Business methods undermine health service

In recent years there have been a number of sinister changes in the National Health Service. The use of deliberately deceptive rhetoric employed in the 1989 White Paper Working for Patients has tried to disguise the fact that the NHS is becoming increasingly subjected to market forces to the detriment of patient care and is becoming increasingly undemocratic. Expressions of dissent are stifled by getting rid of medical and nursing staff who protest at the deterioration in health care.

With a record 1.07 million people on the waiting list for treatment and an estimated two million people waiting for their first appointment before they can even join an official waiting list (Guardian, 7 May), it is clear that there is something seriously wrong with the health service.

Of more serious concern is the fact that so many people are ill. Poverty is the main contributory factor of ill-health and the increase in morbidity rates in recent years reflects the attacks on the living standards of the workers and the continued high rates of unemployment caused by capitalism’s slump.

Almost half the health trusts are failing to reach their financial targets and in 1992-93, £265 million had to be borrowed from the government or from banks and underwritten from taxes (Observer, 22 May).

To try to save money the Mancunian Community Trust is sending letters to its staff asking them if they want to take breaks to start families, take up courses or work overseas. All of these options are cheaper than redundancies, but the Trust’s chief executive Elizabeth Law has warned that if the workforce cannot be reduced by voluntary means then people may have to be forced out (Manchester Metro News, 27 May).

More bureaucrats
Administrative costs in the internal market have risen from four percent in the mid-1980s to eleven percent of NHS spending by 1993, and there are now half as many administrators and clerical staff as there are nurses in British hospitals.

In fact, when one considers that nurses work a three-shift system to cover 24 hours a day, seven days a week, there are actually more clerical and administrative staff working in hospitals on weekdays than there are nurses.

The Health Secretary has the power to appoint the general managers of large hospitals and the chairpersons of trusts are political appointees: Ann Parkinson, Sheila Taylor, Sarah Biffen and Mary Archer, all wives of well-known Conservatives, are on the boards of trust hospitals. The government has succeeded in pushing through unpopular measures by political appointments and patronage. Thus, lacking control of local councils in many areas, Conservative ideology can be imposed on the electorate which would have been opposed by councillors on the old boards.

The NHS has never been particularly democratic. Nurses have been subjected to a para-military, hierarchical management which has placed them in a subordinate position to medical staff. A questioning attitude has been discouraged; speaking out considered “unprofessional”. Consequently, very few nurses have spoken out about shortcomings in the service or their terms of employment. In the past, large numbers of immigrant nurses were dependent on hospital employment for a place to live and continued stay in this country. And this made criticism extremely difficult because of the risks of speaking out.

Doctors have always been in a privileged position in terms of pay, status and power in the NHS and have been able to speak up for their patients. But in the last fifteen years this has begun to change. Doctors who speak out about shortcomings in their hospitals now risk disciplinary action being taken against them.

Disciplinary action
Early in 1990 Dr Helen Zeitlin, a consultant haematologist at Alexandra Hospital, Redditch spoke at a public meeting against the hospital becoming a self-governing trust. She also criticised the shortage of nursing staff at the hospital (Guardian, 10 May 1991). In November 1990 Dr Zeitlin was told that disciplinary action would be taken against her for misuse of a nursing report on staffing levels. Redundancy was then proposed, only to be changed for a different set of disciplinary charges. These charges were then dropped and Dr Zeitlin was made redundant with 24 hours notice instead of the usual three months.

Hospital bosses sometimes go to extreme lengths to silence critics. Dr Bridget O’Connell worked as a consultant paediatrician at the King George Hospital, Ilford from 1977 until the end of 1982 when she was suspended because of her alleged “inability to relate effectively with clinical colleagues”. Significantly, this occurred after she had complained to management of her concern about the standard of care within the paediatric service. For the next eleven-and-a-half years Dr O’Connell remained suspended on full pay of about £50,000 a year before the North Thames Regional Board withdrew all allegations, apologised and paid damages believed to be a six-figure sum (Guardian., 7 May).

A doctor was dismissed in 1993 in Cornwall for misconduct. Nurses had pressure put on them to keep secret diaries of her activities to provide evidence which could be used against her (Nursing Times, 13 April).

The row caused by the disclosure that a consultant in Luton, known to be opposed to trusts, had his telephone bugged by the chief executive forced junior minister, Tom Sackville to intervene. He stated that anyone “bugging” a telephone will be sacked but that individual employers have to decide whether to include confidentiality clauses in their contract of employment (Manchester Evening News, 24 May).

Most nurses have not seen the NHS executive Duncan Nichol’s guidelines on reporting incidents which give rise to concern over treatment or staffing levels, and some NHS trusts have introduced catch-all gagging clauses into nurses’ contracts to prevent them from speaking out, although barrister Michael Douglas has stated that some of them are so broad as to be meaningless (Nursing Times, vol.90, 1994).

Spying, illegal telephone tapping and the use of disciplinary action to silence critics all add to the climate of fear and mistrust pervading the health service. For health workers the message is clear: to speak out against the undemocratic, anti-working-class measures is to risk the sack.

Business methods can never operate in the interests of the workers; the whole history of capitalism has shown that misery always follows in its wake. The NHS, in its slow but inexorable move towards private health care, is showing all the ugly features of capitalism. Only by workers uniting to get rid of capitalism can we stop the misery that the system imposes on our lives.
CARL PINEL