NHS at 75: How can we save the health service

Editorial of the Socialist, the paper of the Socialist Party England and Wales issue 1233

For more on the NHS crisis in Scotland see this article.

As we go to press, Rishi Sunak is trumpeting his upcoming ‘big’ announcement on the NHS. [He set out plans over 15 years to recruit 300,000 more NHS staff in England and zero pledges on impriving the pay of NHS workers]

The idea that this out-of-touch millionaire head of a dysfunctional government and a party tearing itself apart can save the NHS is sick.

A new report by the King’s Fund found that the Tories are killing the NHS. Comparing the NHS to other countries’ care systems found that it had fewer key resources. The cost of decades of Tory – and New Labour – governments’ underinvestment, privatisation, reorganisation and cuts is falling life expectancy, poorer health, and people’s lives lost. The Royal College of Emergency Medicine found that long A&E waits contributed to 23,000 excess deaths in 2022. [In Scotland, the NHS has seen year-on-year cuts with record waiting times and waiting lists under the SNP.]

The King’s Fund reported that the UK compares badly in terms of physical resources and capital investment. It has ‘strikingly’ low levels of clinical staff, whose “remuneration… also appears to be less competitive”. Greece has 6.3 doctors per 1,000 people while Britain has just three. The report also found that the pandemic hit treatment waiting times far harder in the UK than in other countries.

As a result the NHS has become synonymous with waiting lists and crisis. A return to a pre-NHS situation is posed: healthcare only for those who can afford it, and sickness, poor quality health and stunted life expectancy for the majority. The health bills bankrupting US workers and Big Pharma’s opioid pandemic tell us what could lie ahead.

But the National Health Service is the biggest social reform the British working class has won so far. Health worker strikes point to what is needed to defend its existence.

The 75th anniversary must be seized as an opportunity for discussion and debate, among campaigners, trade unionists, socialists and all defenders of the NHS, on how to organise the working-class collective action necessary to save our health service – and to rebuild it.

The NHS is a product of mass workers’ struggle

War and economic crisis dominated the years preceding the foundation of the NHS in 1948, exposing the capitalist class’s inability to provide the promised ‘land fit for heroes’.

Huge waves of workers’ struggles included the general strike in 1926. There were also international examples to inspire workers to get organised and fight back.

In the 1917 Russian revolution, the working class broke with capitalism – a system aimed primarily at realising private profit, not satisfying the needs of society or the planet. The working class in Britain gained confidence and built the trade unions and the Labour Party.

In 1945, the working class found an expression of its unwillingness to continue paying the price for the bosses’ crisis in voting Labour. Fearing the working class’s appetite would grow with the eating, and workers would build a movement which could threaten their right to rule, the capitalists were forced to make concessions – including the NHS.

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.

But the economy and society generally were left in the hands of the capitalist class. Therefore these historic gains faced and continue to face constant attack.

Build a new workers’ party to fight for NHS

The need for the working class to organise, build its own party and develop its programme for ending poverty and exploitation – key factors in ill health – is also a feature of the situation today.

From its inception up until Blairism, Labour was a contradictory party. On the one hand, Labour’s leadership was not in favour of breaking with capitalism – which in the end means the working class must pay the price. But Labour’s working-class base could organise to put pressure on the leadership. Socialists played a leading role in fighting for this.

Under New Labour, Labour became an out-and-out pro-bosses party. This is Keir Starmer’s model too. A Labour government will not resuscitate the NHS because Keir Starmer is determined to prove his party will act in the interests of the bosses. That means a continuation of the policies that are killing our health service.

Starmer doesn’t support workers’ strikes. Jeremy Corbyn’s supporters and policies are being purged. Corbyn’s manifesto pledges, including public ownership, raising funding and expanding “healthcare free at the point of use: free dentistry, prescriptions and car parking in NHS England”, are gone.

Instead, shadow health minister Wes Streeting has said that it would not be “responsible or credible” for Labour to say it would “pour more resources in” to the NHS. Saving the NHS will require mass collective action, including the building of a workers’ political alternative.

The Socialist Party campaigns for a new mass workers’ party, and calls on the trade unions and Jeremy Corbyn to take steps towards its creation. The Socialist Party’s participation in the Trade Unionist and Socialist Coalition (TUSC) is an important part of that fight. That includes standing TUSC candidates at the general election, if preparations are not made in time for a union-backed stand with more authority.

For a socialist NHS

The weaknesses that were built into the NHS, concessions to capitalism, must not be repeated. Pharmaceutical medical supply and hospital construction industries were left in private hands.

The extraction of massive profits still undermines the health service. It is necessary to fight for the nationalisation of these industries under democratic workers’ control, with no compensation to the fat cats. All the profiteers must be kicked out of the NHS and care services.

The King’s Fund report concludes that the inability of healthcare services to meet people’s health needs is a universal phenomenon, just to varying degrees of crisis. But this is part of a general picture of capitalism’s failings.

One third of the world’s population do not have enough to eat. Even in the richest countries in the world, the living standards of the majority have been falling, or at best stagnating, for many years.

Ill-health is a product of all the attacks on working-class living standards – including low pay, poor housing, unhealthy food, stress, poverty, inequality, and all the ways big business pollutes and abuses our environment. The fight for the NHS is therefore inextricably linked to the fight to transform society in a socialist direction.

The Socialist Party fights for a new party to have a socialist programme to be capable of liberating humanity from poverty, inequality and exploitation. This could unite all the sections of the working class against the Tory attempts to divide us along lines of race, gender, age, etc.

Taking the top 150 companies and the banking system that dominate the British economy into public ownership under democratic working-class control and management would be a good start. This could lay the basis for establishing a democratic socialist plan for the economy, based on the interests of the billions not the billionaires, and of protecting the environment.