Defence of the welfare state and a demand for the re-nationalisation of key sectors of British industry in line with retention of Clause 4 has to be coupled with a demand for an extension in democratic control of these organisations argues JANE THOMPSON. THIS IS AN area where the Labour leadership is on weak ground, and potential splits in the bureaucracy exist.
Labour leaders make vague and contradictory calls for more democracy in the health service, but never talk about it in relation to industry.
Labour's consultation document 'Health 2000' for example says:
"Market-driven competition can only lead to chaos and demoralisation...Every penny of public money which goes into the profit element of private facilities is money which could be redirected to better treatment and more patient care.."
So far as it goes, this is true. But we have to ask - why restrict it to the NHS and not apply the same argument to British Rail, or other key industries now in the private sector?
None of the post-war nationalised industries and services have ever been accountable either to their workforces or to consumers and local people. Workers have had no real collective control over decision making, and there is virtually no local accountability in funding decisions.
The Labour leadership apparently considers that an increase in collective control over the NHS is possible. But the principles around demands for more democracy within the NHS are exactly the same as more democracy in production of cars, generation of electricity and banking.
Confusion
The positions of nationalised industries and welfare organisations within a capitalist context has always been confused.
A state controlled island of collectivism in a sea of capitalism is not viable. But this does not mean that we abandon demands for increases in accountability in all economic sectors.
In the NHS socialists are demanding dual control by workers in the industry and the local and community, and this sort of democratic control is what we want to see in other areas of production, distribution and exchange.
It is important to push for the most radical options given for the democratisation of the NHS 'Health 2000'.
The choice Labour offers is between:
1. Some form of continuing ministerial nomination (that is the status quo).
2. Direct election.
3. Integration with local government.
Of course option one is out: no one wants the present network of quangos.
Integration with local government sounds more promising, and would be an improvement on the current situation. However this contains a tacit assumption that the current market-driven "purchaser/provider" split brought in by the Tories will continue.
Option 2. direct election, is the most democratic solution.
Socialists should fight for a different approach:
1. Local health authorities and local hospitals and NHS commuLABOUR AYS.. LOCAL HEALTH CLINICS NEEDED Its vou