Our analysis of what is wrong with the UK health system and National Health Service, the reasons behind it, and what we as ordinary people can do about it.

The British National Health Service is massively under-funded, overstretched and under-staffed. Over twenty years of Tory-initiated privatisation have wrecked the already-imperfect health system, leaving it bureaucratic and top heavy, and driven by government targets rather than the health of the population.

What’s wrong with it?
Much ill-health in Britain can be attributed to overcrowded or poorly maintained housing, insufficient or poor quality food, environmental pollution, bad sanitation, or stress and lack of exercise due to working and travelling patterns. The health service is only set up to deal with people when they've already fallen ill, not to prevent illness in the first place. Until these economic causes of ill-health are dealt with we will continue to have an over-stretched health service regardless of how much money is thrown at it.

Dirth NHS hospital sink

Dirty hospitals - the result of putting profit before people.

Overcrowding and lack of cleanliness in hospitals is part of the same problem. The “superbug” MRSA (Methicillin-Resistant Staphylococcus Aureus) is currently responsible for 2 out of every 1000 deaths in NHS hospitals and 3 out of every 1000 deaths in NHS nursing homes. 100,000 people are infected and 5,000 people killed annually from Hospital Acquired Infections[1], more than are killed on Britain's roads[2]. It is generally accepted that this has been contributed to by the privatisation of cleaning services - putting the responsibility into the hands of private companies, ultimately responsible to their shareholders rather than the public. Labour-intensive services such as hospital cleaning can only be made more profitable by cutting wages, making staff work longer hours or simply reducing the numbers of cleaners. This has lead to a marked deterioration in the service, with numbers of cleaners slashed by 45% - from 100,000 in 1984 to just 55,000 today[3].

Despite this, the majority of healthcare in the UK is still state-owned. This means that instead of private shareholders, the NHS is responsible to state bureaucracy, which is hardly akin to true public accountability. The use of targets (from waiting times to numbers treated) reduces the level of care given to each patient in favour of appearances of efficiency[4]. A patient is ejected from Casualty or a doctor’s surgery too soon, resulting in a larger knock-on cost as ailments go untreated or misdiagnosed. This leads to an almost autistic obsession with numbers as a way of selling the management system to voters, regardless of the actual effect on patient care.

NHS beds

Spare NHS beds - a rare site in an over-stretched, top-heavy service with two managers for every bed.

The centralised structure of the NHS, combined with its size (it is the third biggest employer in the world, after the Chinese People’s Army and the Indian Railway) result in massive inefficiency. For effective decisions to be made, information about changes on the ground must percolate through the entire structure to the top. The problem with this is that the sheer complexity of the system means that any models built by layers of management several levels removed from face-to-face patient care are necessarily incomplete.

Working conditions
Health workers are underpaid and over-worked. This has led to a very high turnover of staff, poorer quality work and high incidence of workplace injuries and other psychological disorders such as stress and depression. In the last year alone, 50,000 UK trained nurses left or retired with just over 20,000 recruits joining and another 12,000 coming in from abroad, leaving a shortfall of 18,000[5]. Pay for many, especially nurses is appalling, especially considering the long hours and years of necessary training. Much of nurses’ time is consumed with form-filling and red tape, which again takes time away from patient care.

Social care
There is a false distinctions between health care and “social care” for the elderly. Many families and pensioners have to be unnecessarily means-tested to the extent that thousands are forced to live in poverty because the government claims they can technically pay for treatment, disregarding the fact that so many of these families have to be able to have enough to live on after they have paid for the “care”. Social care workers are also poorly paid – much more so than NHS staff – but they should not feel morally obliged to work for minimal wages, as it is a job like any other.

The cost of medicine and equipment is spiralling due to profiteering pharmaceutical companies and the patent laws that support them. Drug corporations claim their prices are massively higher than the cost of manufacture[6] in order to recoup their Research and Development investment. In fact top U.S. drug companies spend 2.5 times more on advertising than R&D[7], and only 22 per cent of big pharmaceutical companies’ staff are employed in R&D, while 39 per cent are in marketing[8].

Patent laws protect profits for the corporations, but kill millions of people who die from preventable diseases. When Brazil started ignoring patents and manufacturing generic (non-brand) drugs themselves, the price of anti-HIV cocktail therapy plummeted from $10,000 to only $300 a year, slashing the number of deaths from the illness[9]. We need to ignore these patent laws, protected by governments, as well.

Ultimately we believe that class and capitalism are at the root of most of the problems. Capitalism is a society that is divided by class. The working class consists of all the people in this society who do not own property or a business we can make money from, and therefore have to sell our time and energy to a boss - we are forced to work. Our work is the basis of this society.

Our interests are opposed to those of our bosses and the profit-making corporations we work for. Companies must always be more ruthless in making cuts and making a profit, for if they didn’t they would go bust or another company would take them over.

Cuts in the numbers and wages of hospital cleaners and other staff, therefore, aids capital by increasing profit margins, yet it hurts the working class, who are treated in NHS hospitals and some of whom work in the NHS. Poor quality food in hospitals is good for business, since the cheaper the ingredients the greater the profits, but again harms the people who eat it. Likewise patents are great for protecting the revenues of pharmaceutical corporations, but bad for the millions of workers denied treatment as a result.

The working class therefore has a direct interest in improving all aspects of the health service, where capital does not. It is within us, the working class, therefore that the possible solutions lie.

How can the problems be solved?
We believe that the biggest problems with the health service are things which we can all, as ordinary people, help improve. Privatisation, hospital closures, stressed and unrewarded staff and massive bureaucracy are all imposed by the current economic system – they are not inevitable.

Ultimately we believe that, like all industries and services, the best people to run the NHS are the workers and users of that service. In the case of the NHS, this means the doctors, nurses and other health workers themselves should control the hospitals and care homes, in conjunction with patients rather than unaccountable bureaucrats and profit-driven corporations. Rather than central control decisions are much better made as close to the affected regions as possible - with full input from those affected by them. A decentralised, federalised service, controlled from the grassroots by councils of health workers and patients, and in genuinely public ownership would be far superior to the current system, both in terms of flexibility and accountability to the needs of patients. Far from being a pipedream, co-operative health services were commonplace in Britain before the advent of the NHS, and do exist and have existed in other parts of the world[10].

What can we do practically?
Health workers strike against privatisation

Taking action - NHS workers in Dudley on strike against their transfer to a Private Finance Initiative involving the loss of 70 beds and 160 jobs.

While this will not happen in the short term there is a lot that can be done to take more into the hands of the workers and patients. Decent pay, short working hours and good conditions ensure more effective, happier staff, will improve patient care and fill the workers’ shortfall. Unfortunately these are not reforms which will be handed down from above. Health workers can organise to demand better conditions, being prepared to take action, and other people and patients’ forums should support them. Health workers can take direct action which does not harm patients like a traditional strike might, such as good work strikes.

Communities can organise to fight hospital closures in their areas, alongside patients’ groups and health workers.

We believe that the key, therefore, is strengthening rank and file organisation of health workers, within the trade unions and without, and including contract, temporary and agency staff as well as permanent employees. We should also try to improve patients’ forums, and build links with health workers with regular meetings to discuss supporting one another and improving service. Read more about workplace organising...

Those of us who are do not work or are not patients, we can organise in our communities to create organisations which can struggle alongside these groups, and improve other aspects of our local areas to build solidarity and confidence amongst ourselves. We can argue for organising and taking direct action in our own places of work to build a powerful movement of workers who can stick together to win demands for all of us. Read more about community organising...

These organisations, based on true face-to-face democracy and self-organised direct action, in addition to improving our lives in the here and now, can be an embryonic new society. A society based on the equal co-operation and activity of all people – a libertarian communist society. A society where the social and economic causes of ill-health are greatly reduced, and services are provided according to need rather than ability to pay, and the current postcode lottery of resource provision. Libcom summary
1. The NHS is being destroyed by cuts and privatisation started by the Tories and continued enthusiastically by Labour

2. Bureaucracy and politically-motivated targets are hamstringing the service and damaging patient care

3. The NHS is based on cure rather than prevention of illnesses in the first place – and much sickness is caused by poverty, poor diet and over-work

4. The problems of the NHS are caused largely by capitalism – improving it is in the interests of the working class, but not business-owners

5. It is important, therefore, to attempt to (re-)build a powerful workers’ movement which can win improvements in our conditions at work and in our communities

6. In the health service itself we need to stand beside health workers to resist privatisation, and to help organise all workers in the healthcare industry and fight for better wages and conditions. We can try to build links between patients’ forums and workers, to argue for more self-management, better patient care and less bureaucracy

7. Ultimately we believe the most effective way to run the NHS is as a publicly-owned service, run directly by its workers and patients. We can strive for that, as part of an entire co-operative libertarian communist society, where many of the root causes of much ill health are eradicated.

By libcom
with some information from an article by Colchester Solidarity Group

1. BBC News Online Monday, 7 March, 2005, 15:31 GMT
2. Unison 12 January 2005
3. The Observer, Monday, 10 January, 2005, Page 6
”The figures, compiled by UNISON, the UK's largest union after asking a parliamentary question, showed that there were 55,000 hospital cleaners, either NHS employees or people working in the hospitals for private cleaning contractors last year. In 1984, just before the private contracting began there were more than 100,000.
A spokesman for British Health Secretary in 2003, John Reid, claimed that although the numbers of cuts were undisputed, the size of the NHS estate had reduced by 20 percent in the past two decades and so there was less physical space to clean. Even this is true, it still means massive staffing cuts of nearly 33% per unit of area.”
4. For just one example, see Channel 4 News
5. BBC news online Monday, 25 April, 2005
6. For example, the cost of daily dose of patented vs generic fluconazole anti-fungal drug in June 2002 in Guatemala was $27.60 (Pfizer patent), and in Thailand was only 1% of that - $0.29 (Biolab generic).
New Internationalist, June 2002
7. Deborah Socolar and Alan Sager, ‘Pharmaceutical marketing and research spending: the evidence does not support PhRMA’s claims’, Boston University School of Public Health.
8. Presentation before the World Health Organisation of the Indian Drug Manufacturers’ Association
9. In Brazil, after the Government began producing generic ARVs, prices fell 82% and the price of the AIDS 'cocktail' therapy fell from $10,000 to $300 a year. As result AIDS deaths have fallen by half and the country saved $677 million treatment costs from 1997 to 2000.
10. In Peckham, London, before Labour introduced the NHS after World War II there was a co-operative healthcare system. Also see The People’s Clinic: Italy, June 1971, where people suffering sub-standard care occupied an empty building an set up a volunteer, co-operative clinic.