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Health services con

Under cover of the pandemic, health services are being stripped away

21 September 2020

The British government's response to Covid-19 was a bizarre jingoism. Flags, spitfires, street clapping and endless praise for "our" NHS.

As slogan built upon confused slogan and incompetence built on incompetence, public trust in Boris and his chums has fallen sharply, only matched by the derision in the North of Ireland aimed at the local administration.

However the political establishment have achieved a stunning propaganda victory. Under the banner of "Save the NHS" they have torn down much of the service.

When the pandemic began the capitalists had been hacking at the health service for years with a privatisation menu. The deaths in care homes were based on an imaginary separation of health and social care and defunding the latter. Rather than spend billions rebuilding the service they essentially cannibalised the existing structures to set up emergency coronavirus provision. The waiting list built up. Many died even though a trickle of services returned. Now the second wave is coming and what is being offered is a virtual system where medical consultation is via phone while six month appointments grow to two or three years.

In the North long term planning centres on the Bengoa report, "result based outcomes" in the community and mass privatisation. The 26 county state managed to rent an NHS for a few months from the private sector and to close it down again in a few days. Strategy hangs around Sláintecare, a similar privatisation/care in the community exercise.

But how has the health service been mutilated to such an extent without protest? In part it is because capitalism has been able to hide behind the Covid-19 emergency, but mainly it is because, outside sections of the medical profession, there has been no opposition.

In Britain the new right wing Labour leadership makes only the gentlest of criticism. In Ireland everyone is inside the tent, sometimes snapping at each other but with no fundamental differences about the line of march.

Most fundamentally of all lies the acquiescence of the trade union leaderships. For many decades their position has been that issues such as privatisation cannot be directly challenged. If a government has won power with privatisation in its programme then it would be undemocratic to flout that. The narrow issues are members' wages and conditions, which are negotiated in light of the new privatisation agenda. In this environment mass support for the health service, used so effectively by the government, is actually a mass outpouring of nostalgia. Working people know that health services are gradually being withdrawn and hope that public demonstration will slow the process.

Yet the old services, built on the high profits of the post war boom, will not return. For the capitalists in the future, what you get will depend very firmly on what you pay.

Of course there is much still to be done. Medical workers, patients and rank and file trade union members still have the power to stop and reverse the destruction of services.

However in the longer term the workers need a programme that is the reverse of Bengoa and similar reports. Instead of an ever more centralised and hierarchical system we need local grassroots structures, built by health workers, trade union members and communities that look first at environment - stopping the sale of junk food, cutting pollution and building productive environmental communities that bring to an end the epidemic of mental health issues sweeping the world behind the covid epidemic, the epidemics of homelessness, poverty, unemployment and war that all accompany the death agony of capitalism.

The welfare state of the past is unlikely to return in its old form. What is needed is a workers programme for the 21st and 22nd centuries, based on people's needs rather than profit.

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