27.09.2006

Only democracy can fully meet needs

The National Health Service is unsafe in New Labour hands, says Jim Moody

In BBC 1's Politics show last Sunday (September 24), chancellor Gordon Brown came out and stated that New Labour aims to run the NHS in the 'arm's length' manner of the Bank of England, whose 'independence' from government he established immediately after the 1997 general election. His plan for the NHS looks likely to be one of his key policies when and if he becomes the next prime minister.

Brown boasted that he had made the Bank of England and the Financial Services Authority independent of government, and helped create a new competition authority, where "we devolved power for competition decisions from government". The common feature was that of "centralised power being broken up" and over the next few years what he described as "the next stage" of that process should be entered into.

Brown claims that the idea is to hand over administration to people who are "free from short-term political influences" and are therefore "able to take a long-term view of what [is] right". While government is responsible for "laying down general policy guidelines", there was a case for "letting people who are better able to make decisions get on with it". In other words, the separation of "the making of policy from the execution of policy" should be extended to other areas. I'll bet! It is a good way of avoiding blame, while continuing to ensure your wishes are still carried out.

As further justification, Brown went on to say: "This is a different world. It's not just terrorism and insecurity; it's also global competition and the pressure on the British economy. It's new medical advances that make you change your idea about healthcare." Why "medical advances" should create the need for organisational change was not explained, although his phrase about "global competition and the pressure on the British economy" gave the game away as to the true motive. As always, New Labour looks first and foremost to the profitability of British capital.

What Brown let out of the bag in his clumsy and obfuscating way was that his proposals - vague though they are at this stage - have nothing to do with placing the NHS under democratic scrutiny or control. Rather it will be yet another bureaucratic reorganisation. Democratic scrutiny and control - to the extent that it exists - will be further attenuated.

That is why the NHS in many way resembles the old Soviet Union. Need is partially met - not least due to the humanity of the staff - but the whole system malfunctions. There are meaningless targets and meaningless targets fulfilled. Increased inputs therefore result in constantly disappointing results and every reform exacerbates the inherent contradictions. So when Brown promises to push ahead with the drive to strengthen the 'internal market' it simply shows that he has no solutions.

At present the NHS is a complete mess. Overall, it has a £512 million deficit at the end of the last financial year and this has led to the current rash of closure proposals. But it is central budgetary controls that have forced health authorities and individual hospitals to look for cuts. How much better for the government, then, if these disastrous losses for patients can be safely blamed on faceless bureaucrats rather than New Labour.

And there are more closures to come. Lots of them. Appointed by Blair, David Nicholson took over as NHS chief executive this month. One of his first statements told us that there would be as many as 60 "reconfigurations" of NHS services, affecting every strategic health authority in England. He admitted to The Guardian that this will involve "concentrating key services in fewer hospitals". Nicholson identified accident and emergency departments, paediatrics and maternity services as areas where provision would have to be "overhauled" and warned: "Undoubtedly there will be tough decisions to make over the next 12 months to reflect changing services" (September 13).

There has, of course, been a longstanding New Labour scheme along these lines - health secretary Patricia Hewitt already met Labour Party chairwoman Hazel Blears in July to look at political 'heat maps' of where hospital cutbacks would be least controversial. That is, where they believe closures would do least damage to New Labour's electoral prospects (ie, in Tory-voting areas).

Not only would a transfer of responsibilities for NHS management help New Labour avoid popular anger (they hope), but the proposal would provide new opportunities for corruption. There are fat profits to be made by a private sector that can undercut trade union rates and bribe NHS managers.

We do not, of course, argue for either the status quo or a return to the situation before the establishment of foundation hospitals in the last tranche of NHS reorganisation. No, what we demand is something entirely different.

Democratic control by the workers who run the NHS and the patients who use it - ie, the community - is the only way to ensure that need is fully and efficiently met. That is the fundamental transformation we should be fighting for. Unfortunately, this is too much for Dave Prentis and the Unison bureaucracy and the Royal College of Nursing. They bank on keeping eyes fixed on wages and conditions. But democratisation and fully meeting needs will surely become a rallying cry for all workers. Good health and the best treatment is in the interests of us all.