this means that an expensive new bureaucracy has been created by each provider to cost, price and issue invoices for each patient treated, while purchasers need extra clerks and accountants to check and pay the bills.
Even before the new system got under way, rows had broken out be tween purchasers and providers over the costs of treatment and the number of patients to be treated, with the patients caught in the middle.
Because the new system puts each hospital into competition with others, it has also forced panic measures to wipe out-long- running deficits built up by many health authorities, to create a level playing field' on which all will compete. Hence the huge wave of cuts, bed closures and job losses in health authorities all over the country in the run up to April Printed by Tridant Press, Edenbridge, Kent. Published by Idolrare Ltd, 377 City Road, London ECTV socialls Management were led to believe that they could improve their competitive position by 'opting out' under the Act to form a self-contained business 'Self Govering Trusts'. 57 Trusts were given the go-ahead from April 1: the attraction for managers include the freedom' to tear up national agreements on pay, conditions and trade union recognition (while awarding themselve huge salary increases), and unlimited freedom to close beds, privatise services or sell off land without consulting anyone.
However few of the Trusts had any real financial viability: many began life in deficit and are now looking to cuts along the lines already made in Guy's and Bradford.
Financial crisis
Throughout the NHS the financial crisis is worsening: the new system has all the worst features of a 'market' with all the disadvantages of cash limits.
Health authority budgets are fixed. There is no extra cash in the system, but more bureaucracy to pay for. Any hospital that generates a 'surplus' can do so only by ripping off another health authority and potentially bankrupting another hospital.
The dog-eat-dog competition is most ferocious in London, where high overheads and property values bump up the costs of the major hospitals. The government has already insisted that it will not bail out any losers' in their interal market, while civil servants admit that at least one of the big teaching hospitals could go bankrupt and close.
While NHS managers ape their big brothers in private and privatised inCityhilospital plo dustries in their hunt for cash savings at the expense of the workforce, they are also looking for other ways to attract extra business from purchasers.
This is why some big hospitals, led by Manchester's Christie Hospital, are offering a two-tier service, with queuejumping "fast-track' admissions for patients from health authorities or GPs prepared to pay extra. The improved service for a few comes at the expense of cutbacks for the rest.
Chaos
Even as the chaos of the new system begins to show, more managers are lining up to join a second wave of hospital opt-outs that could include over 100 units. Health Secretary Waldegrave has made it clear that this will Public opposition to the Tory 'market" plans for health has always been massive: but the health unions and Labour Party have failed to tap this or build any serious campaign to stop the legislation, and there was little campaigning against the firstwave opt-outs.
Kinnock now is mealy-mouthed, making no commitment to immediate increased funding of the NHS or immediate steps to disband the Trusts, return the opted-out hospitals to direct management and move towards elected health authorities.
It is clear that the only way these catastrophic changes to the NHS will be halted or reversed is through a change of government. Building high profile campaigns on the NHS can help to ensure that this happens, and is followed by campaigning that ensures a Labour goverment acts to restore our NS.