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TUC CONGRESS 2023 The NHS is at the tipping point – it’s time for renewal

We have been fighting things getting worse — what is needed is to fight to get things better, and that requires a radical change in mindset, writes national officer of Rebuild Britain FAWZI IBRAHIM

A NEW pamphlet by Rebuild Britain to be launched at the TUC identifies two main events that set the NHS on a trajectory towards a US-style health service: the introduction of the internal market in 1990 and the scrapping of the duty of the secretary of state to provide healthcare in 2012.

The pamphlet calls on trade unions to take responsibility for the health service and emulate the 1976 Lucas Aerospace shop stewards’ alternative plan, the workers’ response to the corporation’s decision to cut thousands of manufacturing jobs.

The plan wasn’t a pay-and-conditions claim, a wish list or a set of demands. It was a well-argued and well-researched alternative to industrial decline.

Similarly, in the NHS today, trade unions and other health professional organisations need to come up with a long-term, hard-headed, comprehensive plan that is fully costed and financially viable to set the NHS on a new course.

In doing so, care must be taken not to make demands that exceed the nation’s ability to deliver given the country’s limited resources and the competing claims on these resources. The threat to the NHS comes not just from underfunding and privatisation.

Unrealistic expectations could cripple the NHS. The plan should then form a component part of the submissions that health unions make annually on a par with pay and conditions, negotiated with the same vigour and urgency.  

Founded on July 5 1948, the NHS faced opposition right from the start. The Treasury said it was unaffordable, most doctors were opposed, the British Medical Association (BMA) campaigned against it and many politicians weren’t keen.

It was argued that it would be abused by the working class; if medical care costs nothing, demand would reach infinity, and soon bankrupt the service. In reality, for 75 years, the NHS has served the public well, delivering high-quality universal healthcare at a relatively low cost and rapidly becoming a model for many countries throughout the world.

The bourgeois notion of the “tragedy of the commons” in which workers would selfishly abuse what is commonly owned to the detriment of their brothers and sisters did not play out. In fact, workers did the opposite and only went to their GP or used emergency services when necessary, conscious of “wasting their time.”

Environmentalists take note: to stop the abuse of resources, make them public.

The NHS liberated the working class from the fear of falling ill and not having any savings to pay for medical care, a nightmare that haunted workers and their families.

It gave workers confidence and self-respect that became a unique character of the post-war British working class.

The NHS achieved another fundamental change. Money no longer changed hands between patient and doctor thus liberating the medical profession from the conflict of interest inherent in any private health transaction.

It established a powerful bond and increased trust between doctor and patient. This is the reason why the BMA, alongside other trade unions, royal colleges and professional institutions are today its guardians.

Today private health has morphed into an open “black market” feeding on the scarcity of medical care provided by a starved NHS, much like the WWII illegal market in essentials. In the latter case, those involved were prosecuted and their assets confiscated.

So, the BMA in particular has a special responsibility to take the lead in arguing against NHS doctors moonlighting in private hospitals and the private wings of NHS foundation trust hospitals. Work for the NHS should take 100 per cent priority.

The plethora of negative reforms in the NHS has made those within it wary of the word. But we are not against reform. If anything, the NHS needs to change.

Reforms are necessary to bring it back to its founding principles. Trade unions must work out a strategy for the NHS and force it through. So, when Sir Keir Starmer says the NHS needs more than just funds, it needs reform, we should say “Yes — and these are the reforms it needs.”

The starting point is to ask: “What would we do, what policies would we put into practice if we were governing the country?” It is these policies and how they are financed that must form part of the submissions that trade unions make annually.

The pamphlet calls for two strategic reforms. Firstly, an end to the internal market in the NHS and second, a return of the Secretary of State’s statutory duty to provide healthcare.

It further calls for a national debate on funding the NHS to determine the portion of our national resources that should be allocated to healthcare, an immediate uplift in spending to the average of EU nations, an end to the “black market” in healthcare by commandeering private health provisions and integrating them into the NHS to serve NHS patients, not private customers.

Where appropriate, owners of private health provisions could be compensated either in a one-off payment or in an annual payment based on a small rate of interest agreed by Parliament.

The NHS at Tipping Point — Time for Renewal will be launched at a TUC fringe meeting midday on Tuesday September 12. The keynote speaker will be Professor Allyson Pollock.

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