Resist the government’s plans: For a socialist and democratic NHS

Statement from Socialist Alternative members in PCS and UNISON

The announcement by Keir Starmer and Wes Streeting of the intention to abolish NHS England is claimed to eliminate around 10,000 jobs, to  “cut down on bureaucracy” and bring the NHS “back into democratic control”. The reality and the motivation of the government is quite different.

Starmer, Streeting and co are seeking to emulate Donald Trump and Elon Musk’s slash-and-burn approach to government in the US, massacring enormous amounts of jobs in the name of ‘efficiency’ only to pave the way for more deregulation, privatisation and massive increases in military spending. Almost comically, this supposed ‘democratic’ move comes down as a governmental diktat at a time when the NHS and public services are literally crumbling and will do nothing to solve it. It clearly must be opposed on those grounds.  But what we need is a fully-funded and socialist NHS democratically run by and where decisions about resources are made by workers and patients.

The muted public reaction to this announcement, compared with anger over further cuts to benefits for sick and disabled people, is because most people don’t know what NHS England even is! Far from what capitalist laissez-faire gurus purport, the elements of marketisation of health services have actually made them LESS efficient. NHSE was one of the ‘quangos’ (quasi-autonomous non-governmental organisations) empowered by the hated Con-Dem government in the early 2010s to add elements of fracturing and semi-private control to public services like the NHS. The Health and Social Care Act 2012 that enabled it was a massive attack on the working class as a whole, pushing in this direction substantially.

It is clear there is a layer of private-sector-style management in NHSE, alongside some stereotypical state bureaucracy to manage the ‘Trust’ and ‘Integrated Care System’ models, which are the fault of both Labour and Conservative governments. However, this never seems to get cut, and what is reduced instead is operational management who oversee critical functions like organising patient waiting lists, specialist services and so on, services which have already been slashed to the bone.

For instance, under the guise of ‘corporate cuts’ to management dictated from the top, there have been cases where teams that monitor infection, listen to patient comments and so on have been completely eliminated from certain hospitals. Bigger and further cuts are undoubtedly on the way as many hospitals and NHS Trusts are underfunded and running at a loss. At the same time the lack of beds, massive short-staffing of frontline services and overwork of the existing workforce is shown in disputes like the current battle at Greater Manchester Mental Health where workers have taken strike action to demand increased funding for job creation of frontline posts.  

This shows the type of ‘democratic control’ being argued for by the government, which comes alongside a promise of a blanket elimination of thousands of positions to ‘avoid duplication’, is neither democratic nor solves the problem of eliminating real corporate-style bureaucracy that leeches off the NHS. 

At the same time, the government is following in the footsteps of its Blairite and Tory predecessors in threatening to slash an allegedly ‘bloated’ civil service. The reality is that the numbers of staff have increased because of successive governments’ policies creating more work for the civil service, such as the chaos around Brexit. 

The current civil service is run from the top based on political diktat and bureaucracy, rather than in the interests of fairly paying a proper benefits system, collecting taxes in a progressive way, managing the courts system, and so on. Many of these services are at breaking point due to years of cuts and demoralisation of the workforce. We need to oppose further job losses and demand a massive expansion of a real civil service, a system run to support society with public services available to everyone across the board. This means an end to cutbacks and privatisation. It also means an end to the ‘old-school’ top-down state bureaucracy, and instead introducing actual democracy into our services.

Democratic control of the public sector

Real democratic control means putting those who work in, and rely on, these services into the driver’s seat, those who have the real experience to discern and separate what is necessary from what is not. Instead of unaccountable management boards and quangos, all senior positions would be elected. They would be subject to the right of recall, so actual ‘poor performance’ could be held to account by holding fresh elections. Every NHS Trust and every branch of the civil service has numerous trade unions which elect their representatives every year. If we can do this among ourselves as a workforce, we can do the same for management. Democratically-elected representatives of patients in the NHS, of service-users in the civil service, and wider society would also sit on the decision-making bodies. 

In that kind of democratically run and socialist public sector, it would be able to allocate resources to where they’re most needed, expand frontline coverage and overall rebuild functioning public services which have been weakened through decades of attacks and attempts at privatisation. What the government proposes to do in fact opens the door to more privatisation and policies like increasing the amount of AI digitalisation all to the profitable benefit of private tech companies. 

As union members in PCS and UNISON, we see the government’s plans as part of a wider move by the government to further undermine the working class and the trade union movement under the veil of populist demagoguery. This lines up with an increasing shift to the right by Starmer and Labour since taking power, trying to out-Trump Trump and out-Reform Reform UK on a whole slate of issues from the NHS to immigration. Our trade unions have to resist every step in this direction and put forward a programme that speaks to the needs of working class people, not billionaires and millionaires inside or outside the confines of Westminster. Hand off our NHS! Stop cuts to public services! For a fully-funded, democratic and workers’ controlled health service and a fully-staffed civil service, run for people not profit.

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