Health Feature – Health Service Under Attack

The Belfast Trust is also proposing to end all overtime from 1 October and not to use agency or bank staff. There is already an effective freeze on filling any staff vacancies that arise. As a result there is mounting pressure on the staff who are at work. If there is a major outbreak of swine flu over the winter under-staffed wards will struggle to cope.

These cuts are a consequence of demands from Northern Ireland’s Department of Health on the Trusts to make “efficiency savings” of £700m (or 3% of expenditure each year) over the next three years. On top of that several Trusts have built up deficits which they are being told to reduce. According to Health Minister Michael McGimpsey “They are reporting deficits and these deficits are not permissible under Treasury rules.”

The Belfast Trust has also announced that it will no longer be referring patients to the private sector for operations. Patients are often referred to private clinics for knee, hip, heart and cataract operations, in a bid to reduce waiting lists. The Belfast Trust paid for 7,000 private operations last year and has commissioned another 4,000 so far this year. According to the Trust Chief Executive, William McKee: “It doesn’t appear, at this stage, we have enough money to meet the activity we were able to do last year.” He told BBC Radio Ulster: “This is hopefully a brief pause while we take stock of how much money is available and how much more we can do internally.” He admitted that the Trust was finding things “very difficult” financially and said “hard choices” would have to be made.

Worse to come
These cuts are only the beginning. The three main Westminster parties – New Labour, the Conservatives and the Liberal Democrats – are all committed to a sharp reduction in public expenditure after the next election. The Assembly parties have no strategy to resist the dictates of Westminster and will simply do as they are told.

The Tories attack New Labour’s handling of the NHS suggesting that New Labour plans 10% cuts and will threaten 137,000 NHS jobs. It is laughable to suggest however that the party of Margaret Thatcher is a friend to the service. When Tory MEP Daniel Hannan urged Americans to oppose Obama’s health care reforms and described the NHS “as a sixty year old mistake” Conservative leader David Cameron attacked him. The reality is that Hamman’s outburst tells us much about the views of the Tory party. A large number of Tory MPs, including members of the shadow cabinet, have put their names to Hannan’s two books arguing for the destruction of the NHS and Tory shadow health minister, Lord McColl, is a paid adviser to Britain’s biggest private GP service, something which Cameron has described as a “perfectly satisfactory state of affairs”. Cameron is very careful in his pronouncements because he knows that the NHS is still overwhelmingly popular.

Private Parasites
Whoever wins the next general election, the health service, alongside the rest of the public sector, is going to face an acceleration of attacks. The current capitalist crisis has led to a spiralling of the public debt. While the banks are bailed out, the public sector is being expected to pay the price. And many of the problems facing the NHS are a result of the massive Private Finance Initiative (PFI) schemes which have shovelled NHS funding into the coffers of the banks over the last decade.

Of the 133 new hospitals built since New Labour came to power 101 were financed under PFI. In total there are 149 PFI hospitals in Britain, valued at £12.3 billion. A recent report by University of Edinburgh academics shows that the NHS will eventually pay £70.5 billion for these hospitals!
Lloyds and RBS banks dominate the PFI market and have lent tens of billions of pounds in order to finance new hospitals. According to the Edinburgh report these banks, bailed out by the state with taxpayers’ money, “continue to charge excessive risk premiums to the taxpayer”.
Professor Allyson Pollock of the University of Edinburgh’s Centre for International Public Health Policy said: “Instead of using the opportunity of the taxpayer bailout (of Lloyds and Royal Bank of Scotland) to re-open the contracts and negotiate better rates in favour of the public sector, the UK government is allowing the banks to restore their balance sheet by charging relatively high rates of interest for PFI schemes. The increased costs of servicing the debt are met from NHS annual budgets, and result in reductions in the money available for services.”

Resisting the Cuts
The attacks on the NHS must be met by determined resistance. Communities in some areas are already mobilising – at the end of August around 30,000 people marched through the small town of Hayle in protest at cuts and closures of Cornwall’s hospitals. Similar mobilisations here would send a loud message to the Executive and Assembly.

The NHS trade unions have a duty to organise an effective campaign of co-ordinated industrial action in defence of jobs, pay and conditions. Unison officials in Northern Ireland have made noises about industrial action but they have no track record of organising effective action. Recently in Wakefield and Pontefract Hospitals, as a result of a new PFI development, management attempted to impose new jobs on the workforce at lower grades and lower rates of pay. This move was met with determined resistance by the local Unison and Unite branch memberships. A massive 95% of union members voted to support strike action in a consultative ballot. Despite management’s claims that the job changes were contractually set in stone, the ballot result forced them to withdraw all the proposed down-gradings. This dispute shows that with a determined union leadership and a determined rank and file, management attempts to attack health workers’ conditions can be defeated.

Renewing the NHS
It is necessary to fight for a series of fundamental demands to defend and renew the NHS. All health services (private hospitals, independent treatment centres and care homes) should be taken into public ownership and incorporated into the NHS. The Trusts should be abolished and representatives of central and local government, NHS workers, trade unions and health service users should make the decisions about how the NHS is run.

All new hospitals should be built with public funding using direct labour and not for private profit and existing PFI schemes should be cancelled. The pharmaceutical industry and medical supply industry should be nationalised under working-class control and management. The cost of drugs makes up 10% of the entire NHS budget. Multinational drugs companies take billions out of the NHS through overcharging, price-fixing and blocking cheaper generic drugs. Cleaning, catering and other services should not be run for profit.

If these measures were taken, profit would be driven out of the NHS and it would be genuinely democratised. Ultimately however a socialist programme to eliminate poverty and inequality – the biggest killers and causes of ill-health – is necessary.

Gerry Brown has worked for 18 years as a Bedside and Hygiene worker at Royal Victoria Hospital in Belfast. He spoke to The Socialist about the cuts at the RVH.

Gerry, how did you feel when you heard about the new round of cuts in the Belfast Trust?
Well to be honest, I wasn’t surprised and I don’t believe any other worker in here was either. We have been under constant pressure for almost a year now with management expecting us to carry out more and more duties.

Can you explain what you mean by that? 
They stopped all recruitment about six months ago, and they don’t bring in any agency workers when we are snowed under.

When you say ‘they’, you mean the management?
Yeah, I used to work one level with another domestic and that took you almost all of the morning to clean and get sorted. But then management took her away to another unit and now I have to basically do it myself. When I ask for help, I just kept getting told “do what you can as there is no staff available.”

Have you spoken to your union about it?
What’s the point? Don’t get me wrong I am in Unison and believe that workers should stick together, but you rarely see a rep unless it’s for the AGM and they are looking your vote.

What do you think should be done now?
Well I think staff are getting fed up, maybe not ready to strike or anything just yet but it’s getting there. The Unison leadership is saying that they will support us but I’ve heard that before. If you ask me they are too close to the managers.
I think that the unions will get a bit of time to see what they can do. I don’t have much faith in them knowing what they have done before and I think it will be up to the workers themselves in the end to do something.

Michelle is a student nurse in Belfast. She spoke to The Socialist about what the Assembly’s cuts will mean for student nurses.

“Things are already at breaking point in the health service. For student nurses the chances of getting a nursing job are next to zero. Last year, there were only 3 positions for nurses in the entire Belfast Trust. In my particular branch of nursing (adult branch), there are 150 of us hoping to graduate next year. That is not including the other branches such as children, mental health and disability.”

“At placement I see when people retire, their jobs are not being replaced. It’s another way of cutting jobs. Now with 150 beds being cut in Belfast, there is even less chance of finding a job.”

“Student nurses are being used more and more as a source of cheap labour. We are paid a measly bursary, but are expected and pressurised to carry out work that requires experience which puts patients at risk. We work a 37.5 hour week, but only get paid the equivalent of 50p per hour. Sometimes I don’t get any break at work because we are so understaffed. I know many people who are looking at emigrating to Australia or America, not because they want to, but because there are no nursing jobs here.”

“People are also being encouraged to take a career break to cut back on costs. Managers have even admitted that waiting lists for hip replacement operations will rise from 8 weeks to three years due to the cuts.”

Sarah Salters is the director of NI-ADD, a charity which provides essential services for children and adults suffering from Attention Deficit Hyperactivity Disorder (AD/HD). Sarah spoke to The Socialist about the service and Belfast Health and Socials Care Trust’s recent decision to refuse funding.

“NI-ADD was founded in 1997. We started out as the Belfast ADHD Family Support Group, but have grown over years into a fully developed service. We work to provide a much needed service to young people and families affected by AD/HD. AD/HD affects about 10% of school age children, with a wide variety of symptoms and treatments. It is very important that children are diagnosed early to avoid further problems in adulthood. But because of a lack of resources many children do not get the help they need.

“We operate out of a support centre in South Belfast and are a specialist and unique service providing a range of support from early intervention to preventative services. We recently applied for funding from the Belfast Trust. 54% of all referrals come from the Belfast Trust. Parents are advised by the Trust to come to us for assistance, but they have refused to give us a penny. We are now seriously concerned with the lack of funding we now face an uncertain future.”