Sunday, 9 August 2015

Why we need independent worker/professional organization in the NHS

Over the past year there has been a growth in organization and activism among NHS staff, and increasing engagement in speaking out about the appalling conditions the NHS is being driven to by austerity.

This is an enormously positive development and can not come soon enough. NHS privatisation is rapidly accelerating and engulfing more of the service daily, and the government is committed to limiting the NHS budget in order to force $ 22 billion of savings out of the service over the next 5 years, an impossible target which if met would mean wholesale destruction of huge swathes of service, and much damage to patient's and staff's lives.

Much of the organising has taken place on social media, beginning with doctors and healthworkers speaking out during last winter's A & E crisis, laying the blame publicly on government policy for the crisis. It has been organized around certain campains, like the NHS Bill 2015 campaign for the NHS reinstatement bill, or the Resilient GP campaign around Dr Meirion Thomas. The issue which galvinised the biggest coordinated response was Jeremy Hunt's attacks on Consultants and doctors in general for not working weekends. This generated the #Iminworkjeremy hashtag which was taken up by thousands of healthworkers across the country and received widespread media coverage.

There are indications that activists are now taking steps to cohere this newly politicized layer of healthworkers into organization, forming organizations like NHS Survival. This is necessary as while social media campaigns can secure some victories and raise awareness, they are not enough to secure changes in government policy, or management policy in the workplace.

The next goal for activists should be developing coordination and organization among activists nationally, with the aim of developing local workplace organization which can connect this newly energized and engaged layer with the rest of the NHS workforce, so they can be organized and mobilized together against the governments attacks .

Failure of the NHS unions

It is necessary for activists to construct independent organizations, as we have been let down, and in some cases outright betrayed by our traditional organizations; unions and professional bodies.

I've written at length about the strategic failures of the health unions, and about my own experience with corrupt and conservative union organization. Those give a lot of background to why we need independent worker organization in the NHS.

To put it briefly, health workers and the public have been let down massively by the leaderships of the health unions. Throughout the Blair / Brown years the unions sat on and obstructed struggles initiated by their members, and allowed privatizing instruments like PFI to be brought in without a serious national campaign against them. This created the groundwork for future privatization to be prepared, alongside the growth of the Independent Sector Treatment Centres, and privatization of GP surgeries. 

They failed to thoroughly educate and politicise members about the privatizations and NHS reforms, or consistently lead struggles against them. There were numerous witchhunts of NHS trade unionists, primarily within UNISON, the largest union in health, who spoke out or lead campaigns on these issues. Committed defenders of the NHS were expelled from UNISON simply for opposing Labour's neo-liberal policies.

The unions failures to defend the NHS resulted in situations like Mid-Staffs Hospital, where conditions deteriorated to the point where patients lost there lives. At a national level union failed to sound the alarm over Mid-Staffs, even when warned by their members what was happening. There were no protests or strikes organised despite the deteriorating conditions and endangerment of patients.

Under the Tories their performance has been just as lackluster. There was no united national campaign against the Health and Social Care Bill, despite public warnings from all unions that it meant the end of the NHS. Union leaderships and the TUC took only token gestures against the Bill. At no point did they attempt to mobilize their members against the bill with any coordinated protests at hospitals or national demonstrations. As a simple example, throughout the last five years of Tory government there was not a single national demonstration in London about the NHS organised by any union.

The BMA leadership was particularly obstructive, playing a treacherous role as outlined at length in Jacky Davis SOS NHS book. This was repeated across the unions, with slight exceptions. The RCN actively collaborated with the government over the bill, a shameful stance, while UNISON refused to take any action against the bill beyond a legal challenge and some social media and limited lobbying campaigns. Unite backed small protests initiated by its members and NHS activists, but it did not attempt to take the lead by calling any NHS protests itself, using its minority union status within as the excuse, despite it being the biggest union in the UK.

In all these situations NHS activists tried to push the unions into action There were some successes; the BMA was made to change its stance against the Bill under pressure from its members, several protests numbering in the thousands were called and organized by activists in London . But our numbers were too limited, and our connections within the workforce and between unions was too weak to create the pressure needed to push the unions into effective action, or generate the action we needed ourselves.

We need to develop independent organization to the point where we can effect the change we want and need in our unions, and among our fellow workers. We need to be able to change union policy where its wrong, to push the unions into action where they are lethargic, or organize it ourselves where they refuse to. We need to be at the forefront of politicizing and organising NHS workers so we can build the mass movement among staff we need in order to be able to change government policy on the NHS.

There is precedent for this. Throughout their history there have been radical and reform movements within the unions which have challenged undemocratic practices, or conservative leadership and policy. In the 1920s the militant Minority Movement played a large role in radicalising the unions and laying the basis for the 1926 General Strike. in the 60s and 70s "rank and file" movements in the unions were central to many of the more militant struggles, producing pamphlets and leaflets to educate union members about the economic crisis of capitalism, advancing radical methods of struggle like wildcat solidarity strikes and factory occupations, and creating the organisation within and between workplaces which could generate solidarity actions to support other workers in struggle.

What would this organization to be like? 

A few points on what sort of organization we need:

1. It should be cross union and cross profession, with no barriers to entry. We want all NHS workers involved and engaged, from porters and receptionists, to consultants and surgeons. Just Because someone is not a professional does not mean they can't have a say and be involved and leading the struggle. Levels of unionization are better among the lower paid NHS workers, they have suffered the brunt of privatisation of ancillary services, and any successful struggle to defend the NHS will need to involve and mobilise them.

2. It needs to be Democratic and be able to coordinate regular meetings with activists from across the NHS, to allow the grassroots of the movement, the thousands of NHS workers who will make it up, to have a say in how it is run and what it does.

3. We need a vision for the NHS that we want, of a publicly owned, democratically run and accountable NHS that can inspire people, and be an evidence based, planned response to the government engineered crisis in the NHS . Developing such a plan / programme for the organisation should help reach agreement on our aims, the principles we want to underlie it, and policies we want to adopt.

4. Be part of all the unions, but independent of them. Our unions are vital organizations which organize hundreds of thousands of people, the bulk of the NHS workforce. We cannot ignore or go around them. Standing for elections within them, pushing them to adopt policies and initiate campaigns, lobbying their national meetings, these will all be necessary tasks for any organization seeking to effect change. But any organisation we create should aim to be independent of the unions, representing only the aims and interests of NHS workers and patients, not the institutional interests of the union hierarchy. Unions can be conservative, and they have hundreds of institutionalized ties to management and the Labour Party, and a largely unaccountable bureaucracy which is threatened by independent organization. We need to be wary of this, and maintain our ability to say what needs to be said, and act when we feel it is necessary.

5. Stand up for patients. Of primary importance is making clear we are doing this for the patients, being strong advocates for them. Making links with patients advocacy groups and establishing a working relationship with them will be crucial. As well, we must stand up for whistleblowers, those who have put their jobs and reputation on the line for patient safety. This is another area the unions have shamefully failed to fulfill their roles, and where activists must take a principled stand free from institutional or sectional interests.

6.  Dual Strategy. We need to organize and struggle in two arenas; the public sphere of social media, protests, and street mobilisations involving communities and workers, and the workplace sphere of worker and union organization. Where privatization and cuts have been beaten elsewhere in Europe, it has been through workers strike action backed up by large public demonstrations involving health workers and the community. One does not supersede the other, but we're currently much weaker in workplace organization and ability to organize strikes and protests, so that should be our primary focus as an organization made ​​up of NHS workers.

A first step to cohering such an organization would be to hold a series of forums around the country to get support for the idea among NHS activists, and to convene a national meeting to found the organization once enough agreement has been reach on what its purpose should be and how it should organize.

The Crash Course for the NHS event is one such forum where this idea could be sounded out, and some agreement reached, to lay the groundwork for a larger conference of NHS workers and professionals later in the year.

If you have any comments or criticism on this article, please feel free to comment, or contact me directly at mboothroyd [at]

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