Socialist Party
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3 August 2011

NHS cuts from a nurse's viewpoint

An NHS mental health nurse

Cameron's government claims to be 'defending the NHS.' He claims the health care budget is 'ring fenced'. Anyone working on the NHS frontline knows that this is a lie. Services, already stretched to breaking point, are being further cut by managers with little understanding of their value.

Even when Tory minister Andrew Lansley's Health and Social Care Bill was on a pause for a 'listening exercise', local cuts to NHS services were still steaming ahead. In the mental health trust I work for, the unions had notice of the first wave of redundancies that will hit nurses and others doing essential work.

Lansley's bill lines up GPs to take over NHS budgets, who will link themselves together via huge 'GP Commissioning Consortia'. These consortia will be required to be 'successful' and keep costs down. Many health services will be discontinued if they are not deemed 'cost-effective'. Working class areas, with the highest health needs, will lose out in these new arrangements.

Priority will be given to working in partnership with private providers who pay their workers a pittance and are prepared to sacrifice quality of service to make profits and keep costs down to win contracts.

In the NHS trust I work for, we are told that the 'addictions market is saturated.' A quarter of the NHS addictions in-patient bed capacity has now been slashed. Nurses have to re-interview for jobs that they have done for years. Those who are unsuccessful are dispersed or risk being made redundant.

Meanwhile the private companies are failing to provide onsite medical services, psychological services and methadone maintenance programmes. These cheaper providers, however, are now the 'preferred providers'. In health and social care service provision, competition is invariably based on price, never on quality.

Pressure stepped up

In adult mental health services, community practice nurses and social workers are under pressure to measure our interventions or 'outcomes' in a box-ticking exercise. Price tariffs are put on 'units of care' - six to twelve sessions of 'cognitive behavioural therapy' would be deemed a 'unit of care'.

We are being pushed to either discharge patients from mental health teams before they are ready or to move them onto other teams so that 'activity' can be seen. This activity is a measure of 'success' and means that the hospital trust will earn more money (this is PBR - 'payment by results').

Meanwhile the vulnerable service user is pushed from pillar to post and will be stripped of the chance to develop the sort of long-term relationship with one mental health worker that can really help.

Clearly a fightback is needed in the NHS. Trade union activity can challenge the interests of the big business vultures and their government allies. Health workers must take a stand. We know that high-quality health care services, free at the point of delivery, cannot be provided on the cheap.

Nurses' action

Along with their patients and carers, nurses suffer most from these cuts. As the largest section of the NHS workforce, we must speak out and defend our patients' welfare. We don't lead affluent lifestyles, we are from the same social class as our patients. We need to remember this before we let others higher up the health hierarchy speak for us and our patients!

Nurses and other health staff concerned at the impact of cuts must get actively involved in our trade union branches. The best way to mobilise a union branch is for members to organise, have regular workplace meetings on local issues and put collective pressure on branch leaders.

We cannot let do-nothing careerists dominate our union branches as too many have done for years. It is better to take industrial action than have an entire hospital ward or other service lost permanently.

There has never been a better time to raise the issue of a ballot for strike action in health union branch meetings. Sustained collective pressure from members is the key to getting industrial action on the agenda. We need unity and coordinated action with other public sector workers - cuts to housing, benefits and social services all undermine our patients' health and well-being.

Union members are angry and disillusioned. Ideas to unite and fight back will be welcomed by those who don't wish to fall victim to NHS trust managers' divide and rule tactics.

There will be attacks, both from health managers and even some union branch leaders but genuine activists, who keep our members' interests at the heart of everything we do, will gain these members' support.