8th October 2018
During her career of forty years Chris has been a general nurse – first in Newport, South Wales; a Ward Sister in Glen O’Dee hospital in the North of Scotland – and a Ward Manager in Psychiatry here in Wirral.
Chris said: “It certainly doesn’t feel like that long. There can’t be many jobs as rewarding as those in Labour’s National Health service. But in the seven decades since Nye Bevan masterminded Labour’s NHS, as we know it, there have been massive changes under all governments – by no means all for the better.”
Chris today celebrates 40 years of NHS Service as a nurse. She became a member of the Royal College of Nursing – the professional association for Registered General and Registered Mental Nurses, but she also joined what is now Unison as she wished to be in a Labour Party affiliated trade union as well.
To establish the NHS in the first place, in 1948, Labour had first to face fierce opposition from the Tory Party – and then also from the doctors’ leaders. Until then, local medical care was effectively a commodity to be bought, by those who could afford it, from doctors’ private business – or to be sought as charity.
It was only with Labour’s NHS that health care for all ‘from the cradle to the grave’ became ‘free at the point of delivery’ for all – under what was effectively a ‘nationalised’ health care system, financed by central taxation.
But under this Tory government are we now being dragged, almost surreptitiously, back to the pre-NHS arrangement for increasingly privatised health care?
Few people realise how far the local GP surgeries are now being increasingly pushed back into the status of private businesses. But let’s look at how it all happened and how the Tories are still gnawing away at the NHS in pursuit of privatisation. Back in 1962 the Conservative health secretary Enoch Powell (Yes, him! You have to believe it!) actually tried to launch a huge hospital building plan to create a general hospital in every community. His own Tory government kicked that into touch.
Next, we nevertheless saw years of (albeit grudging) Tory acceptance of the need for the NHS, notably in the somewhat less reactionary RAB Butler wing of ‘consensus’ Tories. (That’s when the term ‘Butskellism’ was coined – to show the increasing consensus between the Tories’ RAB Butler and Labour’s next Prime Minister in waiting, Hugh Gaitskell.) During those ‘Butskellite’ years of relative consensus there were proposals, by 1974, for a large-scale administrative reorganisation of the NHS in England – planned by the Tories but implemented by Harold Wilson’s incoming Labour government. It saw all health services brought into Regional – and Area, Health Authorities.
It couldn’t last. The rot set in during 1987 – when Margaret Thatcher’s Tory government turned sharply to the political right and by 1991 introduced the ‘internal market’ under health secretary Ken Clarke. The ‘market’ split health authorities, which ‘commission’ care for their local population, away from hospital trusts. The crudely divided parts of the NHS were by then forced to ‘compete’ to provide care. At the same time GP fundholding, giving family doctors budgets to ‘buy’ care on their patients’ behalf, was introduced – a form of resource-driven rationing leading towards eventual re-privatisation of local, surgery-level, health care?
Then Tony Blair’s ‘New’ Labour government of 1997 was elected – promising to scrap the internal market and GP fundholding, and to replace competition with collaboration. But ‘New’ Labour soon began to re-adopt the idea of competition, and markets, after the great winter hospital crisis of 2000.
Although Labour massively increased investment we also saw PFI (private finance initiative) used to build scores of hospitals through private enterprise, and private-sector non-NHS ‘firms’ being engaged to provide some clinical services. All this was happening with ‘performance targets’ and bureaucratic national guidelines in the attempt to create uniform standards of care. Those of us then already on the Left of the Party opposed the PFI path – correctly, as even its most enthusiastic advocates at the time now know! That was also when ‘Primary care trusts’ were set up to ‘buy’ healthcare on behalf of GPs. But it was only a logical step to then see the increasing move to the privatisation of GPs’ surgeries we are now witnessing large scale.
After the great bankers’ crash of 2008, but before the 2010 general election, the Tories promised there would be ‘no top down reorganisation’ and no ‘massive structural reorganisation’. Instead, health secretary Andrew Lansley drew up the Tories’ plans to force GPs to ‘take back control of spending power’, to side-line the primary care trusts, and acelerate the private sector’s rapidly increasing role. At the same time, they planned to dismantle much of the ‘regulation’ and ‘targets’ introduced by Labour. In short, the Tories boasted that there would be no ‘top down reorganisation’ – and then implemented the most privatisation-oriented dismantling of the NHS since Labour created it in 1948.
Those of us who can influence the progress of the NHS structures, as they are now being implemented, have no illusions. Within the Tory government’s structures we can at best ameliorate just a little of what the Tories intend – and we can leave in place structures ripe for re-nationalisation by Labour – but the challenges a Labour government will face are vastly greater than those of 1997 and the measures to be taken are clearly articulated in the general election manifestos of the Labour Party and in the Conference pledges under the leadership of Jeremy Corbyn.