Financial health

In my predictions for 2007, I averred that the campaign to defend the NHS would be one of the major campaigns on the year. I stand by that claim, largely because it seems self-evident. Nottingham, might take a little while to catch up, however.

Last night I toddled along to the public meeting held by the local branch of Keep Our NHS Public. There were probably 20-30 people in attendance (I didn't bother to count), but to my mind the problem was not so much the limited numbers, but the limited representation of what I flipantly refer to as "real people." I probably recognised half, perhaps more, of the audience from assorted campaigns. The three largest socialist parties in Nottingham (SWP, AWL and SPEW) were all out in what passes for force in today's Marxist left. Much of the rest of the audience were made up of independent activists and trade unionists. The public were striking in their absence.

In some ways this is actually very surprising. Last year's "Protect the Patients" march in the city (which I missed because I was fighting the system elsewhere), was by all accounts huge, attracting perhaps 3,000 participants. Where have all those people gone? Are they actively resisting government cuts and reforms or have they all now gone back to their lives, content with the fact that they've "had their say" on the issue? Alternatively, are those people put off by a lefty-dominated public meeting in which they are told what many of them (particularly those who work in the NHS) already know? To be honest, I don't know, although I suspect there may be a combination of factors in play.

To be fair, the meeting was much more informative than many I've been to. Demagoguery was avoided in favour of that most dangerous of amunition, information. The picture of the NHS I came away with is an interesting one, but one which I think has not been widely disseminated. Various speakers acknowledged the fact that New Labour had invested record amounts in the NHS, but the key point is not how much money is in the system, but where it's going. It became apparent that what New Labour are doing (whether consciously or not, a question which was raised, but left hanging) is turning the NHS into a corporate welfare system, taking money from the public purse and handing it to corporate interests.

While my notes are less than comprehensive, some of the processes by which this takes place include: new rules require GPs to present patients with at least three "choices" when they are being referred, which must include at least one private provider; Independent Treatment Centres (ITCs) set up ostensibly to reduce waiting lists are guaranteed payment for a certain number of treatments whether they conduct them or not; the outsourcing of both support (catering and cleaning) and clinical roles; and Private Finance Initiative (PFI) schemes which often lead to Trusts paying more for buildings in the long-term. The upshot of all this has been not only a proliferation of private companies providing health services, but a massive increase in administration costs. One speaker estimated that administration constitutes something in the order to 15-20% of the NHS' total budget (at least in England).

It is unfortunate that such an analysis of the problems afflicitng the NHS has not been disseminated more widely. It gets us beyond government obfuscation about the wages being earned by doctors and nurses, while providing an insight into the working of state capitalism (in which the state and capital are mutually reinforcing) which I think guides people implicitly towards a more radical critique than a broadly conservative (note the small 'c') appeal to "save the NHS."

As an anarchist, I'm wary of large state-run bureaucracies, but there can be no doubt that capitalism with a national health service is better than capitalism without (something the UK had not so long ago as an activist from the pensioners' movement noted). At least, if you care about things like quality and length of life. There is much about the NHS which merits criticism, but until we get around to organising the revolution (are you doing anything next Tuesday?) I think it behooves us to protect what's good about it (i.e. free, universal healthcare). How we do that and how we attract more people is a question which I'll leave open, but it's probably an important one.

Addendum: I forgot to mention that there's a regional demonstration in Birmingham on Saturday March 3, which speakers encouraged people to promote and participate in. This seems to be part of a national day of action, so maybe there's something going down in your area which you might care to check out.