Historical physiology and possible future of these disputes.
Healthcare is vital for our well-being and it affects us all to our core. It is always a potential central focus for the class struggle, with well over 1.9 million of us working in healthcare settings and over 1.25 million working in the NHS alone – the NHS being easily the largest employer in the U.K.
All disputes in the health sector then are of vital concern for our class. This time it’s the ‘junior doctors’’ strike and the results are described as stalemate, again. This is despite it including the largest number of consecutive strike days (6 days) within the NHS. The dispute is now into its second year.
With the handshake (enthusiastically or stated as somewhat reluctantly) between health unions and government in regard to many other health workers, the state has felt emboldened to both flatly refuse the doctors’ demands and to accuse them of being selfish and irresponsible. Meanwhile, some Trusts reflecting government policy, tried enforcing a return to work through the use of derogation (demands for temporary cover by striking health workers on a regular basis instead of previously, where it was only used only in emergency situations).
It all appeared so different the previous winter. As a class, our living standards had been under the cosh of state and capital for years. We had been patronised, including being clapped, by the parasites in power. This as many of us had put our lives on the line during a horrific pandemic. Around Westminster there were raucous parties but for health and other workers, long hours and emotionally tumultuous days spent away from family and friends, had often been the norm. A number of friends and colleagues died. Others were facing a long slog back to health.
The RCN had since its inception been seen primarily as a professional nursing body and had as an organisation never supported health workers taking industrial action. It had always maintained a no strike agreement and totally hamstrung its members. The situation though, was now so bad in the health service and among our class, that members of the RCN obtained an overwhelmingly positive mandate for action and were out on historic picket lines (2022-23). This was with nurses making up the single largest part of the workforce in the NHS.
Parallels with other historic and concurrent international actions by nurses (France, Germany, N. Ireland, USA, Argentina…) were drawn and expected by some to be surpassed. Over ½ a million nurses, health visitors and support workers in the NHS were involved in the actions. Joining them were the physiotherapists, radiographers and ambulance workers.
There was a massive swelling of good will among many members of the public. The initial feeling on the picket line was one of determination. “Surely, we could win this?!” Indeed, for those of us who were on the picket lines, it was hard to remember such a degree of support that was clearly evident now. Car and bus horns were blaring, our communities joined the picket line, well-wishing and food was readily provided by passers-by and other striking workers in transport, warehouses and telecommunications.
Contrasting this though, there was unease at the backs of some minds over what would or wouldn’t happen next? For as sure as night follows day, to those with a long memory of struggle, the usual happened: whilst the state clearly showed whose side it was on (not ours!), paralysed by fear of legislation and wanting to appear reasonable to capital, union representatives did little to encourage co-ordinated, unified and determined action. Though there was the usual bluster in speeches, meetings and marches.
On the one hand, ambulance workers were holding widely differing days of action depending on the union involved (GMB, Unite, Unison), whilst the state viciously attacked them, sensing blood. Meanwhile, Unite and Unison failed to organise effective ballots and even encouraged workers in the health sector, including nurses, to accept crumbs. We even heard the excuse, “Well, the RCN used to scupper our actions…”. Occupational therapists, speech and language therapists and associated technicians had no involvement officially at all in these disputes, despite having taken action in the past.
Then, leading into the summer of 2023, a “unique deal for nurses” was discussed through the RCN “leadership”. This was something that would have accentuated the existing divisions between health workers. It also threatened to exacerbate the worst aspects of the already dreadful, NHS health wide, ‘Agenda for Change’ pay scales and job descriptors, and made a total nonsense of the same thing. When this failed to happen, the same officialdom recommended the end of industrial action and a humiliated handshake with employers and government.
Though defying this call in a further mandate for strike action, the determination of the nurses had gone. The momentum was lost and strikes discontinued. Health workers felt demoralised and their positions far weaker than the previous winter. Poor pay and condition deals were now the order of the day, once again! True, not 1% this time but now … wow, 3% plus 6%! Or is it? The lame pay deals are so confusing that who actually understands them? Maybe that’s the point?
Concurrently, little to nothing was offered to address staff shortages and burn out. 50,000 extra nursing students were going to be recruited, or already had apparently, in a complete fantasy land existing purely in the heads of our delightful ruling class representatives.
At the root of what happened, is the tragedy that we have lost confidence as a class. We have been on the back foot for so long that we have forgot what it is like to take unified non collaborative action, determined by ourselves.
So, now we are at this moment, where the medics (doctors and perhaps soon, consultants) are the only ones taking action. Their demands go ignored or ridiculed by the useless Master class and opposition is whipped up by the press. This, a class and its cheerleaders that see no problem in throwing resource after resource down the drain, in pursuit of the Narnia of an attempt at a return of profit rates in capitalism. Whilst enforcing austerity on our class and being unable to provide for a comprehensive healthcare system, they and the capitalist system can always afford mass slaughter in war after war.
A complete mistitle, these doctors are “Junior” in name only. Many have immense responsibilities and stress. The BMA has 46,000 of these ‘junior doctors’ as members. Its demands around pay and better staffing numbers to prevent burnout, if actually taken literally, are in reality more realistic than those of the previous health union ones. But even this would only sets things back partly to the pre-2008 position and then only after a number of years of staged increases. It would hardly be a bed of roses for anyone. It is also true to say that the BMA members failed to stand soon enough alongside other health workers, when the chance arose. Again, hidebound by professionalism and convention, legalism and trade unionism’s sectional and collaborative approach, an opportunity to win a dispute at the most opportune moment had been scuppered.
Still, we need to stand alongside the doctors’ actions outside of union officialdom and magnify them. Indeed, despite naysayers amplified by the bourgeois press, some health workers and members of the public are doing precisely this.
We need to amplify this dispute and lift our horizons. Our living standards continue to fall, exhaustion through work intensification and low staffing levels continue apace. The recent pay deals are already made null by inflation, particularly food inflation. As health workers and as a class generally, there is no choice but to take up the struggle once again. Some doctors say they have learnt lessons about the importance of taking continual action from the recent defeat of other health workers. Such insights, if true in reality, need encouraging.
In response to the raising of their demands, we should also lift our own. A victory for the doctors would represent a victory for all of us! A lifting of the ceiling and a victory in one of the battles of the class war is something to be celebrated. We should never resent or resist the more ambitious material and social demands of other members of our class. Furthermore, the best way to achieve victory is always to unite on the basis of clear class consciousness and solidarity.
Action in dispute need not be demoralising, uncoordinated or result in crap handshake deals between union “leaders”, employers and government officials. The attempted frequent use of derogation seen recently in the daily running of services to allegedly maintain minimum service and staffing levels, can be seen as a weakness on behalf of employers, capital and state. It was clearly an attempted manipulation and it proved extremely controversial. It also demonstrated once again the crucial importance of our class in society. Doctors were only striking for a few hours before derogation was called for or, “services would simply cease to operate and be available”.
Rather than simply threaten to work elsewhere if we can (however tempting), we can unify class wide and build our confidence for future possibilities. Meetings and discussions with other health workers (including agency and locum ones), patients and community members can take place. These via networks and in assemblies run directly by ourselves collectively. Securing the support of other members of our class (which health workers are already in a good position to do), imaginative and effective means of struggle across “job boundaries” that best protects patients and working class communities can be devised.
Though demanding much solidarity and determination in the face of severely restrictive legislation – such tactics as, lightning strikes, the social solidarity strike, slow downs, lock outs of employers, provision for all without question for those attending A&E and various clinics, are all possible. Such actions would obviously vary depending on appropriateness per service and patient group.
Health workers should not fall into the trap of sacrificing their lives for “a calling”. This, a term used not to encourage social solidarity but to simply work us into an early grave. We should not roll over for an insurance based health system but struggle for a truly integrated one built upon real free access; one that provides for all human health needs.
Effective health provision is clearly collapsing within capitalism. There is regular resource sapping state interference, profiteering and brutal cuts (medication, community provision, ambulance, staff and bed numbers…). Health provision could also do without the awful stifling bureaucracy and hierarchy endemic both to the NHS and private services.
No more rationing of provisions, no more obsessive professional and sectional boundaries nor the dreadful merry go round of useless and badly informed managers giving orders. No more collapsing living standards and poor public health. No more divisions between work and play. No more wars in capitalism preyed upon us, where health workers and others in our class face the dreadful results.
There can be no stalemate! Health care is of universal concern for all. So is a truly free, universal healthcare system – one where we have a real say in its operation. Capital exploitation needs to be and can be ended, if we build our self-confidence, united as a class, in struggle for emancipation.
By Bones
AnarCom Network 