Why The NHS Cannot Protect Our Health - Part 1

When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.

The pain in our shoulder comes
You say, from the damp; and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

A Worker's Speech To A Doctor – Berthold Brecht

In a new report out today The Health Service Ombudsman has delivered a damning indictment of the State Capitalist Health Service.

It concludes that it is failing to meet even “the most basic standards of care for older people”. Numerous case studies are provided graphically, detailing the way elderly patients in NHS hospitals were left not only without food and water, but left to lie in their own urine and faeces. Given that New Labour trebled the funding of the NHS, and Britain now spends the same amount on Healthcare as our European partners, where not only would such dereliction not be tolerated, but the general standard of healthcare and healthcare outcomes are much higher, these kinds of deficiencies can no longer be blamed on lack of funding. In fact, the report makes that clear. It comes on the back of the terrible disaster that was Stafford Hospital, the disgrace of rampant MRSA and C-Difficile, which has left many people worried about going to hospital for fear of it making their health worse rather than better.

Yet, workers are paying through the nose for this poor service. If it were for any other commodity we buy, we simply would not tolerate it. If it were a car that was this poor quality, and such a danger to our lives the company would soon find it had no customers. If it was a food store that had such poor standards of hygiene it would be closed down by the Council Health Inspectors. Yet, we tolerate it because it is the NHS, and as a virtual Monopoly we have no choice unless we are rich but to grin and bear it. In part, we do so, because the actual costs to us for this poor quality service are hidden from us. A large part of the cost of the NHS comes out of the taxes we pay such as VAT, which account for a much larger amount of our spending than we realise. Even that part, which comes out of Income Tax most people really don't have a real appreciation of. What we ought to have is a breakdown of where our tax goes. If the Government told us how much of our individual tax payments went to pay for the NHS, we would be able to compare that with how much it would cost us for a private health insurance.

As it is, and as I have pointed out before, the present system is no different than the Truck System which bad employers operated in the 19th Century.

Under the Truck System, workers were paid part of their wages in “Truck” or tokens that could only be used at the shops owned by the employer himself. This had the obvious drawbacks of such a Monopoly. The employer as well as extracting Surplus Value from the workers' labour power, also made a profit from being able to sell above the market value, the basic necessities the workers needed to live on, and which they could only buy from the employer. It also meant that the employer had an incentive to keep the cost of those necessities as low as possible, and so they lowered the quality of those goods through adulteration. Things such as chalk, for example were added to bread to make up its weight and bulk, and that was one of the least noxious things they used to use. Because workers had no choice but to purchase these things from the employer under the Truck System, they could not go to some other supplier who provided better quality. But, that is not as bad as the situation workers face today. Then workers could at least attempt to go to work for another employer, but whoever you work for today you cannot escape the Truck System imposed by the Capitalist State. It is illegal not to pay your tax if you are a worker, though of course Capital and the super rich can avoid it.

In the 19th Century, the Trades Unions, fought a bitter campaign against the Truck System, and eventually got it outlawed, but today, the Trades Unions rather than opposing the Truck System imposed on workers by the Capitalist State, defend it to the hilt. There is a good reason for that. The Trades Unions are imbued with a bourgeois reformist ideology.

Their function is not to fight for Socialism, not to try to move the working-class forward to a position where it can become the ruling-class, but is merely to bargain within the existing system. As part of that ideology it is compelled to view the State not as a Class State, there to protect the interests of Capital, but to present it as a class neutral body, acting in the interests of “society”. Of course, anyone who looks objectively at the Capitalist State can see that it is no such thing. Just look at the role of the Police during the 1984 Miners Strike, or indeed any other strike.

Look at the way that same Police Force, and the Secret Service spend millions of pounds infiltrating the workers movement, buying informers and so on, in order to undermine it in the interests of the capitalist Class whose instrument it is. But, things like the NHS are seen by the Trades Unions as a part of that bargaining process – even though the NHS like the rest of the Welfare State was actually the brainchild of, and creation of the Capitalists not the workers, and was set up precisely to meet the interests of Capital, and to undermine the attempts of workers to establish their own provision under their own control – they are seen as a few more crumbs off the table of Capital, and the only prospect it offers to workers, indeed the only prospect it can offer them, is that they might be able to persuade that Capitalist State to take a bit more “Truck” out of the workers wages in the form of higher taxes, in order to spend on the NHS!

But, there is another reason that the Trades Unions adopt this perspective. Today, 25% of the workforce are employed by the Capitalist State. The NHS is the biggest employer not just in Britain, but in the whole of Europe. The bulk of the Trades Unions membership is itself in the State Capitalist Sector.

What we have developing in Britain, and to an extent in other European countries, is a two-tier Labour Movement. It is rather like the two-tier Labour Movement in the 19th Century that divided unionised Craft Workers, from non-unionised unskilled workers. The Craft workers formed Labour Aristocracy, and were relatively, though not massively privileged in relation to unskilled workers. As a result they formed a conservative bulwark within the Labour Movement, not from the usual sense of that term, on the contrary, it was from this layer that much of the support for the creation of a Workers Party arose, but from the perspective that they had an incentive for defending the status quo, and bargaining within it, not for overthrowing that status quo. The same is true today. With such a large proportion of workers employed by the Capitalist State, and with the bulk of the Trades Unions strength focussed upon those workers, there is a massive incentive to defend the status quo, to defend the Capitalist State rather than to seek its overthrow, rather than to seek to undermine its power, and to build independent workers alternatives to it.

It is no accident that in Egypt, the bulk of support for the Mubarak regime, where a large State Capitalist sector existed from the time of Nasser onwards, came from those employed by that very State Capitalism, upon which their immediate livelihoods were drawn.

It is not surprising that when the pro-Mubarak demonstrations took place, it was not just police goons in plain clothes that were released, but that Government Departments allowed their workers time off to join the pro-Mubarak demonstrations. Nor is it any coincidence that in Jordan and elsewhere the first reaction of the regimes has been to raise the wages of State employees by around 15%! Capital understands the strategic importance of building a bulwark around its most important possession, the Capitalist State. Unfortunately, unlike Marx and Engels and Lenin and Trotsky, many of those today who claim to be their followers, instead of pointing out to workers the danger of a growing Capitalist State, have sown illusions in it, and encouraged its yet further growth.

Instead of encouraging the development of an independent working-class as Marx, Engels Lenin and Trotsky advised they argue against the idea of Workers' Property and in favour of State Capitalism. The reality of that approach is that it is outright treachery to the principles of Marxism and to the working-class, as Trotsky put it.

“What should be the policy of the workers’ party in this case? It would of course be a disastrous error, an outright deception, to assert that the road to socialism passes, not through the proletarian revolution, but through nationalization by the bourgeois state of various branches of industry and their transfer into the hands of the workers’ organizations.”

Trotsky – Nationalised Industry And Workers Management.

Now, of course the Lassalleans and Fabians who advocate the expansion of the economic role of the Capitalist State attempt to present themselves still in the camp of Marxism by tagging on the demand – or at least they used to, increasingly they simply advocate State Capitalism as a lesser-evil without any requirement – for Workers Control.

Marx in his Critique of the Gotha Programme set out why such a demand is meaningless, but Trotsky, more sharply defines what the implications of such a demand amounts to. He writes,

“The workers need control not for platonic purposes, but in order to exert practical influence upon the production and commercial operations of the employers. This cannot, however, be attained unless the control, in one form or another, within such and such limits, is transformed into direct management. In a developed form, workers’ control thus implies a sort of economic dual power in the factory, the bank, commercial enterprise, and so forth.

If the participation of the workers in the management of production is to be lasting, stable, “normal,” it must rest upon class collaboration, and not upon class struggle. Such a class collaboration can be realized only through the upper strata of the trade unions and the capitalist associations. There have been not a few such experiments: in Germany (“economic democracy”), in Britain (“Mondism”), etc. Yet, in all these instances, it was not a case of workers’ control over capital, but of the subserviency of the labor bureaucracy to capital. Such subserviency, as experience shows, can last for a long time: depending on the patience of the proletariat.”

Trotsky - Workers Control Of Production


And, of course that is essentially what we see, but worse. The Trades Unions and the Fabians and Lassalleans even without any measure of Workers Control associate themselves with the Capitalist State, and its defence in the way Trotsky describes here. Instead of class struggle AGAINST the Capitalist State, they engage in class struggle for its defence, limiting their struggle instead to a merely Economistic, sectional struggle for better conditions for the “slaves” within it! And, as Trotsky points out the idea that this Capitalist State like any Capitalist employer would ever concede any measure of Workers Control other than in the most extreme circumstances is completely fanciful, and can only act to mislead the workers. He goes on,

“However, a bourgeoisie that feels it is firmly in the saddle will never tolerate dual power in its enterprises. workers’ control consequently, can be carried out only under the condition of an abrupt change in the relationship of forces unfavorable to the bourgeoisie and its state. Control can be imposed only by force upon the bourgeoisie, by a proletariat on the road to the moment of taking power from them, and then also ownership of the means of production.

Thus the regime of workers’ control, a provisional transitional regime by its very essence, can correspond only to the period of the convulsing of the bourgeois state, the proletarian offensive, and the failing back of the bourgeoisie, that is, to the period of the proletarian revolution in the fullest sense of the word.”

Yet the Lasalleans and Fabians who raise the demand for Nationalisation under Workers Control, who limit their demands to merely a democratisation of State Capitalist property do so as though this is something that workers could here and now realistically demand from the Capitalist State!!! It is in Marx's phrase nothing other than revolutionary phrase mongering. The reality is as Trotsky implies here, Workers Control can only arise under conditions where Workers are already exercising some measure of ownership over the means of production, either through a revolutionary situation where dual power exists within the factories, or else where workers have already seized power, and exercise ownership over all property via their State.

In the meantime if workers wish – and they should – to exercise Workers Control, then it can only be via their own direct ownership of the means of production i.e. as Marx advocated through the establishment of Worker Owned Co-operatives.

The short answer to the question posed in the title of this post is that the NHS cannot protect workers health because that is not its function. The NHS just as much as the Police Force or any other arm of the Capitalist State does not exist to serve the interests of the Workers, and cannot be made to do so. Like the Police Force, it exists to serve the interests of Capital. Just as the Police Force in defending Capitalist property is led to defend workers homes – though usually much less diligently and effectively than it defends big Capitalist property – just as in attempting to effect social order in the interests of Capital, it is led to attempt to maintain some order that benefits workers – though it is working-class areas that suffer the most petty crime, violent attacks and anti-social behaviour – so the NHS in acting in the interests of Capital, also acts in ways that also benefit workers.

But, that is only a side-efect, a consequence of its aim to serve the interests of Capital, not its primary function. The fact, that it is old people, particularly, those who no longer serve any useful function for Capital, and who are in fact a drain on it, who are the ones who suffer most from the inability of State capitalist healthcare to provide even “the most basic standards of care” is, therefore, no coincidence.



But, that is not the whole reason why the NHS cannot and will not protect workers health. The report, after all, talks about the poor treatment and low standards being the product of a “culture” within the NHS, which ingrained. To understand why that is it is necessary to look at the nature of the NHS as a State capitalist monopoly in more detail.

Forward To Part 2