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Ian Burge

‘Democracy Is Interference’

Say Tories

(February 1980)

From Militant, No. 490, 15 February 1980, p. 7.
Transcribed by Iain Dalton.
Marked up by Einde O’Callaghan for the Encyclopaedia of Trotskyism On-Line (ETOL).

“Patients first” is about the last title most people would choose for any proposals from this barbarous Tory government on the National Health Service.

But this name is cynically given to the recent Tory proposals on the restructuring of the NHS. The Tories’ real attitude is of course, one of “working class patients last – first priority to the rich and big business interests.”

Fighting to prevent closures, you can’t help noticing that the NHS is being run on ever more strict ‘business’ lines. Small cliques make the real decisions behind the scenes, and Health Authority members are treated as rubber stamps.

Some Labour members on the health authorities have criticised the cuts and some authorities, particularly when pressurised by local campaigns have delayed some of the worst closures. Ultimately though, the accountants get their way and trade unionists in the NHS and the working class who use the services have no say.

The Tories have raised objections, though, even to the minimal hold-ups caused by pressure from AHAs and Community Health Councils.

Patrick Jenkin told Conservative News that he believed one potent source of delay and waste was the huge amount of consultation required. He wants “normal day to day decisions” (such as closing wards, maybe?) to be taken by “the people actually running the show.”

The Tory proposals are that the present multi-district Area Health Authorities should disappear. In their place a larger number of smaller District Health Authorities.

The proportion of councillors serving on authorities is to be reduced. Other members are to be chosen for ‘personal qualities’, and certainly not to be elected and accountable. These appointments are to be made by the Regional Health Authorities, themselves possibly in the future to be made up of ... District Authority nominees!

The management at District level is to be enlarged, and the grading of hospital administrators is to be raised to reflect the ‘maximum delegation of responsibility’.


The Tories claim that ‘eventually’ the re-structuring will lead to a saving of 10% on management costs (equivalent to about £30m). This saving will not come from top managers. The new district authorities will need even more of these. It can only be from the area headquarters staff that any ‘savings’ will be made – thus threatening thousands of jobs of clerical and ancillary staff.

One bad system is to be replaced by another. We must remember what the Tories’ overall aims are for the NHS – to make it a vehicle for exploitation by private interests, to reduce services and to teach people to make less use of the NHS (as The Times succinctly put it). They want cuts implemented and they don’t want anyone interfering.

Trades Councils, health union branches, and Labour Parties will now be considering the Tory proposals. The labour and trade union movement should reject them.

We should demand that health service government bodies should:

Participation of Labour Councillors and trade union/Trade Council nominees in any future local authorities, set up on the lines of the Tory proposals, is a matter of tactics, as it is indeed with the present structure.

Their role must clearly be to oppose all cuts. They should work together, and with the local sections of the labour and trade union movement, to expose the plans and publicly campaign against the cuts.

But there can be no argument for a lone voice in the wilderness. In the absence of an organised and effective opposition, members serving on such authorities will inevitably be tacitly supporting the cuts. In these circumstances they should withdraw or be withdrawn.

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Last updated: 10 July 2017