Defending the NHS Against Privatisation: John Lister talks to London Progressive Journal (Part One)

TP: Can I begin by asking you a little about the origins and roles of London Health Emergency (LHE). I understand LHE was established in the autumn of 1983 as a collective umbrella organisation for local campaigns defending hospitals, in the capital, against closure. Could you elaborate a little about the reasons for why LHE was founded and what its primary aims were?

JL: Following the election in June 1983, in the aftermath of the Falklands war, the Thatcher government increased its parliamentary majority. In July of that year, Nigel Lawson, then Chancellor, put forward a new budget which included a 1% overall cut in NHS funding. The NHS had already been experiencing financial difficulties and this 1% cut to the NHS budget triggered a round of cutbacks and closures for about two dozen hospitals in London.

Each of the cutbacks or closures was resisted by local campaigns. This was the political heyday of the Greater London Council and a number of the local campaigns got together and decided to put in a bid to the GLC to fund a London wide campaign group. A sum of money was liberated to fund London Health Emergency. The funding was sufficient for three fulltime workers, an office and a publicity budget.

I was brought in to be the publicity officer of LHE in April 1984. Early anger against the cutbacks merged into a big fight against the privatisation of hospital services. In my first week as publicity officer, there was major discussion at the LHE steering committee over the strike that was at that time taking place at Barking hospital in East London in protest at the privatisation of cleaning services.

Was this strike successful?

No, but it was a very large strike that lasted 18 months. It was probably the biggest of the national battles against privatisation and it became a landmark dispute. The strikers became known everywhere and it really symbolised that fact that a challenge was being put down to the unions to mount a massive campaign against privatisation, or the process of privatisation would take place bit by bit locally because there was not enough strength to resist each onslaught of privatisation at the local level.

The Barking strikers were very courageous. Several hundred female cleaners took part and most of them stood solid for 18 months. In the end they became convinced that the national union leaders were not going to support them and so the strike died away. However, there were also several successful strikes across the country, including one that took place in a mental health hospital in Oxford where the privatisation agenda was defeated.

The website of LHE describes the group as being the country’s largest and longest-running pressure group in defence of the NHS. We have discussed the formation of and the challenges faced by LHE in the early-mid 80s. How have the challenges you faced changed over the past 20 years?

I think the biggest change has been in the climate of the trade union movement. The defeat of the miners’ strike caused a period of 25 years in which the labour movement has been very much on the defensive, fearing the repeat of a national dispute on that level. This has had an impact at local level. In the early 80s, there was a strong shop stewards movement and they set a lead for the NHS. There was a whole group of activists in the NHS in 1982 and 1983, having become active around the time of the pay dispute of 1982.

This was the first-ever (and only) national pay dispute which saw simultaneous action by nurses and health professionals as well as ancillary (non-clinical support) staff, who had previously been the main backbone of trade unionism in the hospital sector. The dispute went on for the best part of a year because the union leaders were very reluctant to call for national action. However, a layer of activism was generated amongst nurses and other NHS staff who had not previously been well organised in a trade union sense. This meant that for a while there was quite a strong left wing attitude within the NHS. There were four separate health unions at the time (NUPE, COHSE, ASTMS and NALGO). The national leadership were in general reluctant to drive forward militant action or to link up local struggles: but each of these four unions had local and regional structures through which in some areas members could express more militant demands, and from time to time individual unions could be pressed into taking more concerted action.

If one of these unions took action, there would almost be a competition between the other unions to ‘catch up’ and do the same so as not to be seen to be falling behind. It was a healthy competition in a way. Members could lobby their own union to follow suit.

Nowadays, Unite is a large union in which health is a very small component. UNISON is the main health union and many people who are now in UNISON weren’t in any of the original health unions. Within UNISON and Unite, it is very difficult to take action at local level if no such feeling exists at leadership level.

Do you think it is harder these days for action to come from a grassroots level.

Well, as I mentioned, morale took a battering, following the miners’ strike. It had a big impact on the unions, at all levels. I would be critical, especially in recent years, of some of the national leaders of the health unions for not giving clear enough direction to their members. At the same time, the leaders can turn around and say that too few of the grassroots union members are demanding action at local level. To some extent they are right: there is a real problem with a lack of activism.

Additionally, seven to eight years ago, there was a restructuring of pay in the NHS. This involved most of the local branches of the main unions spending a huge amount of time in joint committees with managers sorting out very technical matters such as grading and job evaluations. The unions have become consumed with such procedural matters. Rather than adopting a ‘bigger picture’ view of the NHS as a service that relates to the public, they have tended to take a much more introspective view, focusing, for example, on issues relating to union membership and other branch matters. There has also been a mushrooming of individual level “casework” involving representations of members one by one: some of this has been driven by grasping lawyers and unions’ fears of possible litigation.

All of this type of work detracts from traditional, collective methods of union organisation and the mobilisation of members to take action themselves to improve their conditions. As such, some of the stronger union braches have become depoliticised and deactivated.

Taking the results of the recent election into account, what do you think the public can expect from a Con-Dem coalition in terms of healthcare and which areas of the NHS could suffer on account of the coalition’s policies?

Well, the first thing coming down the line is cuts. These will be known as efficiency savings. In one of Andrew Lansley’s first statements as Secretary of State for Health, he commented that Labour had not planned to make sufficiently large efficiency savings whereas his party would be ready to make such savings.

Bear in mind that the efficiency savings calculated by the NHS nationally at the end of last year projected that over the next 5 years, the NHS would be facing a funding shortfall of around £20 billion. The rising costs of dealing with an increasingly elderly population, new treatments and more expensive medicines are thought to account for this gap.

NHS London (the Strategic Health Authority that oversees the health of the capital’s 7.5 million inhabitants and has a £13.5 billion budget) has said that in order to bridge the funding gap, they need to consider closing a third of London’s hospital beds within the next 4-5 years. This is an absolutely unprecedented scale of cutbacks the likes of which have never happened in the NHS before.

It is also interesting to note that whilst the Tories ran an election campaign hinting that they were going to ‘ringfence’ the NHS and bring about above inflation increases in NHS spending, the Lib Dems were actually more radical in proposing cuts. Vince Cable MP (current Business Secretary) attacked the Tory economic formula, argued for larger cuts and, saying that it would not be sustainable to protect the NHS whilst making big cuts in public services.

The two parties in coalition also agreed to oppose what Labour had proposed in the run up to the election, namely the policy that for services which are to be contracted out, the NHS should be regarded as the ‘preferred provider’. This meant that until options to improve NHS services had been completely exhausted, these services should not be offered out to contract to the private sector or to social enterprises.

This caused a huge furore among some of the past and present members of the Labour cabinet, such as the previous Health Secretary Alan Milburn, and amongst some of the Labour Party’s advisors, who complained that this policy would impede free competition and would prevent healthy competition which they claimed was required to drive up standards. Here, I am talking particularly about Primary Care Trust services (which cover primary care and most community-based services), which employ about 250,000 staff and account for a large section of the entire NHS budget, around 11% or £11-12 billion a year. The New Labour government had (unwisely in our view) decided that these services, which had been provided by Primary Care Trusts, should be broken away from these trusts and managed separately, divided up again and then offered out to various competitive tenders to create a local market in these services.

The Lib Dems have been advocating competition on the basis of price. For me this really brings back memories of the privatisation of hospital cleaning and support services, back in the 1980s, a consequence of which was increased rates of MRSA. The idea that somehow ‘any willing provider’ can now bid for and take control of NHS services is a serious cause of concern. There is a real determination to force through privatisation, almost as a point of principle, despite the lack of evidence that it is in the interest of patient care.

Let’s discuss the impact these changes to the NHS will have on the staff. I understand that as part of the process of cutbacks being proposed, retiring NHS staff will not be replaced. What will be the implications for the remaining NHS staff? Will they be forced to work in a more stressful environment, having to face a greater workload, an increase in managerial bullying and having to cope with other pressures, such as a lack of beds resulting from over demand on the system?

Undoubtedly, all of the above. Also, add to that the £1 billion-plus immediate cut in local government spending, plus further cuts in the 22nd June budget and the consequences of the freeze in next year’s council tax – all of which are likely to squeeze social services after years of brutal cuts and tightening “eligibility criteria” to exclude all but the most completely frail and infirm from any social service support.

The local government plays a role in relation to health by providing social services and other support which is crucial to discharging patients from hospital and ensuring continuing care outside of hospital. In other words, we have a two pronged attack here- a squeeze on social services which help to look after the frail and elderly in the community. At the same time, we face a squeeze on frontline hospital services.

In addition to this there will also be the implementation of a tariff: limiting the number of patients that hospitals can treat, with a strict cap being put on the number of elective patients that can be referred to hospital. Hospitals that exceed this cap will face a penalty as they will only be paid 30% of the standard NHS tariff payment for each patient treated. We will be facing an all round squeeze on hospital services.

Further to this, older and more experienced staff will likely be the first to leave the NHS, leaving a diminished number of remaining staff left to carry the can without the possibility of bringing in agency staff or recruiting more staff to fill the gap. You can see how stress in the workplace could rapidly increase.

Consider too, the impact on mental health services. Mental health cuts never seem to attract the same headlines as cuts to other services. As such, mental health will be seen a soft touch; an area where cuts can be pushed through with minimal repercussions, as far as the politicians are concerned.

Part Two of this interview will be published next week.

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This post was written by Tomasz Pierscionek