Where next for the UK's National Health Service workers?

A balance sheet of the strikes so far

Hundreds of thousands of nurses and ambulance workers have mounted the biggest strike in Britain’s National Health Service (NHS) since it was founded 75 years ago.

This week’s two-day strike by the Royal College of Nursing (RCN) and almost 12,000 ambulance staff is against a derisory 4 percent pay award imposed by the Conservative government. But every nurse, ambulance workers, emergency care assistant and call handler knows that at stake is the very survival of the NHS as a public service, free at the point of use.

National Health Service nurses picket line in Bath during the national strike on December 15, 2022

The years-long clampdown on pay is only one expression of the deliberate underfunding and sabotage of the NHS, with the aim of paving the way for the escalated privatisation of its most profitable sectors and the massive reduction of what remains to a burnt-out shell of its former self.

Richard Murphy, Professor of Accounting Practice at Sheffield University Management School, calculates that decades of de facto cuts have left the NHS underfunded by £30 billion a year. It should at present be funded by £3,058 for each person in the country to provide essential care, when the actual spend is £2,642.

For patients this means massive waiting lists for treatment and an increasingly poor service that poses a threat to life. For health workers, it means long hours, massive strain and pay so poor that hospitals are haemorrhaging staff, with many forced to resort to food banks to get by.

The pandemic was used by the Tories to push through a massive raid by private operators on the NHS, spending billions on dodgy PPE and failed track-and-trace systems that enriched corporations often directly connected to MPs. Staff were exhausted, fell ill and died from COVID, while waiting lists for operations grew immensely. After the cynical “clap for carers” campaign, the government now regularly and hypocritically denounces striking workers for “endangering lives” despite the constant provision of emergency care to prevent this.

Despite such deliberate sabotage, millions of workers want the NHS to be defended, not replaced. The Financial Times noted that last year’s report on British Social Attitudes, taken amid the COVID-19 pandemic that placed maximum strain on health and social care, showed satisfaction and confidence in the NHS plummeting. But Dan Wellings, a senior fellow at the King’s Fund, noted that “at the same time, we’re not seeing any shift in support for the principles. The public does not want a different model. They just want this one to work.”

The trade union bureaucracy will not defend the NHS

The NHS strikes are the most politically significant action taken by workers during the wave of strikes that has continued since last summer. Enjoying massive public support, and with nurses suffering from the same desperate cost-of-living crisis as millions of other workers, it has the potential to become the focus for an escalating conflict between entire the working class and the Sunak government and the employers.

But for this reason, it cannot be won based upon the limited programme of occasional one and two-day strikes aimed at pressurising the government to make concessions on pay. Nor can it be left under the leadership of a union bureaucracy that is consciously seeking to betray this historic fight.

NHS workers, rail workers, postal workers, educators, civil servants and millions more not yet striking face a government intent on funnelling social wealth to the major corporations and the super-rich, while the working class is made to pay for the pandemic bailout, the escalating war against Russia in Ukraine and the economic crisis produced by rising oil, gas and food prices.

To do so, the government has begun a massive programme of state repression, including the use of the armed forces during the NHS strikes, that will see strikes in essential services neutered or banned entirely by the Strikes (Minimum Service Levels) Bill that will become law by this summer.

The Tories are on a war footing against the working class and workers want to take them on. Time and again, the demand has been raised for unified strike action, including calls for a general strike. But organising such a counter-offensive demands  a political and organisational struggle against a trade union bureaucracy sabotaging every one of these struggles, and a Labour Party colluding with the Tories in their attacks.

NHS workers confront health unions that have repeatedly sought a rotten pay agreement with the government, having imposed one for just 7.5 percent in Scotland—while RPI inflation is running at over 13 percent—and now seeking to do the same in Wales. RCN leader Pat Cullen has offered to end strikes in England if a similar figure is offered, while demanding nothing that would prevent the ongoing destruction of the NHS.

RCN leader Pat Cullen speaking to the media while visiting a nurses' picket line in England

The pattern of closed-door discussions, votes on shameful deals and constantly delayed and disunited action is repeated in every single strike now underway. Not even the threat of strikes being made illegal has triggered unified action from a bureaucracy that has already agreed to abide by the law as soon as the anti-strikes legislation is on the statute books.

Instead, the claim is made that workers must rely on a future Labour government to defend democratic rights, end Tory cuts and protect the NHS.

Labour is a right-wing party of privatisation and war

This is a contemptible lie. Labour leader Sir Keir Starmer is a declared opponent of strikes, has denounced NHS workers’ pay demands as unrealistic and is committed to an austerity agenda in government. Labour’s transformation into a right-wing representative of big business is epitomised by its transition from the party that set up the NHS in 1948 to an avowed advocate of accelerated privatisation.

Starmer has declared that the NHS should not be “treated as a shrine” and needs “unsentimental reform… One of the issues that we’ve looked at is whether or not we’re using the private sector effectively… Our research shows that that’s been underused, and we could do more of it.”

Shadow Health Secretary Wes Streeting has declared that the NHS must “reform or die” and describes doctors and health workers as “vested interests” that would not be allowed to “stand in the way of reforms… I’m not prepared to pour money into a black hole.”

In an interview with the pro-Tory Sunday Telegraph, Streeting said, “We are not going to have a something-for-nothing culture in the NHS with Labour… I’m not prepared to pour money into a black hole.” [Photo: screenshot of Sunday Telegraph print edition, December 11, 2022]

When the trade unions speak of the merits of such a government, they make clear their intention to collude in imposing savage cuts and suppressing wages in what Starmer has called “a real partnership between government, business and unions.”

Above all, workers must understand that NATO’s de facto and escalating war with Russia excludes any possibility of the “compromise” held out by the trade union bureaucracy.

Demands are already being made by the armed forces, the Tory press and leading MPs for the government to double military spending to four percent of GDP, with top military thinktank the Royal United Services Institute (RUSI) insisting that post-World War II “peace dividend” social spending must be slashed to release the required £40-50 billion per year.

The health budget has already been marked out for sacrifice, with Institute for Fiscal Studies Senior Research Economist Ben Zaranko writing in The Conversation last March, “Defence cuts effectively paid for UK welfare state for 60 years—but that looks impossible after Ukraine”.

Labour competes with the Tories as the “party of NATO” and chief advocate of war with Russia. Shadow Defence Secretary John Healey told RUSI that Labour would end all cuts to the armed forces and direct them to “where the threats are greatest… the Ukraine conflict and Russia’s wider aggression,” putting the UK on a war footing. “With a general election, there may be a change to Labour but there will be no change to Britain's resolve in confronting Russia’s threats, pursuing Putin's crimes and standing with Ukraine.”

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War is not compatible with a policy of social reform, nor with the preservation of democratic rights. It demands unprecedented austerity and savage repression. Workers must respond to the grave threats they face by mounting a struggle against capitalism, against war and for socialism.

They must seize control from the trade union apparatus. Rank-and-file committees, democratically elected, must be formed in every workplace, to unify the growing wave of struggles to bring down the Tories. This fight must be waged consciously as part of the growing outbreak of the class struggle in Europe and internationally against the austerity and war policies of the world’s governments, including mass protests and strikes in France and general strikes in Italy, Belgium and Greece. Unifying these struggles is the dedicated task of the International Workers Alliance of Rank-and-File Committees.

This industrial offensive must be linked to the demand for an immediate general election. Workers understand that the Tories cannot be allowed to remain in office. But many also know that Labour offers no real alternative. There is no way of bypassing this political crisis. There is an urgent need to build a new socialist leadership for the working class to politically organise the necessary mass movement against austerity, to defend the NHS, provide a living wage for all, eliminate COVID-19 and bring an end to war. The Socialist Equality Party is that leadership.