Tuesday 12th May 2020

Assessing Where We Are in the Fight to Make Health Care a Right for All

THE SITUATION

Throughout the COVID-19 pandemic the corporate direction and marketesied arrangements that the ruling elite have put in place within our Public Health and National Health Service have become easier to see. At the same time, the ruling elite are desperately trying to use the crisis to try and block any outcome that favours the people. Therefore, it is very important for us to asses the work we have done, and to understand where we think we are in terms of the fight of the Save South Tyneside Hospital Campaign (SSTHC) at this time.

At the moment, everyone in the health workers' movement is talking about how the COVID-19 pandemic is being used by the government to accelerate the handover of all kinds of services to private corporations. This is being implemented even though the privatised arrangements have already failed to supply vital services and provide protective equipment to health staff and other workers in need of them.

For example, with the closure of many NHS laboratories, the privatisation of others, and the fragmentation and under-utilisation of remaining NHS labs, they could not initially do the testing and tracing that was known to be needed in the event of a virus pandemic.

Handing over huge sums of money for testing and tracing to Deloitte, Serco, Boots, G4S and other private companies that have already failed in this duty and who have a history of corruption and failure, is hardly going to bring about a better outcome.

It is a similar story with the privatised just-in-time supply chains for vital equipment, which were privatised under previous governments ending a well stocked public service when the contract was handed to DHL and then Unipart.

While the government is awarding contracts during the pandemic without any scrutiny, NHS England is encouraging independent NHS Trusts to prepare for contract extensions with the independent sector and to lock-in some of the recent changes to services when the pandemic is over, without even any public involvement! Among the changes to lock-in is scaling of new technology-enabled service delivery options such as digital consultations, which is a key part of government/NHS England strategy to keep patents away from doctors in order facilitate the shrinking and further privatisation of services.

These signs from NHS England are consistent with the government/NHS England modus operandi of forcing through changes under the cover of distraction and/or with an opportunistic excuse. They further confirm the intended direction that we have seen unfolding over the years, where successive governments have abrogated their responsibility by making public authorities handover health services to private companies, or to run-down services within an increasingly fragmented and corporate-led public sector driven by continued government cuts. In this way, state bodies implement decisions without consultation that are often opposed by the majority of people who learn about them. This is because decisions taken largely in the interests of big-business typically undermine people's real needs. A good example of this is the mostly privatised and completely fragmented 'care for profit' care home sector, where so many have died in this pandemic.

In an interview with Novara Media, Allyson Pollock (Professor of Public Health and former Director of the Institute for Health and Society at Newcastle University) described the government's response as unconscionable:

It's well known that there has been an extraordinary delay in the response, a delay in putting in travel restrictions, a delay in getting contact tracing, and a delay in recognising the epidemic. That actually is unconscionable, because we really had warnings from January, we could see what was happening in China, and from Early February in Italy, then in Spain.

So, we have had a great deal of delay that has not been helped by the fact that the government had to 'tailor' the epidemic to the availability of health care and NHS services. What we have had is the depletion of public services in general, but especially in health and social care over a period of 20 to 30 years, plus its fragmentation and privatisation, then a long period of austerity. What that meant is that we were not well prepared for this epidemic, and that is evident now in the number of deaths that we are seeing, and by the fact the government had to impose a national lock-down.

Professor Allyson Pollock 2020-05-08

OUR RESPONSE

Over the years the people have escalated their fight to safeguard the future of public health and other health services all over the country. South Tyneside has a population of approximately 150-thousand. We require a comprehensive District General Hospital and community and mental health services. Given the circumstances it has been necessary, together with trade unions and many other fighting organisations in the borough, to build a campaign to save our hospital services.

For about 4 years now, 20 to 30 people — including people from: health unions and other unions, staff at the hospital (working and retired), and people from the community — have convened every 2 weeks to discuss the fight to save vital services, particularly around the the right of all to health care in a modern society, and how to guarantee this. All over the country SSTHC has fought alongside other campaigns such as the Save Lewisham Hospital Campaign in London. SSTHC has played an important role in uniting local people and groups, bringing them together in meetings, demonstrations, and legal battles.

The fight undertaken by SSTHC is a reflection of what is happening in every part of the country. Although people haven't been able to save all vital services in every area, our collective struggle has significantly delayed the implementation of even worse closures. In South Tyneside for example, health leaders wanted to close — by 2017 — hundreds more hospital beds and acute services at our District General hospital, thereby giving less-safe access to vital urgent and acute services by redirecting local people to already overcrowded services at Sunderland and elsewhere. However, because the people resisted these changes, the services were still open and available with the onset of the pandemic. The hospital is largely still here for us because of the fight people have undertaken to save its services over the last 4 years. Through this fight, more people have become involved, extending the fight to other services, such as end of life palliative care when St Clare's Hospice in South Tyneside was forced to close last year.

The COVID-19 pandemic gives us an opportunity to strengthen our demands for comprehensive, fully funded, publicly owned and accountable health care. We must take up the battle against the government and other authorities over their careless handling of this virus outbreak, compounded by decades of shrinking public health and social care services, rendering them far less able to cope.

In South Tyneside, we have been fighting the refusal to provide the right protection equipment in the quantity needed, as well as the refusal to test staff in health care settings and care homes for COVID-19 in a timely manner. We are supporting all those health workers and those in our trade union circles in that fight.

Emma Lewell-Buck MP (South Shields) has drawn links between the government's handling of the pandemic and the relatively high death rate (related to COVID-19) in our region (with South Tyneside and Sunderland NHS Trust — as of 2020-05-11 — reporting the largest number of deaths). Her key points include:

...For almost a decade, pandemics have been designated as the biggest threat to Britain, yet stockpiles of PPE simply weren't there. Even warnings as recent as February to the Government from the European Centre for Disease Control that they needed to be prepared fell on deaf ears. As a result, health and social care workers have been left without adequate protection.

...government have downgraded the diseases status so they could weaken the PPE guidelines. Decisions are being taken on availability not safety.

...Testing and contact tracing are nowhere near the levels needed. Frontline workers are still awaiting tests as they continue to go to work to keep our country functioning and the Government's plans for tracing via an app will exclude many people who don't have access to smart phones. For other means of tracing they have yet to outline their plans in full...

...Behind every single death is a person whose life political decisions may have saved. I will never forget that and nor should our government.

Emma Lewell-Buck MP (South Shields) 2020-05-06

Health workers have been speaking out on this throughout the country, and various actions are taking place against the criminally negligent government guidelines on protective equipment and testing.

University Hospital of Leicester and Northampton General Hospital medical staff, challenged the government guidance and forced those Trusts to implement their own much better guidance. This in turned forced government to alter its national guidance, although it still wasn't up to the standard of the World Health Organisations (WHO) recommendations. That fight goes on with staff and unions demanding the right protective equipment including proper masks, eye protection and gowns that cover the whole body.

A protest on Westminster Bridge in the last week of April with medical staff from St Thomas' Hospital (where Boris Johnson was treated), displayed a banner stating "We Are Not Disposable, We Don't Go To Work To Die". This was a reference to a remark by Matt Hancock (Secretary of State for Health) who said that PPE was a precious resource, implying that the lives of workers are by contrast disposable, and not in-fact a far more precious resource to be protected at all costs by providing the right equipment.

Then there are the unpaid volunteers stepping in where privatised stripped-to-the-bone services are proving inadequate. For example, some people who have expertise in social benefits are advising those who have lost their jobs. Some people are endangering themselves in order to provide food and medicine to those who are vulnerable and effectively abandoned by the state. While it is hugely positive that so many people are taking up responsibility for the well-being of our communities, it would not be necessary in an economy which put the needs of people and planet first. It can't be overstated that at the same time, the government is poised to exploit the COVID-19 crisis for the interests of big-business, which will strengthen their hold on essential public services, including our NHS, and leave many people in our society more vulnerable to this rotten market system.

CONCLUSION

The COVID-19 pandemic is starkly demonstrating the flaws in the arguments upon which the Path to Excellence and its underlying ideology — Neoliberalism — are based.

Neoliberalism came to fruition in the late 1970s. Its core tenant asserts that the market (meaning ultimately, profit-driven big-business) knows best how to organise society, and that no government or democratic system of planning can do better. What logically follows is the belief that most public services should be provided by the market. This doctrine directs our culture towards individualism and survival of the richest. The British government was one of the earliest adopters of this greed-is-good paradigm, and has been a catalyst for its imposition around the world. In Britain from the late 1970s onward, there has been an unceasing transfer of ownership and control (as much as has been politically possible at any given time) of health services and other vital public services to big-business. This has undone many of the gains made by working people since the end of the Second World War.

The COVID-19 pandemic demonstrates how baseless and harmful the Neoliberal doctrine is. The British state — a seat of Neoliberal Capitalism — in the face of this pandemic, was less able to act because it has given away so much control, and was reluctant to act because doing so flies in the face of its religion. When finally forced to respond due to the increasing danger of political blow-back from an escalating pandemic, we observed the typical opportunism and failures (as discussed at the start of this article) that inevitably occur when the interests of the public are put into the hands of large for-profit corporations.

The Path to Excellence is a programme (focussed in South Tyneside and Sunderland) of health system efficiency savings (cuts and closures to you and me). Similar programmes with equally inane and Orwellian sounding names like Shaping a Healthier Future are being imposed throughout the country. The aim of these plans is to shrink the publicly provided health care system (including GP and A&E services) to a basic package, and to separate potentially profitable services (E.g. elective surgery) from non-profitable services (E.g. emergency care). These plans are the local components of an overarching plan that is proceeding to split the NHS into 44 health services, each modelled on an Accountable Care System, which in turn will make it easier for multinational health corporations to take more control of budgets and services, and perhaps eventually provide the basis for the general adoption of private health insurance.

The Path to Excellence is described by South Tyneside CCG and partners as having three pillars. Prevention, Out of Hospital, and In Hospital. The narrative connecting them presented by the Path to Excellence is — very broadly — that by preventing illness and encouraging more out of hospital care, we can safely close and centralise hospital services in order to reduce their financial cost and adapt to the (artificially) low numbers of clinical staff being trained and recruited.

The COVID-19 pandemic fatally undermines the Path to Excellence rationale by demonstrating the unarguable need for more hospital beds, more none-clinical staff (E.g. cleaners), more clinical staff (E.g. doctors and nurses), more equipment, and more services that are accessible locally. It makes the case for public ownership and control of testing laboratories and drug manufacturing at the very least. Our public health services should always have a large spare capacity (and before privatisation began, they did!). There should be no need to swiftly draw up commercial contracts (At all! — Never mind without any scrutiny!) in order to scale up facilities such as the provision of beds, vital equipment and testing. As if it needed blatantly demonstrating again after the 2008 financial crash, there is no shortage of money, the budget constraints on our health services are artificially imposed. Out of Hospital care is never going to be a workable alternative to a comprehensive fully-funded health service.

As an indirect consequence of the ongoing destruction of natural ecosystems and diversity, and with increasing pressures on basic resources around the world, such as fresh water, global pandemics and other health problems will surely intensify. Ironically, it is the Neoliberal unchaining of Capitalist exploitation that is driving both the internal pressures (privatisation & marketisation) on our health and care services, and at the same time producing the myriad conditions from which a wide range of chronic, endemic and pandemic health problems arise — from stress, respiratory problems, cancer... to COVID-19. Put more succinctly, the ideology driving the Path to Excellence is making us unwell and taking away our health services. Prevention is never going to be a workable alternative to a comprehensive fully-funded health service.

The case against the Path to Excellence and the case for the reinstatement of the NHS (an essential step towards building the kind of health services that we have a right to) is not new, but it has been greatly strengthened.