The 24 November march to save the A&E and maternity services at Lewisham Hospital in London was a tremendous demonstration of anger and opens up an opportunity to build a serious fight against NHS cuts.
If this cut goes ahead — triggered by a debt run up under a PFI scheme in a neighbouring NHS Trust — three quarters of a million people in this part of south London will depend on just one A&E department. Working-class people on the demonstration knew from their own experience and that of their relatives, neighbours and friends what this cut means. People will die.
The Lewisham demonstration will encourage other emerging and existing campaigns, especially where A&E departments are under threat, at Trafford General in Manchester and north-west London for instance. That is just another reason why the Lewisham campaign must win.
To win the campaign needs the best strategy. The history of struggles against hospital closures shows the most effective way to fight is to organise occupations.
Such action goes beyond the essential petitioning, demonstrating and other forms of public protest or even strike action by hospital workers.
In an occupation workers take over a threatened building or service and keep it running normally 24/7. Backed up by support in a local community, an occupation can stop management from closing down the threatened service.
An occupation also draws attention to the politics of our campaign. Tory and Labour governments pushed through PFI in order to provide risk free profits to the super rich. For every hospital built under PFI we end up paying for two. We are now losing our hospitals because another bosses’ government wants to honour those financial bits of paper.
Did we agree to that? No! While the bricks and mortar exist, and the skills and expertise exist, we have the political right to do everything we can to preserve those things.
Some activists, trade unionists and socialists involved in the campaign will already know the rich history of hospital occupations. We urge those who don’t to read on and find out more. And soon. The public “consultation” by the Special Administrator appointed to oversee these cuts ends in February.
Occupations put continuous and forceful pressure on managers to keep providing services they want to take away.
Occupations put control of the service into the hands of the workers — for example they can organise to run a full service instead of one that is being run down in preparation for closure.
All workers in the hospital can get involved in an occupation, whatever their union or position in the hospital “hierarchy”. Unorganised workers can get involved. Staff not directly employed by the Trust can join in.
An occupation will be the organising hub for the broader campaign, helping to build support for other actions, demonstrations, press conferences…
An occupation is better able to tackle the obstacles put up by managers. It can be a means to create a coherent and democratically-organised campaign. With inclusive organisation and clear lines of communication, an occupation can give the workers in the hospital and their supporters in the community a real say over the direction of the campaign.
An occupation can become an alternative driving force and counterweight to the local politicians who want to take over and stop any form of militant action. In Lewisham we can challenge the Labour councillors who are making £30 million of cuts — much of which will impact badly on people’s health!
The physical, financial and moral support of people in the local community is essential to keep the occupation going. But an occupation also adds sharpness, drama and purpose to the broader campaign of demonstrations and protests.
People who depend on threatened services will feel strengthened in their resolve to be part of the campaign.
Some on the left are advocating workers’ strike action. Strike action, if it can be achieved, could put pressure on hospital management and be a powerful demonstration of opposition. But it does not make sense as a be-all-and-end-all strategy.
The impact of a 24-hour strike with emergency cover would be limited. Once the strike is over, what happens next? It will not have the dynamic campaign-building potential of an occupation.
All-out strike is very difficult, and probably impossible to organise in a hospital where essential life-saving and sustaining services are provided. Providing emergency cover (i.e. minimum staffing) is not an answer in departments like the A&E, because they are by definition emergency cover departments!
Strikes, whether token or indefinite, are not the only form of struggle in working-class history. Work-ins and occupations also have a central place. The centre pages of this paper explain more.
Much more is at stake in Lewisham than the closure of one A&E and a maternity service. If Lewisham wins, we can go on to stop other A&E closures, other “rationalisations” of maternity services. We can hold back the privatisations that are now coming thick and fast in the wake of Tory reforms of the health service.
We can demand and win the cancellation of the PFI debts. We can win back the health service the vast majority want.
That is a publicly owned, funded and accountable service, which meets all our health care needs, and which is free at the point of delivery.
Occupations: the lessons we can learn
Occupations, or work-ins, are a sharp tool to be used by workers who want to continue to deliver their service in workplaces threatened with closure.
They assert control of the workplace and stop, or hinder, the bosses running it down bit by bit. They act as a centre for community mobilisation in a way that strike picket lines almost never can.
Work-ins where workers continue to be paid can be kept going for longer than strikes in which workers lose the wages they live on. In sectors like the health service, where strikes are never long or complete, and do not hurt bosses' profits, work-ins are often better for building wide support.
Although occupations are in fundamental ways more radical than strikes — asserting workers’ control of the workplace, rather than just a suspension of the economic exchange between worker and boss — they are also, paradoxically, sometimes easier to get going where union organisation is weak.
A determined minority can declare a work-in, and then have the force of inertia helping it rally wavering workers to work along with it, in circumstances where that same minority would only isolate itself by striking and leaving the waverers still at work.
Last week’s Solidarity looked at the occupation of the Elizabeth Garrett Anderson Women’s Hospital (EGA), which ran for almost two years in 1976-8 and successfully reprieved the hospital.
EGA had a national reputation, and the occupation had the support both of the women’s movement and of senior staff within EGA. Management made no attempt to break the work-in beyond piecemeal efforts to demoralise the occupiers and their supporters and further run down the facilities.
Not all hospital work-ins are like that. Hounslow Hospital, for example, was different.
In January 1977 it was finally announced that Hounslow would close in August. Committees had already been campaigning against the closure plan for some time.
By March a work-in was under way. Management tried to transfer staff to other workplaces, threatening those who refused with sacking. They urged GPs not to transfer patients to Hounslow.
Workers continued to get paid from March up to the August closure date. In August, they organised a demonstration and a party for the patients. The closure date passed and the work-in continued.
The law said that as long as there were patients there, being cared for by staff, the Area Health Authority had a responsibility to pay the staff and maintain the hospital. The AHA tried to get round the law but couldn't.
At EGA, consultants taking part in the work-in could admit patients. Hounslow was dependent on GPs referring patients. The AHA was turning patients away and had cut off phones. There were very few consultants in the occupation, and the traditional hierarchy of authority in the hospital had been broken down much more.
In October 1977 a team of district officers took forcible action by removing patients themselves, with police help and using private ambulance staff rather than NHS ambulance workers. The only phone line in the hospital was cut. (These days, occupiers would have mobile phones).
21 patients were dragged from their beds and put into private ambulances. Wards were trashed, and elderly patients were treated in a demeaning and degrading way.
A week later 2000 hospital workers struck and picketed the Ealing, Hammersmith and Hounslow Area Health Authority, protesting against the raid and demanding the hospital be reopened.
The AHA was forced to censure its own officials who had sanctioned and carried out the raid and to call for a public enquiry. David Ennals, then Labour Health Minister, refused the call.
The occupation of Hounslow Hospital continued for a further year to November 1977. The buildings were used for community campaigning and as a base for a national campaign to defend the NHS.
The occupation of South London Women’s Hospital for a couple of months in 1984 was different again.
South London Women’s Hospital was much smaller than EGA. The work-in began in spring 1984, when the threat of closure was announced by Wandsworth Health Authority. By July consultants were admitting fewer and fewer patients. Then they were offered transfer and the work-in ended.
Nurses and other staff wanted to fight on and with the support of local activists they called for a sleep-in as the last patient was moved from the hospital. Their aim was to keep the buildings in good repair and equipment on-site in the hope the hospital would be reopened.
For nine months hundreds of women from all over London and beyond, women from Greenham Common and Women Against Pit Closures joined the sleep-in. It lasted until March 1985, when police raided the building and physically removed the occupiers.
The occupation at University College Hospital, London, in 1993 was different again.
On 15 September 1993, in the middle of a strike over cuts and closures at the hospital, ward 2/3 in the Cruciform Building was occupied after management had emptied it of patients ready for closure.
The occupation was started by some local people and three striking nurses who, the day before, had been on a picket line where the idea to occupy was suggested by an SWP full-timer as a one-day stunt to get publicity. The occupiers decided to continue the occupation indefinitely after Eddie Coulson, a full-time Unison official, turned up to the occupation at 1 am, flanked by hospital managers, with the clear intention of getting everyone to leave.
Coulson declared that Unison members would be disciplined for taking part. He offered to call off the strike and promise everyone would be back at work within 36 hours if the hospital CEO would promise to drop disciplinary threats.
On the morning of 16 September, the strike committee remained divided about the occupation. During a strike rally that day, all the strikers went up to the ward in an act of solidarity with the three nurses already in there. The idea was for them all to walk out together, united with the three nurses.
The three nurses refused to leave and started an emergency meeting to discuss the urgency of the situation and a proposal to take over another ward. Around 1000 people were outside at a rally, but marched off to Whitehall joined by most of the strikers and leaving no-one on the picket line. The hospital managers went in to close another ward.
Eventually the news got to the marchers, and they made their way back to the hospital.
On their return, some of the strikers took over the CEO’s office, occupying it for a while, and others joined the ward occupation. Many of the strikers held a meeting. After hours of discussion they decided to back the occupation.
From 1976 through to 1984 there were around 32 occupations or work-ins in hospitals and wards around the country.
It was a time when, starting with the Labour government after the economic crisis of 1974-5 and continuing with Thatcher’s Tory administration, the National Health Service was being cut back on a large scale for the first time since its foundation in 1948.
It was also a time when the idea of occupations and work-ins was current in the labour movement. Such things were unknown in Britain between the 1930s and 1971; but then, between July 1971, when a work-in started at the UCS shipyard in Glasgow, and December 1975, nearly 150,000 workers took part in over 200 occupations.
The Labour government’s turn to harsh cuts in 1976, under the terms of a crisis deal with the IMF, and then the Tory election victory in May 1979, dammed the flow of factory occupations. But the idea won new strength in the health service, where workers and communities felt more confidence about saying that closures could be stopped.
In 2013 we face bigger cuts to the National Health Service than in the 1970s and 80s. The Tory/Lib-Dem government plans £20 billion of NHS cuts, and their effects will be worsened by the Health and Social Care Act passed in March 2012.
In the past, usually hospitals threatened with closure were run down for a period before the axe actually fell, often before any consultation had even taken place. In 2013 we see Lewisham Hospital’s A&E slated for closure just months after being refurbished, on the sole grounds that PFI payments to private contractors have driven the South London Healthcare Trust into bankruptcy, something that was not possible in the NHS of the 1970s and 80s.
We see services being cut while at the same time billions are being handed out to private profiteers leeching off the Health Service.
Potentially this time too we could see the idea of occupations spread from the factory sector — Vestas, Visteon, and Prisme Packaging in 2009 — to the Health Service.
Occupations are not a one-size-fits-all magic solution. Demonstrations, protests, pickets, petitioning, and many other tactics will be required as well as occupations to stop closures of hospitals and wards.
In every dispute and campaign, workers have to consider which is the right tool for the job.
For workers in the emergency services such as hospitals, especially Accident and Emergency units, strikes are not usually not the right tool, or they are at best only a secondary tool, used from time as a form of demonstration and protest rather than economic pressure like a strike in a factory.
In 1982 nurses called on the support of thousands of miners and industrial workers, directly appealing to them to for solidarity strike action. Miners, printworkers on national newspapers, and others came to their aid.
That sort of solidarity strike could help now, but requires a high level of confidence and organisation in the trade union movement, especially as solidarity strikes now face legal barriers which they did not then.
It is not likely to happen without the campaign previously being developed to a high level through other tactics, which should include occupations.
Lewisham: how we mobilised
By a Lewisham healthworker
The demo on Saturday 24 November in defence of Lewisham Hospital had a great turnout. It took us a while to realise that.
Even though the campaign had distributed over 65,000 leaflets advertising the demo, Saturday dawned cold and rainy. Stewards starting gathering from 11.30am. By 1pm, we were beginning to feel disappointed at a small turnout.
But the advertised start wasn’t until 2pm. By 1.45pm the staff contingent which I was part of had been ushered to the front of the march. My colleagues didn’t get there until 2pm. By then the crowd was so thick that I had to scramble back over fences to find them.
As we headed off, it was hard to tell how big the march was. But when we got to a straight stretch of road, the line of people stretched back further than we could see.
The traffic in Lewisham came to a standstill. Bus after bus was stranded. Without exception drivers honked and waved in support despite the disruption.
The mood of the march was upbeat, but serious. Many people had their children with them, straining their voices to shout the loudest in defence of the hospital..
As we got to Ladywell Fields, our contingent had drifted back into the march, and we weren’t sure how much of the march was still behind us. There were plenty of people already in the park, and a crowd gathered expectantly around the stage. As we approached the stage, an announcement was made that the speeches would not start yet — because the end of the march was only just arriving back in the town centre, near the start of the route!
The placards were soggy and threatening to fall away from their wooden poles by this stage, and the grass in the park was churning into mud.
The delay was too much for one of my children. He fell over in the mud, I knew his friend would encourage them both to roll around in it, so we had to miss the speeches and head for the staff club.
By the time we got there all the seats downstairs were gone, and people were tucking into the buffet. The children ran around upstairs, but the place was soon full to the brim.
An impromptu meeting was held. Everyone took heart from the show of support. The idea of strikes and occupations was discussed, and we agreed that to hold a rally outside the hospital at lunchtime on Wednesday 28th and every week. The staff campaign group also set a time to meet.
Overall it was an incredibly successful event. Traffic control said there were 15,000, which is huge for a local demonstration.
Many of the people attending had not been on demonstrations before. I had to explain the chants to some of my colleagues. The revolution in Egypt had passed them by, but they got to this demo.
The placards made the point that PFIs put profit before people. One colleague said to me she was glad she hadn’t got a placard that advocated strikes.
She had tried to support the BMA pensions dispute, but found striking to be a useless tactic. I explained that I had been all in favour of the 30 November strike and of making it more meaningful, but the unions had seemed happy to use the excuse of emergency cover to keep most of their members at work. Here and now, I said, an occupation seems far more likely to succeed.
There’s a difficulty in striking when a service is planned to be shut anyway, and the strike may really only give management practice in how to manage without the service. There is also a genuine difficulty in health workers walking away from their patients. We don’t want our class to suffer because of strike action, and there is a risk of this in the health service. That doesn’t mean that we don’t strike, but it’s a hard decision to make, and the strikes are likely to be short and partial.
Management want to do away with most of Lewisham Hospital, and the best thing to do is to try to force it to stay open. The idea is to have a ‘work-in’ occupation, where the staff refuse to walk away, and make sure that the service keeps going, even when management want it to shut.