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NHS at 70: a fight for our lives!
Nick Chafffey, Socialist Party Southern regional secretary
The NHS is 70. Over the decades it has saved the lives of millions, eased our pain and seen dramatic advances in heart transplants, cancer care and IVF, for example. All provided free at the point of need, funded from general taxation. A huge social gain for the working class.
But 70 years on, the NHS faces a fight for its survival, battered by more than a decade of austerity and privatisation. Every effort must be made to protect and enhance the NHS on a permanent basis. As we build that fightback we must arm ourselves with the lessons of how the NHS was won and how it can be protected on a permanent basis.
On Thursday 5 July 1948, Aneurin Bevan, Minister for Health in Labour's first ever majority government, founded the NHS. This was no gift by liberal capitalists but the result of mass struggles of the working class over the preceding decades and of the election victory of Labour in 1945, at its roots then a mass party of the working class.
The election of the Labour government and its reform programme was a reflection of the enormous class anger built up since World War One, the blows of a prolonged period of economic crisis, the industrial struggles of the 1920s - including the revolutionary general strike in 1926 - the experiences of the economic crash of the 1930s, and the return to the horror of war in 1939. None of this had delivered Lloyd George's famous post-war promise in 1918 of building a "land fit for heroes".
It was a period without healthcare and without welfare benefits. Families were subjected to the persecution of the "Means Test", at a time during the great depression of the 1930s when unemployment in some industrial areas reached 70%.
In 1915 145,000 children under four died. Diseases of poverty - tuberculosis and rickets - stalked working class communities. Campaigners for better maternity care 'The Workers' Birth Control Group' had the slogan: "It's four times more dangerous to bear a child than to go down a mine."
This was also a time of revolution which saw the rise of the working class and the growth of the Labour Party, against the background of the Russian Revolution of 1917 which inspired the working class in Britain and internationally to the vision of a new socialist world.
In 1918 the Labour Party adopted into its constitution its socialist Clause 4: "To secure for the workers by hand or by brain the full fruits of their industry and the most equitable distribution thereof that may be possible upon the basis of the common ownership of the means of production, distribution and exchange, and the best obtainable system of popular administration and control of each industry or service."
While the leadership of the Labour Party continued to see their goal as working for reforms within the framework of capitalism, the mass ranks of the trade unions were looking towards the revolutionary change witnessed in Russia.
Left-wing doctors within the Socialist Medical Association drew up detailed plans for a socialised health service, and in 1934 a motion at Labour Party conference was passed calling for a national health service.
In 1942 the Beveridge report was produced and outlined: "A health service providing full preventative and curative treatment to every kind of citizen... without an economic barrier at any point... is the ideal plan." Sections of the ruling class, including Winston Churchill, were firmly opposed to reforms as unaffordable. Others recognised the mood among the working class. Tory MP Quintin Hogg, later a cabinet minister, warned in the 1943 parliamentary debate on Beveridge's report: "If you do not give the people social reform, they are going to give you social revolution."
World War Two revealed that the capitalist economic crisis that drove the imperialist powers into the bloodbath of World War One, had not been resolved. Out of these devastating wars and the experience of fascism, Europe faced a revolutionary wave threatening capitalist power. Revolt was brewing across Europe and in Britain too.
A difficult birth
After the sacrifices of the war, the working class was determined not to return to these pre-war conditions. Despite expectations that the war-hero Churchill would be re-elected, he was swept away by a Labour landslide in 1945. As Labour MPs gathered in parliament, this radical mood was reflected in their singing of the famous socialist anthem the Red Flag.
Despite the colossal nature of the reform, it was not an easy birth for the NHS and from the very outset it was constantly under attack. Those who gained most from private healthcare were opposed to the NHS from the start. Consultants in the BMA doctors' association threatened a strike and Bevan conceded that GPs would retain the freedom to run their practices as small businesses: "I stuffed their mouths with gold." From the outset the running of the NHS was left in the hands of senior managers and consultants, with no democratic control by healthworkers through their trade unions or the local community.
Alongside the founding of the NHS, council housing was built, welfare benefits were introduced, and coal, oil, gas, electricity, transport, the Bank of England and later iron and steel were nationalised. The capitalists fearful for the survival of their system were forced to make concessions from above to prevent revolution from below.
This represented a huge advance for the working class. But while these gains were enthusiastically welcomed, Labour left the economic reins of power - the banks, industrial monopolies and big corporations - in the hands of the capitalists. There was no attempt to implement the outlines of Clause 4 and a socialist economy.
Despite the NHS becoming an established fact, supported by Tory governments as well as Labour, health inequality continued during the post-war boom, reflecting the class inequalities that remained. But as the power of workers and the organised trade union movement pushed up wages, improved housing and built the NHS, life expectancy increased, diseases of poverty fell, child mortality decreased. It showed what was possible to transform the lives of the mass of the working class.
As the post-war boom came to end, it was the Thatcher government that sought to protect the profits of big business by attacking the gains of the working class and turning back the clock of history. Health authorities were abolished and the NHS Community Care Act set up NHS Trusts and an internal market system within the NHS.
These attacks met with resistance from healthworkers, despite the weakness of the right-wing trade union leadership. In 1988 the Tory government was forced to water down some of their plans to attack the NHS when nurses and other health workers took strike action, which was backed by action by miners, shipbuilders and other industrial workers.
At the time, the Socialist's predecessor, Militant, called for a one-day general strike rather than just the demonstration and 'day of action' which the trade union leaders called for. In spite of the lack of leadership, there was a 100,000-strong demonstration through London on 5 March 1988, where workers showed their support for the health workers and the NHS.
Thatcher's rule was marked by struggles of the working class in defence of jobs - struggles that potentially could have won with more determined leadership from the trade unions and the Labour Party. The year-long miners' strike, while defeated, demonstrated the heroic willingness of workers to struggle. Victories were scored in Liverpool with Militant supporters leading the city council to win government funding for its house building programme. And Thatcher's reign was bought to an end by the Militant-led Anti-Poll Tax Federation army of up to 18 million non-payers.
While the Tories were finally ousted in 1997, Labour under Tony Blair was now an openly pre-capitalist party, having ditched Clause 4 in 1995, expelled socialists and attacked the influence of the trade unions.
By sticking to Tory spending limits in 1997, Blair's government starved the NHS of cash. It also pursued policies of privatising the NHS by rapidly expanding extortionate Private Finance Initiative (PFI) contracts through health trusts. It also maintained the Tory anti-union laws to hamstring workers fighting back.
While Blair's chancellor Gordon Brown famously boasted of ending the capitalist cycle of boom and bust, the Socialist Party consistently warned of the looming economic crisis and the tasks facing the working class to defend its interests and build support for socialism.
When that crisis broke in 2007-08 the banks were bailed out by New Labour, not in the interests of the working class to carry though socialist policies but to protect the profits of capitalism.
The Tory governments since 2010 have accelerated the process of cuts and privatisation that has seen the worst winter crisis in 2017, with thousands of cancelled operations. Tories bemoan the impossible demands placed on the NHS, the limited funds available, all to prepare the public for acceptance of charges and further privatisation.
Searching for profits, public services are a tempting source of guarantees. Now hidden behind the NHS logo are the big corporations like Virgin Care, Care UK - vultures profiting from healthcare. Drug companies eat huge portions of the NHS budget. What if these contracts were scrapped? What if the PFI contracts were ripped up? What if Big Pharma were nationalised?
It is clear that the NHS is not now what it began as. Its survival is in peril. The central conclusion to be drawn from the last 70 years is that any gains won from the capitalists will be taken back over time if the capitalist system is not abolished and replaced by socialism. That is, a system of democratic planning where the 'commanding heights' - the biggest banks and monopolies that dominate the economy - are taken into public ownership.
Struggles continue across the country to defend the NHS, and successes have been won. The Socialist Party has played a leading role in saving Leicester's Glenfield Heart Centre and the Huddersfield Royal Infirmary. Alongside the strikes of junior doctors and Barts Trust ancillary workers, this shows what is possible.
In the battle ahead, we must mobilise to defend every job, every ward, every bed from cuts. But we must also link that struggle to the idea of changing society - not just to save the NHS on a permanent basis but to deliver an economy that meets the needs of the working class. That means decent jobs, a living wage, benefits and pensions, affordable housing and free education.
Corbyn's general election manifesto in 2017 reflected these goals, and the vote reflected the desire for change. But that potential, if it is to be realised, has to become an active mass movement of millions of working people, of healthworkers and patients, a mass workers' party. Mobilised on demonstrations, strikes and picket lines, a spirit of solidarity and confidence can grow in the possibilities of change.
Any such party should be built around a democratic labour and trade union movement, in a federal structure that embraces all socialists - including the Socialist Party - and the central role of the trade unions. Meetings should be able to discuss and decide on policies, programme and strategy. On this basis support can be won for the ideas of a new socialist society.
This means a decisive battle to introduce mandatory reselection to remove the Blairite pro-capitalist fifth column and ensure socialist candidates stand with Corbyn.
A socialist government would tear up the PFI contracts and nationalise the pharmaceutical industry. Compensation would be paid only on the basis of proven need.
This measure alone would release funds for rebuilding the NHS. A socialist society would also mean the nationalisation of the banking system and other major sections of the economy. Real democratic controls could be introduced with elected committees of health workers, trade unions, community representatives, and representatives of local and national government.
As in the 1940s, the capitalists once again fear for the survival of their system as an anti-capitalist mood grows in society. Our task this time is to ensure a decisive socialist victory.
In The Socialist 4 July 2018:
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