11.06.2003

Democratise the health service

Ernie Shenton looks at the history and the future of the National Health Service

What is the National Health Service for? To provide free, prompt and effective healthcare as of right to everyone, whoever they might be, whatever their income.

That, in essence, was what the Attlee Labour government, wretched reformist warts and all, promised in the 1945 election and, with Nye Bevan at the forefront, was forced to try and deliver by the post-war expectations of the working class. It was a real gain to be celebrated. Imagine being able to go to the doctor or call one in without first having to count the shillings, without having to choose between buying food for the family or medical help for your loved ones. To our younger comrades and readers this must sound Dickensian. It was reality for millions of working class people. Some of them are still around. Talk to them.

The birth of the NHS in July 1948 followed a difficult pregnancy. Like the capitalist owners of the coal and railway industries, for example, the medical profession had to be dragged kicking and screaming into nationalisation; again, like the coal and steel bosses, despite or because of all their squeals, they got a bloody good deal, thank you very much - crucially including the right to continue giving private treatment to those privileged patients who had the money to jump the queue.

Against a post-war background of virtual state bankruptcy, continued rationing of many basic commodities and a climate of austerity, balancing supply with demand was a critical problem from the outset. Bevan memorably warned that “we shall never have all we need”. Fair enough. Healthcare is definitionally a bottomless vessel. There is always more that can and should be done.

The notion of a contributory scheme - funded by employers and workers alike in the form of national insurance, money specifically set aside by government for this purpose - was appealing. There was supposedly a huge coffer in the treasury devoted entirely to the NHS (and pensions - but that is another story). In reality, national insurance was even then and, of course, remains now, just another tax. Some of the bombs that killed innocent Iraqi civilians just a few weeks ago were doubtless paid for by money you might have thought was going to the NHS.

The rot set in early. By the spring of 1951, the government began the retreat from a free service. Prescription charges and fees for spectacles and dental treatment were introduced. A furious Bevan resigned from the cabinet. The idea of a free NHS had lasted about three years, and succeeding decades would see governments of both major parties wrestling with the problem of how to balance their other commitments with funding the NHS without ‘overtaxing’ capital - which brings us to today. The problem remains the same. The supposed solutions vary.

Everyone knows that the state of public services like health and education will play a pivotal role in the outcome of the next election. What are the mainstream parties saying?

Let us start with the Tories’ latest brainwave - the ‘patient passport’, trumpeted by Thatcherite shadow health secretary Liam Fox as the secret weapon that will win the next election for the Conservative Party. The idea is that, having gone to your GP and been referred, when you finally get to see a consultant who recommends an operation, you will be given a ‘passport’ or voucher. Rather than waiting months or years for your surgery, this bit of paper graciously allows you to opt for treatment in the private sector. But the wheeze is that the NHS will pay part of the bill and you will pay the rest, either out of your cash assets or through private medical insurance. NHS waiting lists will shrink as if by magic, ‘freeing up resources’ for other patients.

After six years in opposition, is this really the best that the Tories could come up with? It is a pathetically transparent attempt to shift public money (yours and mine) into the private sector, to consolidate and extend the existing two-tier system of healthcare, creating very ‘healthy’ profits and dividends for shareholders.

It is the archetypal Thatcherite case of ‘devil take the hindmost’: if you do not have the cash or the insurance to exercise your ‘passport’, then bugger you. It is your own fault. Spending your hard earned money on beer, fags and foreign holidays; being disabled, a single parent, jobless, or just working in a shit job for shit money - your own fault. Whatever your circumstances, the onus was on you to scrimp and save. That way, you would have ended up paying only part of the cost of your medical treatment, rather than joining the endless NHS queue on the primrose pathway to the eternal bonfire.

If the Tories’ nostrum sounds daft, perhaps a bit surreal, take a look at the Labour Party’s latest offering of five new policy documents, due to be debated at this autumn’s conference and to form the basis of the health section in New Labour’s next election manifesto. The message is that nanny really does know best. The relationship between doctor and patient is ‘reciprocal’: ie, ‘fat’ people (however defined) and smokers will have to sign contracts with their GPs, promising to lose weight or give up the weed. Failure to do so could result in their being debarred from further NHS medical attention.

If the contracts are meant to be legally binding, then how long before David Blunkett’s civil servants get on the bandwagon and suggest prison sentences for anyone over 15 stone? After all, building and staffing prisons, contracted out to the private sector, is one of the few growth industries in the British economy right now.

The sheer idiocy of these proposals makes further comment superfluous. It reminds you of another time when Tony took his eye off the ball and listened to some of the more lunatic advisers employed by Labour. Remember the idea of frog-marching drunken louts to cash-points, where they would pay instant fines? Quickly forgotten, thanks to the PR machine.

Visit the NHS website (www.nhs.uk) and you will find a superficially more cogent approach - one not informed by the day to day rantings of febrile policy advisers. But, believe it or not, the NHS has outdone Stalin. Five-year plans? Trivial. On the site we see a 10-year plan of “radical action” to “put patients and people at the heart of the health service”. We are promised “more power and information for patients; more hospitals and beds; more doctors and nurses; shorter waiting times” - in fact more of everything. On the basis of what? More rhetoric and more empty promises. Neither this government nor any foreseeable bourgeois administration will deliver on these or any similar promises with regard to healthcare.

Why not? First, the ideological commitment both parties hold - not just to maintaining, but to extending the private sector. Who is the Tory now, Tony or Iain? The parties vie with each other to produce plans attractive to the parasites who make millions out of the health sector.

Let us be clear. The existence of ‘private’ healthcare within the NHS is an obscenity. Permit me a brief anecdote. An aged uncle goes to the consultant with a hernia. The consultant says five years. Uncle says, what if I go private? Consultant: that will be £5,000, and how does next Tuesday suit you? Same NHS doctor, same NHS facilities, leased out for a pittance; just the small matter of five grand. The uncle did not have the money. He died anyway of an industrial disease, for which, needless to say, he received no compensation.

As with private education, the very existence of private healthcare means that people, skills and resources are denied to the majority, who must either wait (sometimes indefinitely), settle for second best or both. Inevitably the most talented, best trained medical workers will be lured to the private sector, where the minority who can afford it will benefit from the quality treatment which should be the right of all - not least those who produce the wealth upon which it is based, the working class.

We hear plenty - all of it true - about the bureaucracy, inefficiency and waste, especially the waste, that is endemic in the NHS. Only one thing can change that. Real democratic control by those who work in and benefit from a totally free and fully funded health service.