Socialist response to the Hayes Report: Chapter 6






As we can see the assumptions underlying the approach of the Hayes Report can all be challenged.  The true situation can be summarised as follows:


1.                  Demand for health services is finite and measurable and in fact not everyone will come forward to take advantage of health care from which they would benefit.  Demand, far from being infinite, is less than real need.


2.                  Demand can be met within the resources available in a modern industrialised economy.  All      that is required is the necessary political will to distribute resources in such a way that the NHS is adequately funded.  The fact that it is not adequately funded is due to the constraints of the capitalist system. Within the system we can fight for increased resources but ultimately only the socialist organisation of society will guarantee the future of the NHS.


3.                  Change is required, but not the change that Hayes and every Western government assumes. Rather we need increased funding and the democratisation of the NHS.


4.                  There is little evidence that large, centralised hospitals are safer or more cost effective.  Larger hospitals are more expensive to run, are more impersonal and less “patient friendly”, and are less accessible, particularly for the poor and those who live in rural areas.


5.                  Privatisation is dismantling the NHS.  It has further impoverished hundreds of thousands of       ancillary workers and handed hundreds of millions in profits to the private sector.  The implementation of the PFI will complete this process at a huge cost.  The private sector is more expensive and less effective than the NHS.


Of course it is necessary to do more than answer the arguments of Hayes.  We must propose an alternative and we must explain how real change can be achieved.


Focus on the Key Issues


To be successful any campaign must take on Hayes on the key overarching issues and must avoid setting one area against another.  The key issues are chronic under-funding, accessibility to acute services for all, the privatisation of the service, and the continuing and scandalous lack of any democratic control over the NHS.


The Hayes Report has drawn essentially the same conclusions as earlier reports drawn up by the various Health Boards and by Direct Rule Ministers.  Whilst the members of the Acute Hospitals Review Group spent many months considering the evidence, and have loudly proclaimed their independence and impartiality, there are grounds for suspicion that the conclusions of the Report were largely predetermined.


“Experts, "consultants", "the great and the good" - in short, the people who receive invitations to sit on government bodies - nearly always accept the constraints of the system.  In health terms this means accepting that "resources are finite" whilst demand is "infinite".  It means accepting as established fact that big hospitals are better than small hospitals.  It means that a high premium is placed on "affordability" and low priority is given to the wishes of patients and potential patients.


The Hayes Group did not sit down with a blank sheet of paper.  Those who accept the system as given, as the only reality, seldom realise that their thought is constrained from the outset.  The correct approach for a real review of Northern Ireland's health service would be to begin with an accurate assessment of the health needs of the population.  Then the necessary resources should be sought.  And the resources are there. 


Simply taking back the huge sums handed to the rich and to big businesses by both Tory and New Labour governments over the last twenty-five years would transform the finances of the NHS.  The socialist organisation of society would generate untold wealth and pave the way to solving the health problems associated with poverty.


We must have a rational debate on the way forward.  It is logical to concentrate certain highly specialist services in one place.  Not every service can or should be provided in every hospital but it is imperative that the NHS provides safe, effective and accessible treatment to everyone.  Despite the need for the centralisation of some treatment, there is no justification for the removal of all acute services, especially Accident and Emergency provision, from local hospitals such as the Mid Ulster, the South Tyrone or the Downe.


Some genuinely believe that safe treatment can no longer be provided in the smaller hospitals.  A key factor in their thinking is that a few consultant surgeons and physicians carry too much of the burden, effectively working 80-100 hour weeks for all of their working lives.  There is no doubt that the introduction of more reasonable working hours for junior doctors, and the desire of many consultants to work in larger centres where they are on-call less often and have more support, is placing pressure on the smaller hospitals. 


Obviously something has to change.  The doctors, nurses and other staff who have shouldered the burden of keeping the small hospitals open can no longer be asked to do so.  Hayes is proposing a 50% increase in the numbers of consultant surgeons and physicians and similar increases in the number of other staff however and such increases would allow us to adequately staff all of our smaller hospitals.


The present hospital network can only survive with substantial investment, in particular a massive increase in investment in people.  Ultimately we need to double the number of hospital consultants to the level in Germany and to more than double the number of nurses.  Nurses can take over many of the roles of junior doctors.  New staff and extra training for existing staff can make sure that all our hospitals continue to provide excellent treatment, with only minimal rationalisation of services when it is absolutely necessary.


This debate is ultimately about resources.  The powers that be argue that there is not enough money to go around.  They can see no way out except by cutting in one sector to give to another.  The new plan is posed in this way - money has to be saved now to allow investment for the future.  As already outlined the reality is that we can have high quality hospital service and a properly resourced community service.  It is only the way that our society is organised that prevents such a desirable outcome. 


Can We Rely on the Assembly?


In 1998 Health Minister John McFall gave his approval to a plan to reduce the number of acute hospitals in Northern Ireland.  He proposed a three tier hospital system with regional centres, such as the Royal Victoria providing specialist services (neuro-surgery, cancer treatment, etc), second tier hospitals providing most services (including a casualty department and a full range of medical and surgical treatment), and a number of smaller hospitals which would not operate as acute units - including the Mid Ulster in Magherafelt, the South Tyrone in Dungannon and the Downe in Downpatrick.


McFall recommended the plan but left it up to the Assembly to implement it.  Unsurprisingly every Assembly member spoke up to defend their local hospital.  They then deferred any decision and created the Hayes Review Group.  Hayes has promptly came up with McFall Mark II.


Assembly members who accept the financial constraints of the budget devolved from Westminster can only defend their local hospital at the expense of others.  By implication they will be arguing for somewhere else to close.  The result of such a sterile debate may well be paralysis, the Assembly unable to agree anything.  That this is the case is most clearly seen in the debate over the future of the  Tyrone County in Omagh and the Erne in Enniskillen.    The Fermanagh Hospital Steering Group assert that “Hayes Got It Right – Support the Erne” and recommend that the Hayes Report should be implemented “as a matter of urgency”.  In other words, close Omagh as an acute hospital as “a matter of urgency”.  The Steering Group includes Sinn Fein MP Michelle Gildernew, Ulster Unionist MLA Sam Foster and multi-millionaire businessman Peter Quinn.


In opposition the Hospital Campaign for the Rural West has drawn up counter-proposals which favour Omagh.  This group includes Omagh District Council Sinn Fein chairman and MLA Barry McElduff amongst its members and concludes that Hayes “barefacedly ignored the evidence on accessibility, sustainability and the clinical evidence”.


One thing that we cannot do is sit back and wait for the main Assembly parties to deliver.  For the first time in a generation the political parties have lost the luxury of criticising from the sidelines without proposing an alternative.  Now they must put up or shut up.  They have largely chosen the latter path.  All accept the constraints of the system. 


The “Programme for Government” agreed by the Assembly in early 2002 states that the private sector is the “motor of economic development”.  All parties are behind a policy of increasing reliance on the private sector.  In Sinn Fein’s West Belfast newsletter, MLA Alex Maskey has argued “we will need to fund an even greater portion of our public sector capital building programme using PPP”.  He goes on to state that  “private sector finance can help accelerate building and investment” and concludes that “we will need to take responsibility for some difficult decisions and rhetoric will not help when the reality hits us that we need to find billions to invest in restructuring our hospitals or our railways”.


In a recent speech, Sinn Fein Minister Barbre de Brun made her case (and her excuses) in a way that any other Minister would echo - in Stormont, the Dáil or Westminster.  "I have to be realistic because resources are tight...I will not promise to do things that we cannot afford but for me 'resources permitting' is not a get-out clause but a statement that there are limitations to what can be achieved".  Francie Molloy, Sinn Fein health spokesman, has stated on Talkback the he is not opposed to private medicine “on principle”. 


An all-party assembly committee on the PFI, chaired by Molloy, concluded: “while the preferred source of finance is public finance… Other sources of finance, including Public Private Partnerships, are likely to play and important role”.   Martin McGuinness of Sinn Fein and Carmel Hanna of the SDLP are presiding over a massive expansion of the PFI in the education sector.  In March 2002 McGuinness announced a number of new PFI projects (seven schools in total) and also decided that school staff other than teachers should be privatised along with their schools.  Mark Durkan was, and Sean Farren is, a Finance Minister in Gordon Brown's image (and shadow).  DUP Ministers are introducing PFI’s into road building and both the UUP and the DUP have long records of voting for Tory economic and social policies at Westminster.


The controversy over de Brun's decision to close the Jubilee maternity unity at the City Hospital in favour of the Royal Maternity illustrates the other profound difficultly in relying on the Assembly to defend our health service.  On what basis did the Assembly health committee, the MLAs and de Brun decide to come down in favour of one unit or the other?  There are reasonable grounds for suspicion that some voted on sectarian grounds for either the hospital based in a mainly Catholic area or in a mainly Protestant area.  No one appears to have raised the possibility that both units could stay open.


Fighting Back


The health and welfare of ordinary people always has and always will depend on their own strength. Marching feet and raised voices can make a difference.  The Rural Hospitals Campaign, which brought together local campaign groups in Omagh, Enniskillen, Mid- Ulster, Downpatrick and Dungannon, has demonstrated well what is required.  United and determined action to secure increased funding for our NHS is the only way forward.  Now the campaign must be broadened, involving campaigners and trade union activists in Belfast as well as in rural areas.


The Socialist Party proposes a moratorium on all cuts and a determined campaign to force Westminster to increase Northern Ireland's budget allocation significantly.  This is entirely achievable.  If it is explained that the money is there, that it has been stolen, that it can be wrested back, the support of working-class communities will be over-whelming. 


In Dungannon, Downpatrick, Omagh, Enniskillen and elsewhere tens of thousands have come onto the streets in recent years to defend their local hospitals.  Fifty thousand marched through Downpatrick several years ago, a mobilisation of almost every adult in the area.  Twenty thousand rallied in Omagh in October 2001. A turnout of this nature on a working day (a Monday), in some cases against the wishes of local employers, had the character of a local general strike.


Relying on “the force of public opinion” and spending large amounts of money on commissioning reports from “consultants” will achieve little. Both Conservative and New Labour governments have long track records of ignoring "public opinion".  A petition with 1,000,000 signatures did not save the accident and emergency department at St Bartholomew's in London.  The Edgware Hospital in Middlesex closed despite the fact that the local Tory MP resigned the Conservative whip before the 1997 election and the prospective New Labour MP promised to keep it open.  It is action that will achieve results, not words. 


It is possible to fight back through the electoral system of course.  Raymond Blaney was elected to Down District Council in June 2001 on a platform of defending acute facilities in Downpatrick.  Two other campaigners failed to win seats but gained respectable votes. Their campaign was met with fierce derision from the established parties, in particular from the SDLP.  


In England hospital campaigners in Kidderminster won a parliamentary seat at the last election.  New Labourite MP David Locke had promised to campaign to keep the Kidderminster Hospital open before his election to parliament in 1997 only to renege on his promise in exchange for a few crumbs from Blair's table.   As a result of his betrayal he was unceremoniously ejected from his seat and Dr David Taylor romped home with a 17,000 majority.


Kidderminster Health Concern have been contesting elections for some years.  In 1999 they won seven seats on the district council.  In 2000 they won eight more and four Labour councillors defected to their cause.  In 2002 they won further seats taking the total to 21 and gained control of Wyre Forest District Council.  They also won six county council seats. 


Kidderminster Hospital served a population of 135,000 before its closure.  Local campaigners argue that it had to close to make a new PFI hospital 20 miles away in Worcester more profitable.  During the period 1996-1999 the projected costs of the new Worcester Hospital doubled and during this period the decision to down grade the Kidderminster (built in the 1960’s) was taken.  In February 2000 John Jones was driven past the closed Kidderminster in an emergency dash to Worcester.  He never made it, a heart attack carrying him off.  Two years earlier he had written to Tony Blair begging him to prevent the downgrading of the hospital.  We will never know if the Kidderminster could have saved him. 


In the last general election in the South six TDs (members of the Dáil) were elected on a health platform.  Recently a newly formed “Health Party” won 23% of the vote in one area of Sweden standing on the issue of closure of maternity hospitals.         


The Role of the Unions


The NHS was not an overnight creation, nor was it the brainchild of one brilliant reformer.  It was the end product of a long and complicated social process.  Over centuries the ruling -class provided various forms of, usually rudimentary, healthcare for the poor.  They did so to preserve social stability and to provide a healthy population for their factories and their wars.  Some individual members of the ruling-class did act for reasons of philanthropy but in the last analysis, as argued by US health care analyst Vincente Navarro, "class struggle was indeed the main force" behind the development of state health care.


Indeed understanding the rhythm of the class struggle is the key to understanding the development of the NHS.  When those who control society sit down to discuss their options they do not have the luxury of doing so in a social vacuum.  They must calculate the degree of pressure from the working class, expressed through the trade union movement and working class political parties.  This pressure means that at times the ruling class concedes temporary measures to buy social peace.  This is the case with the NHS.


There would be no NHS today if it were not for the trade union movement.  It would not have been created but for the struggles of generations of trade unionists before 1948 and it would have been dismantled by Margaret Thatcher if it were not for the resistance of rank and file activists up and down the country.


The unions will be key in the struggle to defend and rebuild our NHS.  In recent months workers in Northern Ireland have shown their strength, emerging victorious from a number of significant disputes.  Fire fighters forced management to sway from attacking their terms and conditions after a ballot which went 100% in favour of strike action in early 2000 and in late 2002 are now again engaged in struggle.   Social work staff in North and West Belfast won a significant increase in staffing levels for childcare services after a solid campaign of industrial action in April and May 2000 (including non-completion of court reports, strict adherence to a 37 hour week, and non-completion of administrative work).


This dispute was centred around the scandalous under-funding of childcare services for some of the most deprived communities in Europe.  The workers involved were fully prepared to talk and to argue their case but in the end it was action that won the day.  The ballot was well over 90% in favour of action.  Management eventually conceded and created ten and a half extra posts in child-care and agreed a review of the service.


It is difficult to argue with the conclusion of dispute organiser and Socialist Party member Kevin Lawrenson that, "the traditional method of struggle, with the union taking on the employer with industrial action, is without question the most effective, and the success of our dispute completely vindicated our approach".  Social workers who work for the Foyle Health and Social Services Trust followed the lead of those in Belfast and have also organised industrial action on the same issue.  Now the issue has been taken up be social workers across the North.


Most significantly school term time workers- mainly secretarial staff and classroom assistants - won a long battle to be paid over the summer and other breaks after a magnificent yearlong campaign.  This group were supposedly almost impossible to organise.  They responded to a militant lead (with Socialist Party members in key positions) by joining the public sector union NIPSA in their scores and taking part in dozens of pickets, lobbies, street stalls and meetings and ultimately organising to take industrial action.  They achieved victory despite foot-dragging by the then right-wing leadership of NIPSA and opposition from Martin McGuinness.  Since then the leadership of NIPSA has swung to the left,  partly as a result of the victory of the term-time staff.  The left group “Time for Change” now has 13 members on the 25-member executive.  Six of these thirteen are Socialist Party members.    In November 2002 socialist Party member Carmel Gates won 39% of the vote in the election for a new General Secretary for NIPSA standing on a” Time for Change” platform.


The giant public sector union UNISON in particular, with 1.3 million members many of whom work in the NHS, is key to the future of our hospitals.  Defending Northern Ireland's health service and resisting the implementation of the PFI here will depend on the rank and file of UNISON for victory.  A number of other unions are also important organisers in the NHS including NIPSA, AMICUS and ATGWU.  All unions, those who organise NHS staff and those who organise workers in other sectors, have an important role to play.


The present right wing leadership of UNISON are tied hand and foot to New Labour and the policies they have borrowed from the Tories.  They have criticised the Private Finance Initiative but in reality do little to resist its implementation, instead relying on New Labour promises to ameliorate its worst effects.  In the NHS the UNISON leadership are relying on the introduction of a national framework for terms and conditions despite the fact that it clearly allows the continuance of the right of Trusts to introduce local variations.   


Recent elections in UNISON have demonstrated that the left is making real gains and winning the arguments on the best way forward.  Roger Bannister, Socialist Party member and candidate for the Campaign for a Fighting and Democratic UNISON (CFDU) gave the right wing a real run for their money in the last election for the General Secretary position.  Prentis, the right wing candidate, gained 125,584 votes (or 55.9%), Bannister 71,021 votes (31.65%) and Malkiat Bilku, a second left wing candidate, 27,785 votes (12.3%).  The combined anti-leadership vote totalled 44%.  Last year the CFDU doubled its representation on UNISON's NEC to six, including three Socialist Party members Roger Bannister, Jean Thorpe and Ralph Parkinson.


The swing to the left in UNISON has since been replicated by left victories in a number of unions.  Left-wing candidates (though some are more left than others) have taken the helm in the RMT and ASLEF (rail-workers), the PCS (civil servants in Britain), and the NUJ (journalists) and in AMICUS (representing workers in both the private and the public sector).  These victories are of vital importance.  There may be a real need to take industrial action to defend the NHS in the next period, in particular to defeat privatisation.


Democracy in the NHS


The NHS has never been run democratically.  In the early years hospital consultants had a disproportionate say.  Under Thatcher managers came to the fore.  Most recently General Practitioners have seen their role expanded.  In theory we all have a say through regular elections with elected politicians deciding on the overall strategic direction and financing of the NHS.  As with much else in society however, the reality is somewhat different. 


Elections every four or five years may or may not replace one government with another but the rules by which they govern do not alter.  Thus a new government may tinker around the edges with the NHS, or any other area of policy, but little of substance changes.  Big business, through their absolute domination of modern capitalist economies, ultimately decide on policy. 


The main political parties in Britain or Northern Ireland do not diverge in their positions on the key political issues.  The market is king, unemployment is a price worth paying for economic stability (stability for the owners of the factories, not for those who work in them) and the welfare state is essentially unaffordable and unsustainable.  This unaffordability means that social policy, and health policy, has become a constant exhortation to keep down costs, to cut waste, to streamline and to centralise in the interests of efficiency.  Any political party or individual that rejects this approach is derided as not living in the real world.  Any real challenge to this political status quo would meet fierce resistance from those who really control society.


Ordinary working class people are perfectly capable of understanding their own health problems and their health service. They can work with NHS staff to improve their health.  Doctors, nurses and social workers do not have to issue judgements from on high to a docile population.  Patients are not "consumers", an odious Thatcherite concept, which reduces us all to being what we consume.  Julian Tudor Hart has proposed that staff and patients should work together as "co-producers".  Together we produce a desired outcome, improved health. 


It is important to assert that people deserve a real say in their health service.  The way forward is through co-operation at every level.  And genuine co-operation means genuine democracy, a real say for everyone.  This requires both locally elected bodies, representing the community and NHS staff, which will decide on local priorities, and a national body to agree a strategic plan for the future, properly funded and accountable.  Services must be equally available to all, regardless of where we live, whether or not we own a car or whether we can afford private medicine.


Inequality and Health


Whilst the NHS is well worth defending this doesn't mean that it is not open to criticism.  Fifty years after its inception it has achieved much.  In particular, it is very good at dealing with acute (or sudden) illnesses and with accidents.  It also helps to lessen the suffering caused by chronic illnesses which are, at this time, "incurable".  The NHS has been much less successful in implementing a strategy for prevention of ill health.   Indeed, its emphasis on acute illness has earned it the sobriquet "National Sickness Service" from some.


At the end of the day however, prevention is much less about what a doctor or nurse can achieve and much more about how society is run.  Much ill health is related to poverty and unemployment.  Even so-called "way of life" factors, such as smoking and excessive use of alcohol, are often directly linked to the stress of living in poverty.   The NHS cannot remove poverty and unemployment, only a revolutionary change in the way society is run can do so. 


The NHS’s failure in this area, or more accurately the failure of society to seriously tackle its social ills, is the reason behind the greatest health scandal of our time, the damming fact that inequality in health has worsened dramatically over the last 30 years.  Whilst the population as a whole has seen its health improving, when measured on such factors as infant mortality and life expectancy, the rich have benefited disproportionately and the poor have lost out.  Every year between 22,000 and 100,000 people die prematurely because of their class in Britain.  If this was an epidemic of influenza or measles it would be tackled resolutely by every known method.  Why isn't the death toll of class tackled?  Surely a "civilised" society would not tolerate such a waste of human life?  And perhaps a society that does is not " civilised" in any real sense of the word.


All measures necessary to tackle ill health must be on the table, and we must place new emphasis on tackling the single most important factor, inequality.  Then we will have a new kind of health service.   


What is Necessary


The Socialist Party fights for the following programme.


                        1.                        The Socialist Party stands for a fully comprehensive, publicly funded and free at the point of access health service.  It resolutely defends the NHS but also fights for changes that will deliver better health for all.  Good health is not just the absence of life-threatening illness but “a state of complete physical, mental and social we-being” (World Health Organisation 1965). 


The WHO has recently re-defined health, arguing that because of the inevitable rationing of health care on a world wide scale, we must restrain our ambitions and target serious illness only.  The Socialist Party rejects this approach.  It is not enough to spend money on disease once it arises.  A proper Health Service seeks to prevent disease arising in the first place. 


This does not mean preaching at people about smoking and drinking. The greatest causes of ill health in this society are poverty and unemployment.  Genuine prevention means taking measures to wipe out poverty and unemployment and ending inequality, the greatest killer.  This requires a 35-hour week with no loss of pay, full employment and a £6 an hour minimum wage as a first step towards £8 an hour (the European Decency Threshold).


2.         In order to avoid health care shortages there must be a massive increase in spending on the NHS. It is only by providing adequate resources that health care problems can be tackled.  The proportion of GDP spent on health in the UK is 6.9%, a lower figure than in nearly every other advanced country.  NHS spending needs to double.  The wealth already exists in society to provide the necessary resources.  Taking the 150 largest companies into public ownership, under democratic control, would generate billions of pounds for increased social expenditure.  A socialist economy would create new wealth which would enrich everyone’s lives and make scarcity a thing of the past.      


3.         There should be an immediate moratorium on any further hospital closures.   A closure is only acceptable if it can genuinely be demonstrated that it is in the interests of patients and the local community. As such a case has not been made we must fight for all current acute hospitals to remain open and plan the way ahead on this basis.


4.         For this to happen there must be an increase in resources, in particular human resources.  The fifty per cent increase in consultant doctor numbers, as proposed  by Hayes, and a similar increase in the numbers of nurses and other health professionals, will allow each hospital to continue functioning.  Ultimately we need to double the number of nurses, doctors and other staff.  The necessary increase in resources will only be won by determined campaigning, spearheaded by the trade unions, genuine community groups and groups representing patients and carers.


5.         We must reward all those who work in our health service with decent wages and conditions.  As a starting point, all NHS staff should be on national terms and conditions, should receive at least £8 an hour (the European Decency Threshold), all forms of Performance Related Pay should be abolished and no-one who works for the NHS should receive more than four times the pay of the lowest paid.


6.         Many of our hospitals require extensive rebuilding programmes.  To use the PFI to fund this rebuilding is ludicrously expensive.  Instead the finance ought to be provided by central government.  A direct labour organisation (building workers, architects, etc directly employed by the NHS) should be established to rebuild our hospitals.  There should be no profits in ill health – for building companies or the banks. 


7.         All privatised services must be brought back into public ownership, including all nursing homes, residential homes and ancillary services.  This would save the NHS money as there would no longer be the need for profit for the private companies involved.  It would also allow the staff to be brought into the NHS, to be paid a decent wage and consequently improve their health.


8.         We must complete the task unfinished when the NHS was created in 1948 and bring all areas of health care into public ownership.  The pharmaceutical industry (drug companies) make £1.5 -£2 billion profit from the NHS every year.  The pharmaceutical industry tops every league of profitability.  In 2002 US company profitability fell by 53% overall whilst the profitability of the drug companies rose by 32% (from $28 billion to $37 billion).  The drug companies make a profit of 18.5 cents on every dollar invested compared to only 2.2cents in every dollar invested for the average US company.  The high street chemists (pharmacies) and the medical supplies industry also make hundreds of millions from the NHS.  It makes no sense to hand over these huge sums.  The pharmaceutical industry, the pharmacy chains and the medical supplies industry should be brought into public ownership and integrated into a new democratically controlled NHS.


9.         The New Labour government plans to spend £50-£100 million each year on paying private hospitals to carry out operations for the NHS.  Instead we should bring the private hospitals, including the two in NI, into public ownership.  All private beds (pay-beds) in the NHS should revert to the public sector. Then we could utilise the beds available in the private sector without the expense of creating profit.  Private medicine should be outlawed as a form of discrimination (it discriminates on the basis of class).


10.       At present General Practitioners are effectively self-employed and huge sums are squandered each year on administering a complex system of payments.  Dentists and opticians are also paid per item of work.  Primary care, dental and optical services should be fully integrated into the NHS, with all practitioners becoming salaried NHS employees.


11.            Community care must be expanded.  The Socialist Party is in favour of caring for as many people as possible in the community.  This can only be done with adequate resources.  Developing community care must not be a back-door method of closing beds in hospitals or privatising services previously provided by the public sector.


12.              Genuine democratic control should be introduced into the NHS.  The Trusts must be scrapped.  The service should be overseen by local and national bodies representing health service unions, the wider trade union movement, patient groups, carers and elected local and national politicians.  Managers should become administrators, responsible to elected bodies.                        


The NHS in Northern Ireland should be run by local committees, made up of one third local councillors, one third of members representing the staff of the local service (elected through their unions) and one third of members representing community groups, voluntary groups and patient groups in the area.  These bodies should elect two thirds of the representatives to a regional body which will oversee the NHS across Northern Ireland, and which also has seats for representatives of central government.  There should be similar democratic accountability at all levels in the NHS.                                                                                                                                                                     

Capitalist society makes ordinary people feel powerless and makes them feel that they must hand over control of their health to experts.  Under a new NHS everyone can have greater knowledge and greater education about their own health. We can all be co-producers of our own health, alongside health professionals.


13.       There needs to be a new emphasis on the prevention of ill health.   Ultimately there is only one way to finally to tackle the toll of health inequality – through the democratic socialist organisation of society.  This requires the public ownership of the large companies that dominate the economy, and the utilisation of the resources of the economy in the interests of all. 




The assumptions underlying the conclusions of the Hayes Report are just that, assumptions.  There is no robust evidence to back up its main conclusions, that more hospitals and beds must close and that the private sector must be given further opportunities to make a profit from ill health.  A revolt by ordinary working people can stop all of this in its tracks.


We want a moratorium on further closures, a determined campaign to wrest increased funding from Westminster and a NHS run openly and democratically in the interests of everyone. Rallies and marches, and ultimately strike action, both of hospital workers and other workers, will be necessary to ensure that this campaign is a success.  The excellent initiative taken by Raymond Blaney and other hospital campaigners in Down may be only the first such.   Hospital Campaigners across the North should consider standing candidates in the Assembly elections , if they occur, and in the next local elections.   


In the 1970s patients and staff occupied a number of hospitals in London to prevent closure.  There was a fierce struggle around the future of the Elizabeth Garrett Anderson Hospital in particular.  The idea of occupation should now be on the agenda in Northern Ireland.  If moves are made to close a hospital such as the Downe, in an area where a strong campaign exists, the staff, patients and local community should refuse to accept closure.  If they occupied and prevented management removing equipment this would have an electrifying effect across the North.   Such a move would clearly also provide the spring board for an electoral challenge on the issue of health.   


This is a rich and sophisticated society.  There is no need for anyone to lie for hours on a trolley in casualty or to die prematurely because of their class in the early years of the twenty-first century.  We can sweep away all the rubbish of the past and create a new service we are truly proud of.  The resources and the technology are there.  All we need is the will.     

Socialist Party Publications


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Should anyone feel the need to check the actual Hayes Report, here it is: