PAM JONES, a NUPE shop steward from the Elizabeth Garrett. Anderson hospital, speaking at last Saturday's conference of the East London Action Committee Against the Cuts. Unfortunately the conference, attended by 55 delegates, was prevented by its International Socialist organisers from discussing any real programme of action which could link up all those fighting the cuts. Photo: LAURENCE SPARHAM (IFL) to prevent its closure. This has involved not only the EGA workers themselves, but also unions in the other hospitals of the area, women who have used the service, the Working Women's Charter and National Abortion Campaign groups, the Camden Cuts Campaign, and the London Regional Committee Against the Cuts.
The EGA workers, in fact, have ony recently become actively involved in the campaign. An action committee was formed in 1974 when Castle first cast a shadow of doubt over the future of the hospital, but this consisted mainly of consultants and senior nursing officers, and made no attempt to in-volve the mass of workers.
Many of the latter are members of the National Union of Public Employees, the only union with any significant base in the hospital. It is now up to NUPE to take the lead in organising regular mass meetings to ensure the maximum participation of all the workers. Out of these a representative committee could be elected to take on the task of preventing any further run-down DHSS bureaucrats, They could also co-ordinate activfactorIes Given the weak position of many For capitausin So ULE HAZARDS left the factory. be made to say what it intends to do Those lefts on Camden Council who say that they oppose government the working class. democrats - most notably the Socialist Medical Association - is to reform the NHS. But this fails to confront the issues of who controls the health service and in whose interests it is run.
The SMA makes most of the correct demands for reforming the NHS. It calls for more funds: the abolition of pay beds; the introduction of preventative medicine; the extension of health education; and the nationalisation of the drugs and supply industries. It also explains that if the NHS is really going to serve the needs of working people, then it cannot be left in the hands of the consultants and the These policies must be fought for as part of the fight to transform the NHS, but they would not transform the NHS into a socialist institution.
The first thing to note is that the socialist planning and provision of health care not only requires that hos• pitals, staff and supplies are brought together in one planned national system - it also requires that health care gets at the social roots of illness. Socialist health care depends upon the democratic planning of all social life. Drainage, housing, production processes in the - all have to be freed from the anarchy of the capitalist market before socialist health care can begin.
It is not possible to bring about socialism piece-meal - first the health service and education, later private housing and industry. I is because were can Do no island of socialist health care in a capitalist country that the ngnt to transton the health service has to be seen as part of the fight for socialism and the ending We can see this still more clearly if we look at the second policy put forward by the SMA - the introduction of reforms into the us suct as an occupational health service, preventative medicine, and As soon as you seriously begin to examine health hazards at work, it is necessary to begin to question the whole way in which production is organised. In the car factories, for instance, the speed of the line, the monotony of the work, the constant noise, and the machinery used not only result in accidents on the shop floor but also affect the health of workers in their personal life long after they have An occupational health service that accepted the 'rights' of employers to make a profit. and theretore to organise ine speed of the line, the division of labour, the machinery used, and all other aspects of the production process in order to maximise their profit, could not even begin to get to grips with the problems of health at work. Indeed, because these 'rights of the employer are defended by the ico servand police be force to operate HEALTH SERVICE health service would be forced to operate within those confines - trying to prevent the worst excesses' of the employers It is necessary to fight for such reforms in the NHS. But we should not pretend that in themselves they will "put a little socaism back nto me near service Rather we should explain in the course of this fight that, at present, the NHS is not at all designed to serve the needs of The SMA, however, see the solution in terms of "democratising' the NHS. What do they mean by this?
In the resolution to the last Labour Partv Conference (1975). which was a composite of resolutions from the SMA NUPE and Wavertree CLP, 'democratisation' was posed as follows: Management bodies to be democratically elected and to include representatives of all grades of employees within the health service. What are these management bodies?
The present administration structure in the NHS - the pyramid of the DHSS. the Regional and the Area Health Authorities - was not created just because Keith Joseph was a Tory and wanted to exclude workers' representatives on these bodies. The creation of this highly centralised structure was part and parcel of the reorganisation of the NHS, which involved closing smaller hospitals and concentrating resources in large ones, abandoning plans for new community health centres. etc. to achieve the massive cutbacks in spending that the Government wanted to carry out.
PYRAMID To carry out this rationalisation, the new pyramid structure was created, with all the people on the Regional and Area Health Authorities being appointed by the DHSS. At the time this caused quite a controversy. Organisations like the SMA carried out a campaign denouncing this as bureaucratic and undemocratic, and demanding that these bodies include representatives of the labour movement.
That these bodies are 'undemocratic is neither here nor there. The point is that they were created to carry out a certain job for the state - to cut back the NHS. which also required re-organ ising the NHS.
To fight for representation on these bodies is to mislead working class people as to their real purpose and the true nature of the health service. For example what would we say on an Arca nearn Authority when the DHSS says - "cutback by this amount now? We would have to do what other representatives have done in the past - either walk out o such Dogles and say we will no! participate in implementing the cuts, or start to naggie about the best way to make the cuts, as do those who argue for more tor Brent and icss tor mersey side, or those who say more for health and less for education.
To participate with the state and the medical profession in the running of the health service is to accept the arguments of Barbara Castle and the Labour leadership - that cuts are necessary and what has to be discussed is how to carry The proposals of the SMA, which are also supported by those like Tribune, lead right back into class collaboration; despite their reforming' intentions, they cannot challenge the grip of capitalism over the NHS. Next week, in our final article, Red Weekly will put forward the Marxist alternative to the crisis in the CRISIS IN THE THE SOCIALIST SOLUTION STREGGLE FOR HEVETI PAMPHLET No. 4 IMG PLBLICATIONS 15p New IMG pamphlet, price 15p plus 8p p&p from Red Books, 97 Caledoniar Road, London N.1
----- pull-quotes -----
In previous articles we have shown that the National Health Service is domi- nated by the needs of the capitalist system. The 'solution' of the left social