Kevin Morley discusses the recent Irish general election in the context of a national health service.
I can remember exactly where I was back in 1986 when Sinn Fein (Provisional) had taken their momentous decision to break their own rule book entering the twenty-six-county parliament, Dail Eireann. This caused a split in the organisation, not for the first time over the issue of entering Dail politics. Out of this, just as the provisional wing of Sinn Fein came into being, so did Republican Sinn Fein come about. I was sat on the London tube, Northern Line travelling to work at a Builders yard, Waterloo, wearing my work clothes, denims, steel toed boots and a Donkey Jacket still sporting the COAL NOT DOLE stickers from the previous year’s Coal Miner’s Strike. I glanced up and read the headlines of a broadsheet which read; “Uproar As Provos Enter Dail” which was referring to the above mentioned decision by the former revolutionary party to enter the Dail.
The man reading the newspaper was, in sharp contrast to my dress, wearing his work clothes consisting of a three-piece suit and suede shoes! I recall thinking, fucking wanker! These enterist policies into the world of the bourgeoisie and their parliaments – all parliaments of liberal democracies are institutions geared solely to governing the affairs of the indigenous capitalist class.
From Congress in the USA to the Bundestag in Germany, then West Germany, including Westminster, this is the role of what I call “Pandoras Boxes”. They are not there to govern the interests of the working-class, we are just led to believe this crap for five minutes every five years or so – I thought, what about the much heralded 32 county socialist republic? This was Sinn Fein policy and for many years afterwards remained, at least in public, to be so. Their paper, An Phobolacht, at least the one sold in Ireland and Britain often referred to the party’s aims of a 32 county democratic socialist republic. The one sold in the USA, I understand, made less reference to socialism, after all can’t be upsetting the capital of bourgeois ideology. The capital in the modern world yes, but not the originators.
As we know in Ireland, 26 counties, we have recently had an election and Sinn Fein are not the only party to drop their revolutionary clothes. People Before Profit, PBP originates from the Socialist Workers Party who trumpeted as their motto: “No Parliamentary Road to Socialism” which is as true today as ever. Their partners, Solidarity, come from the old Socialist Party and espoused a similar revolutionary road towards socialism. The SWP, I remember, ran down O’Connell Street many years back to the astonishment of shoppers shouting in their massed ranks; “one solution, revolution!” Both Sinn Fein and PBP/Solidarity are voteable and preach progressive policies. They are the best of a bad bunch in many respects.
Now we see these former revolutionaries trying to cobble together a “left-wing government” and I wish them well in this venture. The alternative is years of the same tried, tested and failed Fianna Fail and Fine Gael policies. The policies of homelessness, a health service not worthy of the name – no fault of the nurses and doctors employed – and more of these policies will kill, literally, many people. In the case of Fianna Fail they were unlucky enough, in one respect, to have been in office when the international capitalist economies collapsed. They presided over the effects of this in Ireland and could have done a lot more to cushion the blow on working-class people, but they didn’t. They instead, and true to form, looked after their friends in big business.
Sinn Fein and PBP/Solidarity both champion the establishment of a nationalised health service, and rightly so, single tiered with treatment free at the point of need. Modelled closely on the UKs NHS and funded from general taxation, primarily Income Tax, these policies are certainly progressive though not revolutionary. Below I shall briefly examine the UK NHS from its hey-day to present decline.
When the Second World War ended in 1945, the United Kingdom, including the six counties, was in a state of needing repair. In the election of that year the British electorate – not including the six counties, though they benefited for once – voted in by a landslide a labour government. Out went the wartime leader, Winston Churchill – who presided over the war time coalition – who, despite what many said about him being a great wartime leader, which may or may not have been the case, he was too closely remembered for the hard times of the pre-war years, the thirties. Britain (and empire) had been on the winning side, along with the USSR, USA, Canada to name three in the war against fascism and people demanded better. The thirties had been austere years for the working-class in the UK, even in Belfast during the outdoor relief schemes of the early thirties the boss’s biggest fears were evolving before their very eyes. Protestant and Catholic workers were united in their poverty and for a period it looked like the old sectarian divisions were in the process of being broken down. This was more than the employers could face and, as usual, they played the sectarian Orange Card thus resurrecting the age-old divisions between Catholic and Protestant, which Britain used for years as justification for their occupation. The 1945 election saw Churchill kicked out of office and the election of a parliamentary constitutional socialist government headed by Clement Attlee. This was the first ever majority labour administration and Attlee won by a landslide. His manifesto was radical, as were some of his ministers like Aneurin Bevan, a firebrand socialist who believed passionately in health which was the Ministry he was given. Attlee also nationalised some of the major industries, Coal, Rail, Transport to name but three. The programme was not revolutionary but by the standards of the day was radical. The labour government elect also included a broad-based Welfare State which included a National Health Service (NHS). Among the slogans of the welfare state was the maxim; “never again” meaning, “never again will people be means tested” before aid will be given. To cover the whole welfare state would be too broad for this piece so we shall look at the NHS. Aneurin Bevan, Atlee’s Minister for Health had a huge battle with the health professions, doctors in particular and even today most doctors practices, though incorporated into the NHS are in fact private business’s. Hospital Consultants were also a problem who had to be overcome but, and against massive odds, Bevan overcame them.
On July 5th 1948 Bevan unveiled the NHS where treatment would be given “free at the point of need” irrespective of a person’s ability to pay. Gone were the days when before treatment would be given a person’s bank balance had to be checked first. Another part of the post-war labour government’s policies, were the adoption of a mixed economy based on the principles advocated by the economist, John Maynard Keynes known as “Keynesianism.” These policies were geared towards full employment, an essential ingredient for labours vision. The new NHS was to be funded by general taxation, particularly Income Tax, and for this to even stand a chance full employment with everybody paying their share of Income Tax was essential. The UK as a whole needed rebuilding after the war many hands were needed for the task. For this reason, the bourgeoisie never objected to these plans, it would save them paying for the job, and, in many cases, they would profit out of the work which needed doing. Only about five percent of industry was nationalised leaving plenty of spare room for private companies to make money. Of course, a strong, large healthy workforce was needed which provided much impetus for the NHS and full employment. The welfare state provided unemployment benefit, the dole, which nobody claimed because everybody was in employment. Only those between jobs, sometimes called frictional unemployment which was not even registered, were for a short period, usually a week or so, out of work. Nobody claimed the “dole” even though it was considerably more relative to wages, than an unemployed person gets today. This drives a stagecoach through the theory of people not being willing to work, preferring to live off “hanouts”, for a living, often pedalled by the bourgeois media in modern days. The middle-classes, bourgeoisie, knew one day they would get their nationalised industries back, at a cut rate, once the post-war project was complete. How right they were! The political theatre after the war became known as the “Post War Consensus” in Britain – again the six counties were different, one party unionist rule prevailed there – and by consensus it was meant; one party would not do too much to undo what the other party had done while in government. So, in 1951 when Churchill was returned his administration did little if anything to reverse the nationalisation of Attlee and the previous labour government. Similarly, the conservative administration went along with, and even developed, the NHS. They too realised the boss’s needed a strong, large, reliable and healthy workforce to keep industry working and profits coming. If people were off sick, and could not afford healthcare they would be away from work much longer, thus costing the economy money. If they could receive healthcare free at the point of need, the quicker they’d be back at work. This consensus thrived and kept Britain going throughout the fifties and into the sixties. In 1960 Conservative Prime Minister, Harold Macmillan once boasted to the British people; “you’ve never had it so good” and this included the jewel in the crown, the NHS.
During the sixties the first cracks appeared in the consensus, as capitalism recovered after the war, it was seen that the NHS costs were rising and therefore, in order to suit the needs of capitalism cuts were introduced by the labour government of Harold Wilson. It was Wilson’s administration who first introduced the closure of coalmines and it was in 1963 that Dr Richard Beeching closed many railway Branch lines which were uneconomical. These cuts became known as; the “Beeching Axe”, officially called “The reshaping of Britain’s Railways” and coupled with the cuts in coal production saw the first reduction in nationalised goods and services. The NHS did not escape these cuts, many rural “cottage hospitals” were closed. In the cities some smaller hospitals were closed in favour of larger, what would later become, “centres of excellence” and specialised hospitals. All the same and despite the cuts the NHS was still the jewel in the crown of the consensus, and the best in Europe. it was also the largest employer in Europe, and still, despite the cuts and privatisation of certain areas one of the largest employers in Europe.
In 1979 the election of Margaret Thatcher as UK Prime Minister signalled the end of the Post War Consensus. She hated the consensus with a vengeance and was determined the nationalised industries would be privatised, and the trade unions, strong in these industries, destroyed as a meaningful force. This was her policy, union bashing culmination with the year-long miner’s strike in 1984/85. She also dispensed with Keynesian economic practices replacing these with those espoused by Milton Freidman and the “Chicago School” of economics, monetarism. There was less emphasis on full employment and much more was aimed at reducing inflation, without telling anybody what the real causes of inflation were/are. If she could blame the unions for inflation, and enough gullible people believed her, then that was good enough. Unfortunately, through her control – unofficial – of the media it worked. Once she had tackled, or reduced the power of the trade unions, the NHS would have to be trimmed, but she was acutely aware this could not be done in one sweep. The people would not stand for her butchering the health service as she had done with other industries. This had to be done bit by bit, and while the cuts were being initiated she continuously told the public, “the NHS is safe in our hands”. By 1990 Thatcher had gone, but Thatcherism lived on and, arguably, still does! With unemployment, purposely rising – this was all a factor in defeating the unions, if people were out of work, the less likely those in employment were to go on strike – meaning again, less income tax revenue. That meant the NHS had to look increasingly more to private investment for funding. Now, private investors do not invest unless a profit can be made. The NHS was/is not supposed to be a profit-making organisation but the private sector would not invest their money unless a profit could be secured. Work it out for yourselves, I won’t insult the readers intelligence with all the details, but the NHS had to, for these people, return them a profit for their investments. Privatisation of certain areas of the NHS was on the cards!
Through the nineties, morale in the NHS among staff was ebbing fast. It was still among the finest health services in Europe but was beginning to look a shadow of its former self. Capitalism no longer needed the large healthy workforce it once did, new technology brought in by private employers deemed workers, human ones, unnecessary. Everybody began to believe the myth unemployment was inevitable, due to “automation and new technology” which of course is bollocks. It is not, was not, the automation of industry which causes unemployment, it is who owns this technology? The new means of production, distribution and exchange, just as their Fordist forerunners and before, right back to the Industrial Revolution, were/are not in themselves responsible for unemployment. Private ownership of the means of production now, as in history, is the cause of unemployment. Therefore, this private ownership is indirectly or otherwise, of the means of production, causing unemployment, is a major factor in the demise of the NHS. In the six counties one major reason against Irish unity the unionists could, with some justification, point to was the disparity in the health systems, north and south. The NHS was leaps and bounds above the HSE in the 26 counties. Not because the Doctors and Nurses were any better in the NHS than the HSE (or its previous name) but because of the structural set up delivering treatment and care free at the point of need practised by the NHS in the six counties. Contrast this with the system in the south, VHI and Medical Cards, and we can see why the NHS comes out well on top. That gap, however, had narrowed in recent decades, not because the HSE has caught up, but because the NHS has digressed. The UK National Health Service, once the jewel in the post war consensus crown, initiated by the government of Clement Attlee, based on the wartime report of William Beverage, is now in the lower part of the European health table. The twenty- six counties are lower but the gap between the two is much narrower!
Last year a report on the state of the finances in the NHS was commissioned. This was compiled by Sir Robert Naylor and has become known as the “Naylor Report” or, “Naylor Review”. It advocates the selling off of NHS “surplus land” and hospitals, disused buildings owned by the NHS, and the money raised used to invest in what is left. Building new hospitals is one way of investing, so we are told, but where? If all the “surplus” land has been sold to private speculators to build houses, private dwellings on, even if the money raised was sufficient, where are any new hospitals going to be built? Hospitals which do not sell land have been told they will be punished. They may be strangled of repair and building monies! To accelerate these sales hospitals will get a “2 – for – 1” offer roughly translated this means, to my understanding, the government steps in and doubles the cash received for the sale. The money to be paid straight to the hospitals, not private developers – supposedly to finance building projects. Again, the question must be asked, if hospitals have sold their land and receive this money, where exactly are they going to build? On new land costing more than the old land, even with the government double money, was sold for. More than what was received for the old land? What would be wrong with the government giving this money without the hospitals selling the land, they, the government, obviously have it, to build or develop for health on the land they already have? This could also lead, in order to get this cash, to the NHS selling land which isn’t really “surplus”! The Naylor Report recommends selling NHS land and buildings worth around £2 billion rising to £5 billion to build homes on. In order to secure this money, cash which should have been there from taxation, is tantamount to a drive to further privatise the NHS. Leading Doctors have criticised the “Naylor Review” claiming it is a drive towards the “complete privatisation” of the NHS.
Various conservative administrations have been dismantling the NHS for many years now while telling people, “the NHS is safe in our hands”. It is akin to telling people the weather outside is warm and sunny when, in reality, there is a foot of snow and freezing. Unfortunately, and despite evidence to the contrary, many people believe what they are told irrespective of what they can see.
Down here in the 26 counties we hear Sinn Fein committed to a national single tiered health service. This is progressive without a doubt, but if they are going to fund it from general taxation they must also be committed to full employment. If this is the case, as surely it must be, then how are they going to force employers to take on staff they do not need? They cannot instruct employers what to do, it would be in breach of neo laissez faire (none governmental interference in the economy) economics. Therefore, it must be assumed in order to secure full employment, to fund, through Income Tax, a national health service free at the point of need, Sinn Fein, or People Before Profit/Solidarity or a combination of both must be committed to full employment, and this can only be done through the common ownership of the means of production, distribution and exchange. It must therefore follow, that to achieve this the private companies, large ones, must be at least nationalised. However, despite the radicalness of their policies in the build up to the recent Irish election, I heard nothing about breaking with laissez faire economics and governmental involvement in the economy. But it is Sinn Fein policy to build a national health service, single tier based on the British model. That means funding through general taxation which must also mean, everybody paying Income Tax! We can go around the mulberry bush for ever here, but these are essential ingredients, which was why Clement Attlee embraced Keynesianism as the 1945 labour administrations economic policy.
To summarise, 1945 the end of the war. Unlike their predecessors in 1918, the troops coming back from fighting fascism wanted a better society than the one they left behind. They wanted no more means testing, no mor being afraid to visit a Doctor or hospital because they could not afford the fees. For this, among others, the electorate in Britain elected a radical labour government who promised, and delivered, a welfare state including the NHS. Capitalism allowed these radical reforms as it benefited the capitalist class as well as the proletariat. The United States were not entirely happy with the British electorate for rejecting Churchill and, using some bullshit excuse about Britain abusing Marshal Aid, stopped this lifeline to Britain. So much for the special relationship! The “Post War Consensus” briefly explained above, became the status quo between 1945 and, ultimately 1979 which allowed for incoming governments not to dismantle their predecessors achievements. The consensus. Margaret Thatcher dismantled the consensus and arguably introduced a new right-wing variant epitomised by the Tony Blair (New) Labour Government which did little to attack Thatcherism. By this time capitalism, the priority of any government in a liberal democracy, no longer needed the sizable workforce which they did when the NHS first came into being. With unemployment rising, due to various government policies – chiefly conservative administrations – Income Tax revenue was falling leading to less funding which taxation was supposed to pay for. Enter private sector. If taxation was no longer sufficient to fund the NHS, and still they kept giving tax cuts to benefit the rich, then funding would be sought elsewhere. This is clear evidence that governments, despite what they say, are in the business of privatising the NHS. If they were not, even allowing for unemployment, they would stop giving tax breaks to the rich! On to 2019 and the “Naylor Report” and the selling off of NHS land and buildings, including old hospitals which could be refurbished, or, demolished and a new one built on the site!
This in brief is the rise and what looks like the fall of the UK National Health Service. Things not set to improve any time soon, the electorate don’t seem that bothered yet. If they were, they would have voted in a labour government, as they did in 1945! Unfortunately for the people in the six counties who did not vote for Johnson and his version of conservatism they will have to put up with him as their Prime minister. Never mind the Legislative Assembly, they are not, no matter how it is dressed up, the government any more than Greater Manchester Council are!!
Any government or potential government in the twenty-six counties must be prepared to interfere or intervene in the economy if they want to establish a nationalised, single tier health service. Failure to do this will not result in such a service coming into being. Clement Attlee had the Second World War to build his NHS on the back of, the people needed radical change and he broke with all previous protocol and delivered. He intervened, as Keynesian economics allowed, in the economy and delivered his “jewel in the crown”, the NHS. This service applied to all parts of the UK including the six-counties. Today, the ideas of Keynes are points of history as monetarism, which does not allow the scope for the same government intervention in the economy, is the policy of the day. So the question must be asked: how far would the capitalist state allow such intervention? For socialists, it would not matter, the state would have to be engaged to get all measures through and a socialist state established, but would the capitalist economy allow for some moderate intervention in order to deliver a nationalised health service delivering care free at the point of need? Or, would the capitalist class link arms, possibly using the army if matters were to go too far threatening their state based on profits for the boss’s? Chile was an example of a constitutional government, socialist, under Salvador Allende being overthrown when the capitalist class felt he, Allende, had gone too far. It resulted in a fascist takeover and cost Allende his life. The capitalist world looked on and did nothing why? Probably because they felt under such circumstances, they would have done the same, their armed forces and their police would take out the government! If anybody has seen the film; A Very British Coup about a left-wing British Prime Minister brought down by the state they’d see what I mean. The film epitomises the power of the state over governments. Would this happen here in Ireland if any government, constitutional government, broke with aspects of laissez faire? These are all arguments for the old maxim; “no parliamentary road to socialism”, which brings us to the meaning of left-wing and right-wing. Left-wing tends to be those committed to social change and sit on the left wing of parliament. It originates from the French Revolution and is a bourgeois political concept. Right-wing tends to be the forces of conservatism who sit on the right wing of parliament. Therefore, in the British parliament the labour MPs sit on the left wing or left side of parliament, the conservatives sit opposite. In the former USSR the CPSU (Communist Party of the Soviet Union) would be considered right-wing, wishing to conserve the status quo, whereas Boris Yeltsin, who wished to dismantle communism – Soviet version – was considered left-wing. During the fall of the USSR western media often mentioned “conservative communists” a contradiction in terms to most people listening or reading. They simply meant the people who were in power at the time, the CPSU who wished to conserve the status quo.
Whether you agree with the revolutionary road to socialism, or still believe a parliamentary avenue remains open one thing all must agree on is; we need a new health service, free for all at the point of need! Just as Clement Attlee’s labour administration back in the forties brought about the NHS and nationalised certain industries which, as it turned out were only on loan, as progressive these moves were, they did not equal socialism. Socialism cannot coexist with capitalism and of all the isms the one which capitalism fears is socialism. Capitalism can coexist, even thrive, under fascism and as history tells us, under certain conditions the capitalist class will resort to it as their saviour. Nationalisation of industry, a move in the correct direction certainly, must not be confused or mistaken with “workers control of the means of production” it is not the same. The latter cannot be brought about without the removal of capitalism. If a Sinn Fein and possibly PBP/Solidarity coalition ever do bring about an Irish variant of the NHS, funded by general taxation, and if the capitalist state allow it, that same capitalist state can take it away. Just look at the UK! It will not be a substitute for the Socialist Republic which Sinn Fein once claimed to subscribe to, remember? That fight must continue!!
Kevin Morley, writer, activist, author of A Descriptive History of the Irish Citizen Army & Striking Similarities & The Misogynous President.