The Tory offensive against the National Health Service has been so comprehensive and so dominant in the thinking of most health workers and campaigners that it has been easy to get bogged down in simply righting cuts.
Since 1979 Thatcherite policies have:
• Slashed the share of national wealth allocated to health care, • Privatised a growing element of continuing care for the elderly, • Closed tens of thousands of hospital beds, • Privatised key support services in many hospitals, Boosted numbers subscribing to private health schemes from around nine to almost twelve percent of the population.
The Tory onslaught has now introduced the bureaucratic nightmare of the 'internal market', generating a runaway increase in numbers of top managers, accountants and clerical staff at the expense of front-line nursing and support staff.
Means-testing
From next April, community care reforms will subject tens of thousands of elderly people to means-tested charges for care they could previously. have received free under the NHS while millions of sufferers from mental illness receive little or no support from the NHS or social services.
Although John Smith's wretched Labour Party, and its especially wretched shadow health secretary David Blunkett, are content to echo Tory arguments and show no sign of opposition to the Tory approach, there is an alternative that socialists can fight for.
While it is obvious to all that the chaotic Tory health market must be scrapped, Trusts abolished and services brought under local and national planningand control, this is only the first step that must be taken.
A starting point must be a complete rejection of the Tory myth that demand for health care is necessarily 'infinite'. A finite, measurable number of people stand in need of a finite, measurable amount of treatment: but the Tories have no interest in measuring these numbers because they have no intention of treating them all.
The real problem is that the government - having set other political priorities, such as tax cuts for the wealthy - has set an arbitrary limit on the resources available to provide health care, and the limit falls far short of demand. The result, as with any shortage, is a queue: the waiting list.
Rather than increase the cash available, to clear the list, the Tories have ACCOUNTS preferred to keep fiddling the figures to cross names off and make the queue appear smaller than it really is.
But most other capitalist countries in Europe manage to provide health care without enduring the 'British disease' of waiting lists because they invest a greater share of their national wealth in health care.
There is no way around the necessity for a massive increase in spending on health services: even the TUC has raised the demand for an immediate extra £1 billion a year - less than half the amount by which health spending has fallen behind inflation and growing demand for care since 1980.
We need an immediate cash injection, coupled with a serious effort to measure the real levels of need for the various forms of health treatment, including care and support for mental illness sufferers and people with learning difficulties who are currently largely cared for by relatives with little or no state support.
A proper costing of the services needed to meet these demands can then be carried out, together with a plan to tackle the vast £2 billion-plus backlog of maintenance on NHS hospitals. A socialist government would incorporate these cash allocations into its core budget of basic and indispensable services.
Of course not all health services are best provided in hospital. But community-based services, notably for the care of people with mental illness, must be properly planned and resourced if they are not to result in tragic gaps in care. In almost every case these services are more expensive than hospital-based care, and require additional bridging loans' to enable vital capital investment in facilities before old-fashioned Victorian-style hospitals are closed.
It should be a principle of any socialist health policy that all means-tested charges for community care, prescriptions, eye tests and dental treatment should be scrapped, and NHS facilities developed in place of profit-seeking private nursing homes for the elderly.
Recently the Tories, again obediently backed up by Labour's David Blunkett, have chosen to claim that improved 'primary care (GP services) and community health services can replace hospital beds by reducing levels of hospitalisation.
This might prove to be true - if the new services were fully resourced, though there is no hard evidence to support these claims.
Yet this is the same government that has hacked back and closed down community and cottage hospitals, axed family planning and many other community services, imposed cash limits on GPs, and drastically widened the 'poverty gap', creating an equally large 'health divide between rich and poor.
While Tory health White Papers prattle on pointlessly about setting targets for reducing ill-health, other government departments preside over a rising tide of unemployment, chronic poverty, a housing crisis and a collapsing infrastructure of local government and other public services. Tory policies actuaordin rand policies actually generate avoidable illnesses and conditions and thus increase demand for health services. GP services can't substitute for all hospital care
protest against the privatisa