Tuesday 15 September 2009

Healthy Debate

I caught some snatches of debate at the TUC over Health. I don't intend to write a critique of the debate for the simple reason that I did only catch snatches of it. But, in one of those snatches the comments of one delegate struck me as symbolising what is wrong with much of the Left's attitude.

The delegate commented that the NHS had been transformed from the poor condiiton it was in in 1997 as a result of the billions of pounds of funding that had been pumped into it. She also said that the targets set had also had some effect in bringing about improvements, but then went on to say that now targets were having a negative effect. The comrade gave the example of A&E waiting times. The Government's target was that no one should have to wait more than 4 hours. Unable to meet this target she related how hospitals had resorted to keeping people in ambulances so that they were not registered as waiting!

Now, it could be me, but is it not a bit cock-eyed to be blaming targets for this situation? Having piled billions of pounds into the NHS, to bring its level of funding up to the same level as other socialised Healthcare systems in Europe, is it not reasonable to suggest that this money be used to achieve improvements for those that depend on the system? Is it actually unreasonable to demand that people should not have to wait more than 4 hours if they have had to resort to a visit to A&E???? I don't think so. Surely, what is unreasonable is that given the vast amounts of money pumped in, hospitals were still failing to meet such a basic requirement! Surely, what is unreasonable is the despicable attitude of hospital administrators, who fail to have regard for the health and welfare of patients by keeping them in ambulances so that they do not show up as waiting!!!!

In fact, those are precisely the same kinds of bureaucratic attitudes and actions that characterised the bureaucrats who ran the state owned enterprises in Eastern Europe, who went to ridiculous lengths to subvert the targets for production given to them rather than actually improve the efficiency of the plants they were supposed to manage. To be honest, we see similar things in large private companies where professional managers and bureaucrats try to look after their own personal interests, but there the private owners of these companies will only allow so much before they clamp down. The problem in Eastern Europe, and the problem in State Capitalist enterprises is that there is no means by which the supposed owners - the workers in one, "society" in the other - can exercise the kind of control that private owners can through a Board of Directors etc.

I've spoken elsewhere about the way in which State Capitalist bureaucracies work such as that in the NHS, and in Local Councils. My own area is not exceptional. One of the first things that happened after Labour made available huge sums for the NHS was a massive new building programme was introduced. At the local hospital already inadequate Car parking space was built over to accommodate new accommodation, making the parking even kore horrendous for patients and visitors. Then the bureaucrats ran out of money, and their first reaction was to make redundant hundreds of nurses!!! I saw the same thing at my local Council. From when I first started work there over 1,000 manual workers lost their jobs as part of CCT. At the same time the number of Managers and Supervisors increased!!! Every year during the Tories reign budgets were cut, and services to the Public were reduced. Yet, not one of the Accountants or Solicitors lost their job. Of course, as a Trade Unionist, you are not going to argue that such workers SHOULD lose their jobs, but as a socialist you have to question whether the function of a Council is to take large amounts of Council Tax from one group of workers, simply to keep a few other workers in jobs, whilst the workers who were actually providing a service get sacked!!!

Why, is it that such jobs get protected whilst the jobs of those providing the service get axed? Because the power, status, and salaries of the top bureaucrats is dependent upon the number of higher paid bureaucrats directly beneath them, not by the lowly paid minions who provide the service to the Public!

The tendency to try to subvert instructions is also indicative as I have said elsewhere of the problems of a directive planning system, be it bureaucratic as in the Stalinist states, or democratic as Trotskyists have suggested as some kind of miracle cure. In a sense the targets for the NHS ARE an example of such democratic planning. "Society" has democratically decided on a Governemnt committed to an expansion and improvement of the NHS. It has by the same means voted financial resources to achieve it, and set targets for the improvements it seeks. But, the fact that all of that has arisen democratically does not change one jot the fact that for those working in the NHS those targets and directives appear as instructions from above. Nor would it make any difference in that regard if this democratic process consisted of extensive discussions amongst all workers in a Workers State of such priorities, leading to the formulation of a Plan. The same thing applies to be carried out that Plan requires a set of instructions and targets then to be drawn up, and sent to each economic unit for implementation.

The fact that workers in any economic unit have been involved in that process is no guarantee that they will accept or implement the directives as they are handed down to them, any more than people necessarily accept democratically fomulated laws not to speed or use mobile phones whilst driving! Arriving at such a situation will take a long drawn out process during which what Marx described as the alienation of Labour withers away. It requires that worekrs see themselves not just as producers in one sphere and consumers in another, and that they do not see themselves as producers in this enterprise as opposed to some other, but as workers within one huge enterprise comprising the entire economy meeting their own as well as every other workers needs.

See: Alienation of Labour

But, the fact is that although Capitalism on the one hand creates the conditions for achieving this by replacing the individual labour of peasant and artisanal production with the collective and Co-operative production of the global division of labour, it more powerfully works in the exact opposite direction. It divides worker from worker in a myriad of ways within the factory, between factories, between industries, and between countries. Its little wonder that within the bounds of Trade Union struggle on the basis of Capitalist production there has been little advance in developing international workers organisation and solidarity, because the whole basis of Capitalism reinforces the most basic competition BETWEEN workers on a daily basis - hence demands such as "British Jobs 4 British Workers". Moreover, there is a great incentive for workers to take the attitude that they should do as little work for as much wages as they can irrespective of the consequences for other workers in the quality of the products etc. Such attitudes will not change overnight.

That has been demonstrated by some of the other debates at the TUC I have heard. Pretty much without exception I have noticed how little any of the contributions have to do with CLASS struggle or CLASS interests. Every delegate that has got up to speak has been concerned to advance their particular SECTIONAL interest. Of course, its not presented that way often. Delegates frame their argument in terms of why it would be good for everyone if there particular resolution were adopted, but the driving force behind it is to advance the interests of their particualr group of workers. Its a bit like the way things happen on Committees where the members basically take the attitude of look I'll support your proposal if you support mine. Lenin and Trotsky criticised that method of operating within the Second International, and there are many similarities. Just as an international programme cannot be simply an amalgam of various national programmes so a class programme cannot be simply an amalgam of various sectional programmes and interests.

Believing that "after the revolution" the simple transformation of property forms into collective ownership - still less state ownership - is going to change that is to court disaster. Had workers in Russia after 1917 taken an active interest in their vast majority in actually running the factories they were now the supposed owners of, then the bureacratisation could not have occurred. Change of ownership simply is not sufficient to change that mindset and level of class conscioussness in so short a period of time.

That is why only by workers now becoming the direct owners of the means of production, and running them on a Co-operative basis that requires their active involvement on a daily basis, only by breaking down the distinction between worker and owner so that as producers Co-operative workers have a direct incentive to work effectively and meet the needs of worekrs as consumers, only by building increasing links themselves between one Co-operative enterprise and another can that reproduction of competition between workers inseparable from Capitalist production be broken down. Only by such a change in real ownership and control of the means of production can the alienation of labour begin to wither away.

15 comments:

Anonymous said...

I have watched most of the TUC coverage, and I have to say I was hugely impressed with most of the politics on show, I just don’t see your sectional interests.

The NHS debate was partly party political, contrasting Labour with the Tories.
However, that doesn’t change your argument, in my area the hospital even charge for parking. And it’s a labour controlled area!!!!

I work in finance in the public sector and when we meet the front line service workers they say “Why is it we have less beans but more bean counters”. I have to say I think they have a point.

Having said that the Tories and now New Labour are promising that they will cut the back office services and protect the front line ones. And New Labour has been driving through efficiency savings for ten years now. Fewer workers are doing more and more work. The crazy thing is that the cost of monitoring this efficiency is probably greater than the actual savings!

I agree with your point that workers are incentivised to do as little as possible; this has increased now that promotion for work performance has been superseded by academic attainment. I suspect this may be an attempt to raise the value of management level work. Hasn’t Stiglitz made similar points to explain market inefficiency?

I have to endorse your concluding point –“Only by such a change in real ownership and control of the means of production can the alienation of labour begin to wither away.” Though I would have tagged on the end “and only then can a genuinely communist society be built”.

JamesT said...

Shouldn’t the board of directors, in say, local authorities be the elected members? Why do they not recognise this situation? What the hell are they doing!

Also do you recognise the fact that the state attempts to provide need where no market exists. The state could answer your inefficiency arguments by streamlining all services, delivering real value for money but achieving this by simply stopping providing some existing services. So it can then set targets against this reduced service.

Boffy said...

James, in theory yes the elected members should act like the Board of Directors, but in practice they don't, and nor can they. Having both worked for a Local Authority, and been a Councillor, I can tell you that this simply is impossible. The Council Permanent State machinery are the rrepresentaives of Capital. At best the elected members are reformist representatives of Labour. The power relations are simply such that all the advantage rests with the former.

The bureaucrats have an army of people behind them who have access to all the necesary data. It is the Chief Officers who formulate policy in papers to be presented to Committee. Committe Chairs have a symbiotic relationship with the Chief Officer, and in reality the Chair simply becomes a conduit for the policies developed by the Chief Officers. Where polcies are formulated by the political representatives, the Chief Officers can simply provide a mountain of evidence as to why those policies cannot be implemented if they oppose them, and can effectively frustrate them in operation if they are passed.

With Councillors in particular you are talking often about people with limited skills to understand or pick apart the vast quatitities of material put before them, especially as they normally have to hold down a job as well. They lack any kind of independent research or support. Although, Marxists recognise the fact that Parliamentarians have no real control over the state apparatus, at least MP's have researchers and other machinery to support them.

Only if representatives of a Workers Party were elected to Councils based on a large externally mobilised working class, capable of providing both the kind of altaernative view, and muscle for its impleemntation could those power relations be changed. Even then as the example of Liverpool demonstrated, the likelihood would be that taken as individual authorities the central state would intervene.

Yes, the state DOES provide for needs where no market exists - what economists call Public Goods, and externalities. But, it does this not because it seeks to act in the interests of workers, but because it works in the interest of Capital. Education and Health are both Public Goods, for which there is only a limited market. But, the Capitalist State does not provide these because it seeks to look after the needs of workers for these goods. That is why the quality of both is so poor, compared to their private provision in the market! It seeks to provide these services because Capital needs a relatively educated, relatively healthy supply of workers!

And it does, "streamlin(e) all services, delivering real value for money but achieving this by simply stopping providing some existing services. So it can then set targets against this reduced service.", and does so precisely because it is working in the interests of Capital.

That is why marxists should not tell workers to rely on this State to provide for these things, but should instead look to the working class bringing the provision of these vital goods and services under its own direct ownership and control as the only guaranteed means by which it can ensure that they meet the real needs of the workers, not the bosses!

Anonymous said...

We call value for money, shit but cheap!

Anonymous said...

How can a bureaucratic, non productive-heavy public sector serve capital? I would think it/they would want as streamlined a service as possible that delivered what it desires, i.e. more front line staff and less managers. I would also think that capital/capitalists would want the public sector to only be involved in areas that they could not make money from and only then if the cost of not providing was social breakdown or unrest of some kind.

Now I don’t doubt your arguments against some public sector provision and that direct worker control would bring better results but I can’t see how these bureaucrats serve capital, they just seem to serve themselves.
I also don’t fully buy the argument that the state is nothing more than the tool of the ruling class. I think governments or trade unions can act in the interests of workers, though without actually changing bourgeois social relations.

At the TUC an RMT delegate made the point that the rail networks were reducing the hours of cleaners to save money. This shows that in the ‘efficient’ private sector that efficiency is marked against what is being done but takes no account of what isn’t being done or what level it is being done at. (A point I unsuccessfully tried to make in the last comment). This demonstrates that socialist should be wary of labelling the private sector efficient.

Boffy said...

On sectional interest. Trade Unions by their nature are sectional. Their function is to promote the interests of a particular group of workers. In one debate a delegate actually began by saying "You might be wondering how I am going to manage to talk about my Dinner Ladies in relation to this motion"!

If you work in the Public Sector you will no doubt have a similar experience to myself, in which there was almost as much rivarly between NALGO (then UNISON) with the other unions at the Council as their was between unions and Management! When I became Branch Sec. I tried to overcome that by pushing as much stuff to the JCC as possible, and where possible suggesting joint union meetings of all members. Its why I favour concentrating on setting up Factory Committees, which can organise workers on the shop floor across union boundaries, and even pull in non-union members.

One of my first TU activities was when I was 19, and elected to serve on an ASTMS Negotiating Committee set up to negotiate a Spheres of Influence Agreement with CATU, the other main union in the Pottery industry. It was a nightmare, and even as a socialist you end up being drawn towards defending "your" union, advancing its interests, simply by the logical of the process, and by the fact that the other side is trying to do exactly that.

Boffy said...

“How can a bureaucratic, non productive-heavy public sector serve capital? I would think it/they would want as streamlined a service as possible that delivered what it desires, i.e. more front line staff and less managers.”...

Yes, of course it does, which is why it continually tries to achieve those things, by imposing targets, and where that does not work looking to see what it can privatise. Capitalism is full of such contradictions, the activities of Managers in private industry itself is an illustration of the problem.

“I would also think that capital/capitalists would want the public sector to only be involved in areas that they could not make money from and only then if the cost of not providing was social breakdown or unrest of some kind.”...

More or less. The industries that were nationalised in 1945 were core industries like Coal, Steel, Power and Transport that the Capitalist economy depended upon, but which were not capable of meeting the needs of that economy, because they had been run into the ground through lack of investment in previous decades by private owners. The first thing the government did was to severely rationalise them, close down dozens of pits, and then to put in the investment to make them more efficient, to meet the needs of the economy i.e. Capital. What it did not nationalise were those industries that were very profitable, and could have challenged the power of private Capital – the Car industry, the electronics industry, the Pharmaceuticals, and Petro-Chemicals industry or the Banks. Only when those industries themselves became unprofitable did it begin to prop them up and nationalise them.

”Now I don’t doubt your arguments against some public sector provision and that direct worker control would bring better results but I can’t see how these bureaucrats serve capital, they just seem to serve themselves.”...

They do both. Capital needs an educated workforce. It does not need a workforce educated to the level of the Capitalist class itself, which is why it can maintain a market based sector catering for the needs of the Capitalist class, and providing a higher level of Education and access to the top posts in the economy and State, but it does need workers educated to different levels of academic or technical proficiency. Experience tells Capital that trying to provide such Education through the market is ineffective, and probably unprofitable. It can only achieve this end if it is provided on a socialised basis, thereby ensuring also that it can compulsorily make workers pay for it from their taxes.

But, having been led into that option, it then has the problems that all provision of this kind faces i.e. the fact that it is bureaucratic, and that it cedes a great deal of power to those bureaucrats that run it. It is to use Marx’s phrase, part of the faux frais of production.


Cont'd

Boffy said...

”I also don’t fully buy the argument that the state is nothing more than the tool of the ruling class. I think governments or trade unions can act in the interests of workers, though without actually changing bourgeois social relations.”...

But Governments and Trade Unions are not, in a bourgeois democracy, part of the State. They are in a Bonapartist regime, and there might be a continuum running from Bourgeois Democracy to Fascism on which varying degrees of separation or incorporation of such organisations into the State can be identified. Yes, a Trade Union can win concessions from an employer under certain conditions, but as Marx pointed out, the employer will always by one means or another recoup those concessions where they fundamentally challenge the needs of Capital Accumulation. The same is true of Government’s. Governments can act as a political version of a Trade Union winning concessions from Capital as a whole, but such concessions will never challenge the basis of Capitalist power. The State whose function it is to implement them will always, neuter them in that process, frustrate them, and eventually if necessary overturn them.

In the extreme the State will do what it did in Chile, and simply overthrow the Government.

”At the TUC an RMT delegate made the point that the rail networks were reducing the hours of cleaners to save money. This shows that in the ‘efficient’ private sector that efficiency is marked against what is being done but takes no account of what isn’t being done or what level it is being done at. (A point I unsuccessfully tried to make in the last comment). This demonstrates that socialist should be wary of labelling the private sector efficient.”...

But, in the private sector it tends to be the case that what isn’t done is what does not add to profitability. Take the question of cleanliness. There has been virtually no incidence of MRSA or C-Diff in Private Hospitals. Some have no incidences at all. A couple of years ago my wife had a lump removed from her forehead on the NHS, but it was done at a local private hospital, because that was the quickest appointment. The difference in the provision there, even for an NHS patient, compared to the local NHS hospitals was amazing – rather like the comparison between the provision at a private Fitness Club, and the Council Leisure Centre. At about the same time, my Brother in Law had a lump removed from his scalp in the local NHS hospital. It was done apparently by one of the hospitals top doctors. A week later he had to go back in, because his head had swollen, a huge lump had appeared, which then burst. When they did the operation, they had not even bothered to shave that part of his head, and provided him with no antiseptic dressings and so on, which had resulted in it becoming seriously infected.
Why the marked difference? In the private hospital, if its not kept clean, if it has a record of infections and so on, paying patients will simply go to another private hospital that provides a better service.

Boffy said...

As an afterthought the comparison here between the hospital case and your railway case is the fact that a market exists in one, and not in the other. You can choose between several local private hospitals, but if you want to go between A and B, on the train you have to use those particualr stations and trains, however, dirty they might be.

Perhaps one reason that many people still prefer to use their own private transport to Public Transport!

JamesT said...

Can I just point out that I am not the other anonymous. For some reason JamesT didn't appear on the last message (sent 17th sept 9.37). I may have forgot to put my name down?

Boffy said...

Just for my own information James, are you JamesT of the Weekly Worker?

Anonymous said...

Boffy,

“On sectional interest. Trade Unions by their nature are sectional. Their function is to promote the interests of a particular group of workers. In one debate a delegate actually began by saying "You might be wondering how I am going to manage to talk about my Dinner Ladies in relation to this motion"!”


Ok but the TUC taken as a whole do form a coherent critique of capitalism and how it may be changed. At least this is how it appears at the conference.


“If you work in the Public Sector you will no doubt have a similar experience to myself, in which there was almost as much rivarly between NALGO (then UNISON) with the other unions at the Council as their was between unions and Management!”


Boy can I relate to this. I’m a Unison member and where I work the GMB has been suddenly trying to get members to recruit to them from Unison. We recently had a strike and the GMB advised their members not to strike, this split the workers with obvious affects. I have held a grudge against the GMB since.

It isn’t easy keeping an objective ‘what’s best for the class’ perspective when you are there on the ground.

Boffy said...

Well I'm sorry but nothing I've seen convinces me that there was anything coherent from a class perspective. All I have seen is an amalgam of different sectional interests, and your recognition of the existence of inter union rivalry - let alone inter industry rivalry - illustrates why that has to be the case.

Capitalism on a daily basis reproduces competition between workers at an individual, union, workplace, industry, regional and national level. That can only be changed by changing the basic social relations that lead to that reproduction - which is why Marx advised workers not to get hung up on these day to day Trade Union battles. But, those social relations can only be changed if the property relations on which they are based are changed.

In other words workers have to begin to claw back ownership and control of the means of production, by establishing Co-operative enterprises and structures. That is the fundamental basis on which Co-operation will repalce competition between workers in the workplace, in the Trade Union, in the Community and between regions and countries. Without that all hope of a socialist revolution is a pipe dream.

Anonymous said...

Not seperate interests but issues particular to that industry at a particular time. These issues, however, will affect all unions (workers) at one time or another, as they all basically face the same employement and trade union laws.
So an individual motion brought by one union will find support from others and the whole thing forms a coherent whole.

It's is misguided to suggest otherwise frankly.

That is not to say I don't recognise the limitations of many of these demands.

On the cooperatives I would think unions will become superfluous as coops increase, I guess this is one reason why the issue is not spoken about in the union movement.

Boffy said...

I don't deny that there are areas of commonality such as opposition to anti-union laws that would be to deny that there are shared class interests for workers as a whole. I simply state what is my experience as a socialist and Trade Unionist, an experiecne you have confirmed yourself in your relations with the GMB that on a daily basis Trade Unions represent sectional rather than class interests, indeed they often represent even narrower union v union interests!

In my series on "Can Co-operatives Work", I looked at the issue of the role of TU's in a Co-operative. There is considerable evidence that union bureaucrats, and some union militants actually attempt to frustrate the development of Co-ops because they undercut their function and power base. I think Gramsci related such evidence too.

There are clearly conflicts as my post on that illustrated, but they are by no means insurmountable. There needs to be mechanisms within the Co-op to deal with conflicts, but there also needs to be the potential for workers to take individual grievances to some external arbitration. The reason is obvious if the Co-op is run by all the workers and all the workers are in the union then logically Co-op decisions will be union decisions too. An individual who felt victimised would have no real internal resort for taking their grievance!

That's why unions have to continue to have a role within the Co-op. Moreoever, the Co-op cannot be a standalone. It has to be a part of the class struggle, offering support to other groups of workers, and the Trade UNion is a fudnamental means of extending that support.