Kate Ahrens, a health worker and shop steward in the Leicestershire Health branch of the public sector union Unison, spoke to Solidarity in a personal capacity about the issues facing health workers.
Working in the health service, it’s easy to think that everyone is as aware as we are of the huge threat posed by the Health Bill and the ongoing cuts and attacks on the service.
But I suspect that the wider public have very little idea of what is coming their way.
Waiting lists are going to spiral out of control this winter as bed closures and staffing cuts mean that operations will be cancelled over and over again to make some room for the emergency medical admissions over the winter months. And once the service begins to decline, the pressure to bring in private management to “sort out” our “failing” hospitals will grow.
Never mind that the failure has been deliberately engineered by government policy or that private companies will be just as bad at managing the insufficient resources. And private health companies are licking their lips at the huge profits to be made from selling private top-up health insurance to the middle class “worried well” who will want to ensure that they can have access to medical care whenever they want it while the poor are left to wait or do without the care they need.
The union’s propaganda on this issue so far has made some reasonable efforts at describing bits of the attack.
What it’s been very weak on however, is identifying any ways, beyond writing to your MP, to fight against it.
The union’s demands on safeguards from the government are just wrong. While Unison is busy demanding that the NHS remains “free at the point of use”, the real socialist aspect of the NHS (that care was planned based on an assessment of the health needs of the population) is being done away with.
Now, the consideration hospital trusts make is “what care can we get Primary Care Trusts to pay for?”, not “what does the local population require?”
And GP commissioning will cement the idea that competing for money is the way to organise healthcare resources.
The NHS is far from being perfect, but the core aspect of it that we should be fighting to keep is precisely the idea that the Tories desperately want to get rid of: healthcare provision planned to deal with the healthcare needs of the whole population.
This isn’t just a fight for those working in the NHS, but for everyone who uses the health service. My fear is that we will only wake up to the importance of this fight after its too late.
On top of all that there’s a pay freeze which was accepted by all the unions without any fight at all. There are threats to our pensions both in terms of our contributions and the benefits. They will extend the period we will have to work for at least another five years, and more for the younger members of the workforce.
There is also the Health Bill, the implications of which are only just really being revealed. On top of that there are the cuts to services, the staff shortages, the constant reorganisations, and the perpetual battle for resources which makes just getting through each shift and giving the care that you want to give a struggle.
The fight over pensions isn’t the biggest issue in people’s minds. I would imagine that staffing levels are probably more of an immediate concern.
Of course, people are angry at the attack on their pensions. But there are such vague signs coming from the national unions about a fightback that the temptation is to assume that the battle has already been lost.
There is also a lot of personal fear: the NHS seems to be in a permanent state of reorganisation so that everyone is slightly off balance: worrying about their jobs, worrying about keeping their flexible working arrangements. Will they be moved to a different ward, a different site, a different speciality, downgraded etc.?
So I haven’t heard a lot in the way of militant anger from health workers, which is what we need.
Unison’s national approach to the pensions issue has been nothing short of despicable.
Dave Prentis bolstered his image inside the union in the run up to national conference by appearing to be militant and radical over the pensions issue and using all kinds of fiery language.
But the move to separate scheme-specific negotiations without having won any concessions from the government in the joint talks led us into a blind alley.
Health workers have had no kind of national dispute for decades and I think its extremely unlikely that a ballot for action focused only on health would be successful. But the national union’s strategy appears to be solely focused on winning a minor concession or two in Local Government, in the hope that this will appease what’s seen as the more militant Service Group in the union.
I think the only hope for health workers to avoid this fate lies to a certain extent outside of our hands.
It relies on Local Government workers not being prepared to be bought off for the rubbishy deal that will be offered to them.
A ballot for industrial action in Local Government, against a better deal than the one being offered to health workers, might just be the thing that could galvanise a mood for a fightback in health.
The initiative from Camden, Tower Hamlets and Kirklees for a branches-based conference on 24 September to discuss the pensions issue it is significant, although I think its a shame that its not reaching out across the service groups more. The left has spent a long time in Unison hemmed in by the anti-democratic rule book which prohibits branches talking directly to each other. The pensions issue has finally broken past that.
However, it’s easy to get carried away. This is still a very small minority of branches and until we can stretch beyond the “usual suspects” of left branches then this new found channel for democratic discussion is extremely vulnerable.