The New Worker

The Weekly paper of the New Communist Party of Britain

Week commencing 4th July, 2008




Save the National Health Service!

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Lead 

DARZI PLANS NHS DEMISE


by Daphne Liddle

“CASH-LED
cuts dressed up as a rational planning process” was the way that health campaigner and trade union activist Geoff Martin described the major review of health services and 10-year plan published by Health Minister Lord Darzi last Tuesday.

The review focuses on health provision in London but is likely to be applied throughout England eventually.

The plan is full of all New Labour’s favourite buzzwords about “patient-choice” and “improving outcomes”, with subtle hints of the cuts to come, like “shift the emphasis from increasing the quantity of care to improving its clinical quality”.

The culture of targets, once heralded as a panacea, is now old hat – hinting that waiting lists can be expected to rise again.

But the culture of competition between NHS hospitals – the very issue that cost the Tories millions of votes in 1997 – is to be increased, with the publication of “death rates” for various surgical procedures, comparing surgeons and hospitals – and the publication of patient satisfaction statistics.

The “death rates” will be very misleading as currently – and under any sensible scheme – the most skilled surgeons are called upon to perform in the most difficult and desperate cases. They rescue the patients that other doctors could not; inevitably their death rates are high because they treat many whom no one could save.

But under the new scheme they will be reluctant to try to save patients who have little chance of survival because that will spoil their statistics. It’s school exam pass rates all over again, where hopeless cases are abandoned early so as not to spoil the stats.

Patient satisfaction is a subjective quality, not easy to measure. But this no doubt will be done with tick-box questionnaires with questions carefully framed to protect the management and the Department of Health policies at the expense of front-line staff – and most patients are sympathetic with front-line staff and will feel guilty about being critical.

Big general hospitals are no longer needed, we are told, and will make way for specialised hospitals. Darzi, like so many senior health professionals, is under the delusion that desperately ill people do not mind travelling long distances to be treated if that is more convenient for the doctors – while all the evidence is that most patients prefer to be treated as near to home as possible. And pity the poor patient who dares to have more than one condition or complication needing treatment at different specialist hospitals.

Recently general practitioners have been warning about the Government plans for super polyclinics offering a range of GP and other out-patient services. The GPs are worried this will end their near supreme power over their registered patients as the only gateway to all other NHS services. But their warnings about potential privatisation of all these primary services are well founded.

Now we discover that the polyclinics are to replace not only GP services but local hospitals as well, performing many small and routine procedures. And many services now delivered in hospitals – such as chemotherapy – are to be delivered in the patients’ homes – saving the NHS millions.

Patients with chronic conditions like diabetes or asthma are to be put in charge of their own health budgets to spend as they choose. But what happens if they get the sums wrong and the money runs out? Or if the budget does not keep pace with inflation? Already many of these people are not getting the treatment prescribed because they cannot afford the prescription costs. These costs are now £7.10 for each item and many low paid people who need several items every month cannot keep up with the costs.

Experienced and highly qualified nurses will get to take on yet more of the roles and responsibilities of doctors – again saving the NHS millions. If these nurses are doing doctors’ jobs they should get doctors’ pay.

The review pointed out rising public concern about hospital infections but does not propose the one measure that would cure this – bring hospital cleaning services back from the private sector and put them under the direct control of senior nursing staff – and introduce proper training for cleaners.

That would save the NHS money indeed but at the expense of the great god private enterprise.

There is no doubt that the overall message of the Darzi review is that the NHS is going to get smaller, with patients left to be treated by nurses, pharmacists, relatives, local wise-women and themselves. Those who can pay, of course, will still be treated by doctors or the complementary practitioners of their choice.

Doctors have given the review a very cool reception. Speaking for the British Medical Association, Jonathan Fielden said: “It is pushing an old agenda, not a new one. Our concern is that this strips resources from hospitals and GP services.

“Clinicians have not been as involved as they should have been with this review and the concern [with the national review] is that that will continue.

“The last administration worked by having a pre-conceived plan and then having a consultation as a sop to the public. The fear is this could happen again. Changes to hospitals must involve clinicians and the public.”

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Editorial

What Labour could do...

GORDON BROWN has just completed his first year as Prime Minister and it has been a disastrous year for his ratings in the opinion polls and in the local elections in May. Then just last week in the Henley by-election the Labour candidate came fifth – behind the British National Party.

Brown is also facing further rebellions over the withdrawal of the 10 pence tax band, leaving thousands of very low paid workers facing higher tax bills. Brown promised to sort out a compensation package but clearly what he has produced is not adequate, still leaving thousands worse off.

Seeing the Tories rising in the polls, all New Labour’s wealthy business friends are abandoning the sinking ship leaving the party significantly short of millionaire donors.

This leaves the Labour Party once again dependent on its founders: the trade unions, for funding and the leaders of the big unions have been meeting to discuss the policy changes they want to improve Labour’s election prospects.

Though the press is attacking Brown’s leadership, the unions, along with left Labour MPs like those in the Labour Representation Committee, recognise that a change in policy direction is more important right now than a change of leader.

Each major union will present its own demands ahead of next month’s national forum to draw up the party’s programme. Unison is to propose that all primary school children should get free school dinners to help families and increase healthy living.

 The GMB wants environmental workplace representatives to encourage “green” workplaces. Unite wants more access to flexible working for parents so they can prioritise the needs of their children. The shopworkers’ union Usdaw wants “lifelong learning in the workplace”, better protection for young workers and help for parents and carers to balance home and working lives, tackling crime and anti-social behaviour.

The free school dinners would have a major impact on people’s lives. Improved hours for parents needs to be backed up by full implementation of the European Union directive on working hours, and help for those parents who are compelled to work longer and longer hours because they are up to their ears in debt.

We could add other demands that will have a real impact on working people’s lives and raise the popularity of the Labour Party: free prescriptions; bring hospital cleaning back from the private sector and under the control of the hospitals – with more properly trained cleaners. It could enable local authorities to build new council homes – and allow mortgage payers in serious arrears to apply to their local council to buy out the home and allow the family to remain in the home as council tenants.

Labour could also stop impending local authority cuts that are closing down the very youth projects that are doing some really valuable work in diverting youngsters from gangs and criminal activity. Far from cutting these there should be far more investment.

Labour could also stop the cuts to legal and benefits advice centres. It could improve public transport significantly while reducing fuel tax for those who cannot avoid car use. And it could cap domestic gas and electricity prices. All these things would improve the lives of millions of people and they could all be funded by restoring tax rates on the rich to where they were in the 1970s.

But at a time when they really at last have some real power over the Labour leadership, the unions could be asking for so much more. For decades they have called for the full restoration of trade union rights – rights that are recognised as basic human rights by the United Nations. Now those rights could be in their grasp, like rabbits they have dropped the demands.

They could and should still be demanding the full restoration to the public sector of all the privatised utilities – and a complete end to the disastrous imperialist adventures in Iraq and Afghanistan.

Hard times are coming globally, with rising unemployment on the way as prices rise and people cannot afford to buy anymore. This is beyond Brown’s control; it is part of the capitalist system. As usual the capitalists will try to make the workers bear the brunt. So at a time like this the workers need the strongest, most assertive and demanding unions – not a bunch of compromisers and class collaborators who cannot use an advantage when it falls in their lap.
 
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