The hospital ancillary workers' strike is important not just as part of the general fight against the Freeze. It also reflects the grave crisis of the National Health Service 25 years after it was set up. For in spite of an annual budget of over £2,000 m., a real increase of over 25% in 15 years, the NHS is now less able than ever to meet the needs of those who use or work in Waiting lists for hospital beds now top half a million, yet due to staff shortages the number of available beds has been falling. People may have to wait for up to two years before gaining admission for some non-urgent operations. So it is not surprising that the private insurance companies are cashing in on the anxiety thus induced, with full page ads in the national dailies for their "queue-jumping' services. ORIGINAL N.H.S.
Even the original NHS was far from the model of perfection which the Labour Party prided itself on, But it did not then have to cope with the rapidly tising demand for its services which has taken place over the years. This can be traced back to four main factors. 1. The increase in the ratio of the very old and very young to the rest of the population; these requiring more attention from the health service. 2. The phenomenal rate of advance in medical knowledge, which is often accompanied by hughly expensive techniques such as kidney machines. 3. The higher expectations of a population whose standard of living was rising in other respects. 4. The rise in both physical and mental diseases caused by the stresses and tensions of life in advanced capitalist society.
During the years of the boom, and indeed almost up to the end of the sixties, it was possible to alleviate some of the pressures of this increased demand through increases in expenditure. The percentage of the Gross National Product devoted to health, for instance, rose from 4 to 5% during the sixties. But in the last few years, faced with a continuing crisis of profitability, British capitalism has had to seek new solutions to the problems of the health service which will enable it to direct state expenditure in more profitable directions. THREEFOLD REMEDY The Tory Government's remedy is threefold: to reduce demand, to raise finance from other sources than the Exchequer, and finally to rationalise ruthlessly the operation of the NHS. The way of dealing with the first objective has been to abolish welfare benefits or drastically increase charges for them. We have already seen the imposition of higher charges for prescriptions, spectacles, and dental treatment, putting them out of reach of an increasing number of working class families. In the near future we can also expect attempts to make 'hotel" charges for use of hospital beds.
Charges, running at £100 m. a year, are also an increasingly important source of revenue. Moreover, the increasing popularity of private medical care within the NHS can be expected to lead to an expansion of the facilities for private patients in NHS hospitals, with all the detrimental effects this will have on ordinary consumers in terms of longer waiting lists and reduced access to consultants, etc. Companies who organise their executives into private health insurance schemes already get tax relief for this purpose, and no doubt there is further scope for state encouragement of this practice.
PROPOSED RE-ORGANISATION However the main strategy of the Government lies in its proposed re-organisation of the service, which is being legislated in the present parliamentary session. The ostensible purpose of this re-organisation is to unify the existing tripartite division of the NHS (the three parts being the hospitals, the GPs, dentists, opticians, etc., and the local authority health services). There is no doubt among health workers that this ought to be done; but the Government have given the game away by not really carrying out this unification at all, merely renaming a whole lot of committees and authorities. Their real intentions were given away when they invited a top firm of American management consultants to advise them on it.
The underlying theme of the Government's Bill is managerial efficiency and cost minimisation. In other words, the streamlining of the NHS has the purpose of exploiting the existing facilities and workers to the maximum regardless of the quality of care which would ensue, or of the interests and conditions of the workers involved. All semblance of democracy will be done away with in the name of maximum delegation downwards with accountability upwards. Thus the centralised apparatus of the state will be strengthened, to ensure that the interests of the patient or the health worker do not override those of the state. And to avoid clashes with staff who put clinical considerations above 'efficient' administration, there is also an attempt to co-opt a wider layer of professional health workers into the management structure. Also a key component in a labour-intensive industry like the NHS is the question of wages. It is hoped that a more efficient management will be more successful in selling productivity deals to the ancillary workers, in spite of the chronic shortage of staff. Unfortunately union leaders are eager to collaborate in this, hoping that the higher rates will cover up the fact that for a long period of years they have allowed their members to exist on a poverty-line basic wage. Part of the present claim, for instance, is for a Et "lead-in" payment for those not yet under bonus schemes.
RESISTANCE However the Government's multi-faceted attack on the NHS is unlikely to be accepted without resistance. The newly-awakened militancy of the ancillary workers provides an excellent basis for a struggle against capitalism's attempt to solve the financial problems of the NHS at their expense.
In the last few months there has been a steady growth in the formation of stewards' committees and in unofficial rank and file groups like LASH. Among professional health workers, opposition is growing to the cynical way in which the Tories are subordinating the health of the population to the interests of the bourgeois state. This is reflected in the popularity of radical journals like Needle.
What is necessary now is to unite these currents around issues which expose the class nature of the NHS as part of the bourgeois state. This must be done in opposition to the line of the CP and the "lefts' in the unions, who call for more democracy and participation i.e. for an alliance with those forces whose interests are essentially opposed to those of the working class. To this end a campaign of action against private practice, especially within the NHS, would be an obvious starting point. This would also be extremely important in relation to the present struggle of the ancillary workers against the Freeze, since it would clearly make the direct object of their action the real enemy, ie. the bourgeoisie, rather than working class patients.
Health workers are in the best position to know what is happening to the NHS and to the health of society. By relating that to the general issues of the class struggle, it is then possible to understand the importance of raising the question of the crisis of the NHS among the working class as a whole, who alone can lead the struggle for a service which will meet the needs of society. Socialists in the women's liberation movement came together for the first time over the weekend 17/18 March in Birmingham, when over 300 attended a conference on Women's Liberation and Socialism. This marked a significant step forward in the development of the socialist current within the women's movement. On the first day various workshops were held. Discussion centred around general problems of Marxist analysis of the family under capitalism, sexism, Mariarosa Dalla Costa's pamphlet, Engels, etc. They showed that we still have a long way to go in developing an adequate theory and in clarifying our differences. STRATEGY The second day opened up a discussion on strategy. This focused firstly on the relation of the women's movement to the revolutionary left organisations. The main organisations represented (IMG, IS, CP) outlined their positions on women's liberation. However the discussion was mainly around the problems of male chauvinism in the revolutionary left and amongst male trade union militants, and was generally somewhat diffuse and inconclusive. The socialist women at the conference all recognised that a socialist revolution is a necessary pre-requisite for women's liberation, but there were various differences on how this would be achieved. The essential difference was between those who saw revolution arising out of the development of a whole number of different movements, including the women's liberation movement; and those who saw the need for a revolutionary party to centralise all such initiatives within one overall strategy.
Finally, the question of further meetings of socialists in the women's liberation movement was discussed. It was decided to hold a further conference to discuss the state of the movement and to evaluate campaigns and demands, in London on the weekend of 30 June/1 July. Margaret Coulson LONDON WORKERS AGAINST FREEZE The second meeting of the ad-hoc mobilising committee for the All-London Conference of Workers Against the Freeze was held last Sunday, 25 March, with just over 30 representatives attending. It was decided to hold the conference in two sessions, the first covering the present situation and the second concentrating on the way to deepen the struggle against the Tory Government and its policies. Several well-known speakers from the labour movement in London will be invited to speak at the first session, and already Briant's have agreed to provide a speaker.
The mobilising committee also agreed to pres-