By a health worker
Delegates at the public sector union UNISON’s conference for health workers at the end of April gave Health Secretary Patricia Hewitt the silent treatment when she spoke to them. They then voted for the union to “find ways to take national industrial action against the cuts”. Activists must now campaign to ensure this action includes strike action. At the very least action could include an overtime ban, a refusal to do bank work and the withdrawal of good will, i.e. a refusal to do the unpaid overtime on which the NHS relies. The union leadership will now take legal advice. The rank and file need to gear up to organise a fightback.
For the delegates Hewitt’s spin on the crisis just did not tally with the harsh reality of life and work in the NHS. In speeches many delegates accused her of lying.
The conference was seething with anger and resentment, not only about the cuts crisis but also over continuing problems with Agenda for Change, the NHS’s new pay system, further delays to a new system of payments for night and weekend working, and rumours of problems with a deal done to protect existing NHS pension scheme members from whatever retrograde changes are going to be brought in for new starters.
What lies behind the NHS crisis and the cuts? For a start it’s not money. A very few individual trusts have overspent but the overall debt is less than 1% of the national budget. Some trusts have produced surpluses of millions of pounds. The money is available and Blair and Hewitt could pay up. Instead they want to make an example of a few Chief Executives, at the cost of thousands of jobs, in order to make a political point. They want the NHS to be a business accountable to the market not a public service accountable to staff and patients. The market means winners and losers, but the ultimate losers here are the patients and their unmet health care needs.
It’s also not about “greedy staff”. The pay deals for doctors, nurses and other staff have had an effect on this year’s budget. But the problem is that the Department of Health got its figures wrong about how much it all would cost. Meanwhile nothing has been said about how these same greedy staff contribute thousands of hours every week in unpaid overtime.
The real reasons behind the crisis are the costs building up year in, year out through privatisation. Management costs are predicted to grow to 14% of the NHS budget as a result of introducing the internal market. This, according to Frank Dobson, is the price of having to cost, code, log, invoice and pay for each treatment‚.
The long-term threat to the NHS is the bloodsucking of the private sector. That is draining money away through PFI, LIFT (PFI in primary care) and mopping up low risk, high profit operations and services. For cataracts the private sector costs around £1,000 whilst in the NHS the cost is £700- 800. A new round of commissioning for Independent (Private) Treatment Centres will not only drain away more money but NHS staff and skills as well.
And Blair wants to speed up privatisation.
So when Patricia Hewitt turns up at UNISON health conference and says the NHS has had its best year ever she means it. From her point of view, signing up for more PFI deals, getting more Independent (Private) Treatment Sectors, forcing through greater efficiency at the cost of staff health and welfare are all great successes. The numbers look good: more patients treated and shorter waiting lists — but we know much of this is being achieved by sleight of hand. The fact that all of this has gone by largely unchallenged by her own backbench and the union movement is another reason for her to cheer.
A commitment to industrial action is one thing. But our starting point is a low level of experience and organisation. Since its creation, UNISON has never organised nationwide industrial action within the NHS.
People talk about the 1988 NHS strike wave that was triggered by nurses in Manchester protesting over low night payments. This action was taken up and spread nationwide in the space of a week. But times are different now and we can’t just expect a repeat of that example. Health workers need new tactics and dynamic leadership.
Strike action is possible in a number of places directly affected by the cuts. NHS Logisitics staff are currently threatened with privatisation. Because supplies are delivered to every hospital every day this group of workers has immense potential power. And health workers all over the UK would know that someone was fighting back.
UNISON General Secretary, Dave Prentis pledged he would support industrial action against any redundancies. But in his world “support” does not mean that the union will call for or lead such action. Activists must use the decisions of the health conference to force the leadership to deliver on a national strategy to lead a fightback.
On a local level, linking up with local communities and campaigns such as Keep Our NHS Public will be key in providing extra political muscle to the campaign.
A concern in the past has always been that during industrial action, usually strikes, healthworkers continued to provide emergency cover. Now that many wards are running on minimum numbers anyway this policy will need to be revisited.
Joint action with other unions, even the RCN, should not be ruled out. UNISON is supporting the lobby of parliament on 11 May originally called by the RCN, and we should actively pursue joint ventures with other unions such as AMICUS.
UNISON, AMICUS and the other health unions are big players in both the TUC and Labour Party where we should be putting forward demands to stop the cuts. The UNISON political fund could threaten to withhold funding as it has over the Local Government Pension Scheme in next week’s local election. This would represent a slight holding to account of the New Labour leadership who have ignored countless conference decisions against the use of PFI, marketisation, and privatisation of our NHS.
The conference also agreed to ask the Labour Link to get UNISON representatives in the Labour Party to organise to deselect Blairites MPs such as Hewitt and replace them with candidates who will defend union policy in parliament.
Finally we need to build a broad national campaign in defence of the NHS. Keep our NHS Public could be the start of that. Its conference voted to call for a national demonstration on the scale of the biggest anti-war demos. The potential for public support for the NHS and those who work in it is rarely tapped. When it is, the size of demonstrations and protests against hospital closures is astonishing.
The unions need to provide a national framework of action to inspire and motivate the membership:
• Build for strike action wherever possible, particularly in those areas where cuts are being made or being threatened.
• An end to free overtime is a possibility and may tie us in with other unions.
• UNISON should be challenging and leading other unions to follow us, and demand from the TUC its active solidarity and support.
• Build the KONHSP campaign, affiliate to its local groups and prepare Britain’s biggest demonstration in defence of the workers biggest ever gain: the National Health Service.
The continuing existence of a public, free NHS is now at stake. We need to mobilise now!