The UK junior doctors’ dispute has entered a critical stage.
Health Secretary Jeremy Hunt has defended the government’s action in adopting the “nuclear option” to impose the contract by August 1 on 55,000 junior doctors in England. The junior doctors have demonstrated their determination to defeat this attack, which threatens the existence of the National Health Service (NHS). A series of national strikes has meant the cancellation of thousands of operations, but continues to command the support of workers who value junior doctors’ defence of a universal health service, against a Conservative government committed to the destruction of health and social care provision.
The imposition of the contract is a test case for the restructuring of the terms and conditions of the entire NHS workforce of over 1 million. In addition to a six-year pay freeze and the strain of coping with the longest spending squeeze in NHS history, junior doctors are meant to accept a radical reduction in payments for working out of hours and Saturdays and the undermining of safeguards against working excessive hours.
The risk that this may force many to leave the NHS is a calculated one. The government’s plans are dependent on severing the allegiance of clinicians to a health service which places patient care before efficiency savings and performance targets.
The pleas for Hunt to rethink his position or calls for his resignation are a diversion. He is only the latest in a succession of health secretaries, Conservative and Labour, who have taken the NHS ever closer to privatisation. His predecessor, Andrew Lansley, who oversaw the Health and Social Care Act 2012, stood down because of widespread unpopularity, but the legislation took effect. Under the previous Labour government, Alan Millburn and Patricia Hewitt, who introduced pro-market reforms, moved on to lucrative positions as advisors to major pharmaceutical and private health providers.
The government’s “7 day NHS” is a Trojan horse for the stepped-up privatisation of hospital services. The imposition of the contract is to ensure profitability to private providers who will be invited to take over more non-urgent procedures and testing.
The claim that this is to reduce mortality rates is not held up to scrutiny or account by the media, which has centred its fire on the principled stand by junior doctors. This includes not only the right-wing press but also the Observer and The Independent, who have decried the strike and portray junior doctors as placing their sectional interests above those of patients and the NHS.
The British Medical Association (BMA) has called on the government to re-enter negotiations and stop placing “politics before patients.” It wants to end the dispute by assuring the government that its settlement is cost-neutral and complies with the squeeze on the NHS budget. The demand not to politicise the dispute is supported by all the trade unions and the Labour Party. Its purpose is to deny the working class an independent voice and conceal the extent to which the foundations of the NHS have been eroded.
The election of Jeremy Corbyn as Labour Party leader has not resulted in any change in its treacherous record. Labour refused to officially support the strike and has confined itself to criticising the government for provoking a protracted industrial dispute.
There is no constituency in the Labour Party to defend the NHS as the debacle over the NHS Reinstatement bill indicates. The cross-party bill, presented as restoring the NHS to public ownership, received the backing of Corbyn and a handful of other Labour MPs in a private capacity, but fell on its second reading this month after a debate in parliament lasting just 17 minutes and attended by less than 50 MPs.
Labour’s 13 years in office (1997-2010) witnessed an extension of the market and enabled the private sector to provide NHS funded patient care. Independent Sector Treatment Centres established the precedent for the private sector to cherry pick the more profitable low risk procedures and divert funds from the NHS.
The Private Finance Initiative (PFI) was a Conservative policy, but it was Labour which signed the contracts in which new hospitals were built by private consortia and leased back by the hospital Trusts.The extortionate interest rates have been a driving force in cutting beds, staff and other facilities. The creation of Foundation Trusts forced hospitals to compete for patients and develop relations with the private sector, paving the way for the unprecedented situation in which hospitals can be declared bankrupt for closure or mergers.
The Trades Union Congress (TUC) has not mobilised any support behind the junior doctors. The basic principle of an “injury to one is an injury to all” is a dead letter. Unison, with nearly a half-million members in the NHS, along with the other main unions, are engaged in negotiations over the 2016-17 pay award for the entire workforce and maintain that improvements to the 1 percent pay freeze can be negotiated even as the government tears up the terms and conditions of junior doctors. A Unison bulletin complains, “Talks are progressing slower than we would like as the employers and the Department of Health have been tied up on the junior doctors dispute.”
There has been no call to unite the fight of junior doctors with that against the government’s scrapping of the NHS bursaries for nurses, midwives and Allied Health Professionals, which will have disastrous effects on recruitment.
The unions are not organisations which function to defend the working class. They serve only the interests of the ruling class and a privileged bureaucracy.
The NHS, founded in 1948, is the most far-reaching reform won by the working class of the UK in the post-war period. But though it is portrayed as a “national treasure”, it does not stand above class interests or outside of politics. It was viewed by the ruling class at the time as a necessary concession when confronted by a working class animated by sentiment of an anti-capitalist and socialist character.
The financial aristocracy has seized on the 2008 crash to roll back every reform, plunder public assets and reduce the working class to penury. It is intent on clawing back all concessions made in the post-war period and embodied in what was once known as the “welfare state”. It views the continued existence of the NHS, which constitutes approximately 10 percent of GDP, as a coveted prize, and the egalitarian principle with which it is widely associated as a political affront.
The three major principles of the NHS—a universal, comprehensive service, free at the point of delivery—are being shelved. The Health and Social Care Act 2012 removed the responsibility from the Health Secretary to provide a universal health care system in England. Clinical Commissioning Groups were awarded the majority of the NHS budget. They have no obligation to provide for all their patients and have started the rationing of the range of services provided. Health services have been fast tracked to the private sector under the Any Qualified Provider rule.
The NHS, despite being continually undermined, is still the most cost efficient and effective health service in the developed world, but it is being remodeled along the lines of its worst—the United States private insurance-based scheme.
The junior doctors’ dispute brings into sharp focus the necessity for the working class to strike out on a new political course. The Socialist Equality Party initiated the NHS Fightback campaign in 2012 based upon the recognition that the defence of jobs, the attacks on pay and closures of hospital facilities could not be taken forward through the trade unions and the Labour Party. This stand has been vindicated.
The defence of health care requires a challenge to the grip exercised by the financial and corporate elite, based on a socialist and international program. It means above all building the SEP as the new leadership of the working class.