THE NHS is now a central battle round not just for the defence of a tal interest of the working class but the whole ideology conomic/political objectives of the Thatcher government.
This confrontation has deliberately chosen by the government. The evidence is overwhelming that while there is a long term problem of funding the NHS on Tory priorities there is no short term problem at all. The decision to provoke confrontation in the NHS now, at the beginning of the Tories third term, is a deliberate one. What is the evidence For this conclusion and how does it fit into the Tories overall strategy?
First, as regards the reality that there is no short term crisis for funding the NHS, this is made clear in the government's own January 1988 public spending white paper. Due to higher than expected receipts from council and new town house sales, treated in Treasury accounts as negative expenditure, government has been underspending on its own plans in 1987-88 by £1.3 billion. Furthermore there was in January still £600 billion left in 1988's reserves. On the income side the chancellor is, as the Financial Times put It, awash with revenues due to 1987's rapid economic Resources The demands made for extra funding of the NHS are modest compared with available resources. For example the National Association of Health Authorities is asking for only £231 million for next. year •OVe governmen Viculis. Phillip Hunt, director of the National Association of Health Authorities, noted: 'People are talking as though the health service has to be financed in some other way, yet for the moment all we are asking for is another f230 million that would provide authorities with the stability they need for the coming year. That would work wonders morale and allow some expansion? Yet the government refused to meet even gich a minima demand.
Many of the demands which are being pressed on the government are tiny compared. to the underspending and reserves of £l.9 billion - let alone the revenues available for tax cuts. Even the call of the Labour Party organisations that £11.3 billion be spent on the NHs. could be mei serious problem at present. Furthermore, given the figures, it is clear the government could make both tax cuts and increase spending on the NHS. The decision in the public spending white paper, and in the government's projections for been the budget, not to give extra funds for the NHS is therefore primarily a political, not an economic, decision. therefore, is the government choosing to make this attack on the NHS at the present time?
First, over the lọng term, the Tories clearly forsee low growth in the economy and a crisis of funding of the NHS* which requires a two per cent increase a year to maintain its present level of service However, as the figures shows, this is not the main factor in its refusal to fund the NHS.
The decisive factor is an understanding that the NHS is a battletield for the politics and ideology of Thatcherism.
The Sunday Times, a paper pushing the ed on 31 January the shift in government strategy signalled by the decision to hold a policy review on the NHS: For weeks past, the prime minister had struggled to would about the NHS and its failure to cope with demand for hospital beds...
'All her efforts to get the story of a growing crisis out of the headlines were being smothered by the increasing cries of chaos from within the NHS. She had thought that by constantly repeating the figures of increased spending and the extra-NHS staff since she came to power, she could win through.
Last weekend. mind, not by opening the Treasury coffers to the NHS cash-seekers but by deciding to be more daring that she has ever been before in domestic policy... he idea took hold that this was an opportunity not to be missed and that the Indeed it has been not just Labour or the nurses that has opened up fire on the government. The development of groups such as 'Birmingham Consultants for the rescue a lit NHS, supported ingham Showed and medical which worried the government.
willoul d Oakley government has never been more on the defensive over its handling of the National Health Service. The time bought by its injection of an extra £100 million funding before Christmas has already. run out, and it joins debates with Labour today in a bad state of jitters!
gordian knot of the political crisis she was facing by announcing, on Panorama on 25 January, a review of the NHS totally controlled by the government. It will be carried through by an ad hoc group of ministers and advisers and is supposed to report before the summer.
Tax relief
present Announcing: the made her intentions clear. She repeated her belief in expanding private medicine. When the question of tax relief on private health insurance was raised she stated, 'ministers were considering all of these things. She stated that with health as on education: 'we will hold our own inquiries and our own consultations.
dent of the Financial Times, put it 'Like public concern he debate of the past two years leadin Tip to the current Education Reform Bi Mrs Thatcher is having no truck with time-consuming royal commissions or the semi-public Fowler social security in quiries. discussions.
within the Tory party on the health service is clear. The most extreme mooted publicly that she changed her minister Rhodes Boyson # who has callLed for the privatisation of the NHS and the substitution of a state voucher of £300 a year which could be cashed with a private insurance firm. Hospitals would ›e transferred to private ownership too electorally unpopular to have any chance of being adopted. But others are trying to get similar results by different means. Madsen Pirie, right wing Adam Smith Institute, for example has concentrated on promoting private health insurance. 'A part of the private health insurance…..A by start was made in 1981 when the then the Birm- Chancellor made surance a tax free bonus for those earnThe Times political editor Robin noted on ly january: "The Thatcher therefore decided to cut the Thatcher As Peter Kiddell, pontical corresponShe wants full control of the The nature of proposals being floated ex-government Boyson's proposals are too blatant and president of the private health ining below £8,500 per year and entered by their employer. This group could be expanded by granting a tax rebate for those undertaking private medical insurance A second tack was shown in the report on the NHS by the Carlton Club/Conservative Medical Society. One of the pal authors of this was Sir Gerard Vaughan. This report called for replacement of the NHS with a national health * insurance scheme, for tax relief on health care premiums, and, in particular, steps to destroy the health service unions.
In preparation far-reaching changes in the NHS the Tories have taken steps to prepare the legal ground
eNHS S VILL popular as was achieved, over a decade, with public housing.
The 1988 public spending white paper shows that gross NHS spending is planned to rise by 2 per cent after next year allowing for inflation - just on the limit of the 1.5-2 per cent annual rise required to meet the growth in the number of people aged over 75 and medical advances. But it does not include any allowance for real rises in NHS staff pay.
The government's projected figures show that the real rise in gross NHS spending is planned to slow to 1.3 per cent in 1989-90 and to 1.7 per cent in 1990-91. Capital spending on English hospitals is shown as increasing by only 1 per cent. These figures take the NHS down to the level where the service will begin to deteriorate further. Clearly the aim is to make the NHS unpopular inefficient. couple aged between 30 and 49 with a family costs f952 a year for the use of London hospitals, f614 for large centres outside London and £513 in rural areas. With such prices, while private health insurance has been rising it still only Lovels It is for this reason that the private medical companies, and the Tory right wing, led by Social Services secretary John Moore, are so strongly pressing for tax relief on private medical insurance. This has already been introduced for anyone with private health insurance earning under £8,500 a year but virtually all the two million plus policy holders, million people, The result is that the number of private insurance is still very low. Only about one quarter (586,000) of those with private THE NURSES strikes have brought to public attention the crisis in the nursing profession. But this crisis is not new. Already at the beginning of last year Nursing Times ran an article When the tap runs dry, showing a likely shortage. of some 10,000 trained nurses by the year 2004.
In the past the NHS has just managed to replace the 30,000 nurses who leave annually with new students and some qualified staff returning to nursing However, the number of young women with between five "O' levels and two A levels leaving school is falling due to population changes. At present nursing recruits about 25 per cent of this group but by the mid-1990s it will, if nothing else is done have to increase this to over Royal Infirmary This would by itself create a major staffing problem, even if everything else was fine. Everything else is far from fine.
Of course, compared to many of the low paid ancillary workers in the NHS nurses are very well paid. However in comparison with other "professions nurses rewards are very poor.
A nurse earns £7,300-f8,600 a yea compared £7.600-£14,300 for teacher, £7,700-£12,800 for social worker, and £8,400-£14,000 for a police constable. Further up the scale the picture is the same. Senior teachers, principal social workers and police sergeants tion in overlap can mean an in ease risk of violence for nurses, the vast ma jority of whom are women, as hospitals are built in badly lit res areas.
Low staffing levels normally auras the Midlands children unable to hase surgery because of lack of nurses. However, low levels of constant featare of work in the Ta In far from unusual for only one nurse to be on a ward. Low kuds or fing means that nurses are tract , the standard of care they woek ik have to work hard simply it cost: tients receive the most basic a SeE levels have to be maintained ta ste Ise al bank nurses agenc whatever their individual attrie not be as aware of the needs e: je = dividual patients as full time se This constant struggle to basic care demoralisation amongst staff - expressed through increasing levels of sickness which in turn put greater stress on those who carry on working. In order to maintain staffing levels some 60 per cent of nurses work overtime, often without pay or time off under health authorities have also been selling off accommodation. This has led to a crisis, particularly in London. Whilst it is possible for nurses in some areas to buy houses or flats the explosion of house prices in London and the south east puts even the cheapest property out sce me aire or muse duise. • Not sur prisingly the greatest nursing shortage is in the four Thames health authorities
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public was ready for a fundamental Consultants