Five demands for England's NHS we must not compromise on

We must demand the NHS has enough, decently paid staff. We can afford it - if we scrap the market, the PFI, and/or Trident. 

Peter Pannier
21 October 2014
peter pannier occupy.jpg

Peter Pannier and OurNHS editor Caroline Molloy running an NHS privatisation workshop at Occupy Democracy protest.

Campaigners must make clear demands for the NHS. Here are my five:

·         Pay all NHS staff a fair wage

·         Mandatory minimum staffing ratios

·         Deal with PFI

·         Healthcare Not Nuclear

·         Remove the market in the NHS

The NHS needs enough staff - and it needs them to be decently paid

The NHS is nothing without its staff. But about 40,000 staff in the NHS are paid less than the living wage, according to Rachael Maskell of Unite. Many rely on in-work benefits and food banks for bare essentials. Many low paid jobs have been outsourced, “so the NHS can deny its responsibility to those staff”.

NHS staff, like the rest of us, deserve wages that they can live on. How have we got to the point where this is seen by anyone as a radical demand?

Private providers can only make profits if they can cut the wages and conditions of staff. In Doncaster, 50 NHS health workers transferred to Care UK have been taking strike action against attempts to cut their wages by “up to 35%...”.

Introducing the Living Wage for NHS staff would cost the Treasury “as little as £5m”. We should be pushing for more – should people who care for us from cradle to grave really be paid as little as £7.65 an hour?

This week Jeremy Hunt attempted to deflect blame for the biggest industrial action in the NHS in a generation, claiming “14,000 nurses would be sacked if we agreed to 1% pay rise”. He has again raising the spectre of understaffing at Mid Staffs.This Hobson’s choice can and must be avoided. It’s possible - indeed essential - to demand both that the NHS is staffed with a safe level of staff, and that those workers are paid well enough to focus on their jobs.You cannot solve a staffing crisis by underpaying staff any more than you can solve it by understaffing. We have a health secretary who is doing both, and experienced staff are leaving in droves as a result. This weeks CQC report highlighted that 4 out of 5 hospitals have safety issues, as a result primarily (they said) of too few staff.

The 4:1 campaign, organised by health-workers, seeks mandatory staffing ratios of no more than 4 patients to 1 nurse (more for some specialities). They point out that “Several countries and states have implemented mandatory nurse-to-patient ratios, with great improvements in care, job satisfaction and health for patients and staff. There is a wealth of evidence to support their implementation, and they guarantee protection against abuse and lack of care”.

Why hasn’t the Francis report led to mandatory staffing ratios already? Again, it’s about private profits. At Hinchingbrooke hospital, now run by Circle Healthcare, for instance, just 27% of workers feel there are enough staff “to do their job properly”.

So - how can we pay for an NHS ‘with time to care’?

There are three very obvious sources of funding: dealing with PFI, not renewing Trident, and abolishing the NHS ‘market’.

Campaigners should insist on sufficient well-paid staff to deliver comprehensive, universal healthcare as non-negotiable demands, leaving it to politicians to figure out how these necessities will be funded. Such healthcare is a human right for us all - and we are the 7th richest country in the world, after all.

Politicians would do well to look at the three most obvious ways of finding the necessary funds, however.

A number of campaigners are exploring different options for dealing with the £79.1bn total repayments associated with 118 PFI projects (projects with a capital value of only £11.6bn).

On Saturday 1st November, Medact have organised a conference to debate the “The People vs PFI”.

Drop the NHS Debt” say that “two hospitals could have been built for the cost of just one, had public sources of finance been used”. Defaulting on debts, of course, has hardly been a rare occurrence in recent years. Indeed, there is a case to be made that PFI debts are ‘odious debt’ that could, via a ‘Citizens Audit’ process, be repudiated on those grounds.

As the Rethink Trident campaign argues, when “Britain faces the deepest public spending cuts in living memory, the country can ill-afford to be spending in excess of £100bn on replacing Trident with a new generation of nuclear weapons”. Even if it didn’t save money, we should get rid of this destructive arsenal. But with the money saved, we could not only provide a National Health Service and a free and comprehensive National Social Care Service as well, but probably a universal National Veterinarian Service to boot! 

And finally, we can save a fortune simply by scrapping the market in the NHS. Health academic Professor Allyson Pollock and colleagues have drafted a proposed “NHS Reinstatement Bill” to "stop the NHS becoming simply a memory". The bill provides a legal route-map to remove the market from the NHS.

Even if it didn’t save money, we should scrap the market. Competition in health services creates perverse incentives and undermines care, and there’s no moral case to make profits from healthcare.

But it has has been estimated that the market currently diverts £10-30billion from patient care. Getting rid of it is a way of ensuring enough, and well-paid, staff - the bedrock of the NHS.

We need to unite around supporting this comprehensive bill – and avoid being too distracted by more limited, short-term suggestions for dealing with the fallout from the Health & Social Care Act.

Health workers acting collectively across union and workplace boundaries. Health workers linking up with patients and other members of the public. These are the foundations of a movement capable of not only making these demands, but forcing concessions from government of any hue.

A variety of campaigning tools are needed. Campaigns must be designed to allow room to escalate. Industrial action will be essential, legal cases may help buy time to organise, occupations and other activities can attract media attention and force decision-makers to accept the depth of feeling.

This is the second of a two-part story by Peter Pannier - an edited version of this piece also appears on the Novara website.


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Solidarity! For a health and care on the basis of need, not profit! 

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