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3 Reasons the Fight for the NHS Needs to Go on the Offensive

Junior doctors will start their fifth strike in just a few weeks’ time – and this time it will be a full walkout, meaning all emergency care will have to be provided by senior doctors. The escalating intensity of the dispute is making it more and more obvious that the current contract dispute is actually a fight over the future of the NHS itself.

Jeremy Hunt’s intention is to impose worse working conditions on the staff who make up the NHS, and continue to force the service deeper into crisis. The health secretary’s plan seems to be to push the NHS to the verge of collapse in order to make way for profitable sectors of our once-universal free healthcare system to be sold off at an increasing speed and scope.

This means the junior doctors’ strike is a social issue which has implications far beyond one specific set of workplaces. We all have a stake in this fight, so we should all be willing to take action to change its outcome. We need to throw our collective power behind the doctors and help them defeat the privatisation agenda. And so, to break the stalemate, we need to go on the attack.

1. Overcoming limitations and increasing our leverage.

The only way for doctors to change the power relationship between them and the government is to escalate their strike action.

However, here there is a problem. Socially reproductive labour has a ‘dual characteristic’: it both produces people as labour-power, but also people as people. This means unlike strikes in direct production processes, where workers can withdraw their labour without harming anyone, strikes in social reproduction processes can risk damaging ourselves by withdrawing care from the people on our own side. That point is currently a long way off (despite the scaremongering of the mainstream media), but it does exist.

So there is a barrier to the escalation of doctors’ withdrawal from work. If Jeremy Hunt is willing to accept the costs, he can hold on for a while longer and try and wait the doctors out. The doctors’ defensive strategy (employees involved in the contract dispute withdrawing their labour at their immediate workplace) is limited in how much power it can exert.

But the rest of us have no such limitations. In adopting an offensive strategy, we can change the rules of the game, and we can broaden the sections of society taking part in the fight. Rather than allowing it to be one specific set of employees versus the government, we can begin to make this fight into a direct confrontation between the social majority who support a public NHS and the government.

2. Going after the government and the profiteers.

Most people know of the chummy connections between privatising companies and this government. The two are so close, it verges on corruption.

The initiative to privatise the NHS comes not only from an ideological commitment to neoliberal deregulation and a ‘long term economic plan’ to dismantle the welfare state, but also because companies are eyeing up billions of pounds in NHS contracts. It makes sense, therefore, to have a strategy that hits out at both the big players behind the privatisation agenda: the government, but also those who seek to profit from the demise of the NHS.

An offensive strategy recognises that our enemy is not just the Tories and their nastiness. Instead, the fight to defend collective healthcare is a fight against the structural reorganisation of the welfare state towards a system based on private interests and profit.

3. Demanding offensively.

This strategic movement from defence to offence has to be matched by a political movement. That is to say, we need to start demanding more than just a return to the post-war settlement. ‘Save’ the NHS by trying to turn back the clocks, and it’s doomed. In any case, didn’t we always want so much more than very limited wealth redistribution paying for universal healthcare?

We need directional demands that point to the future we want and, if we win this time, will improve our ability to win again. This means not just demanding the NHS as it is, not even keeping state provision – i.e. the social wage – as it is.

We need to start taking our social reproduction into our own hands, funded by taking the value we create back from the state and capital. We’ve been in crisis for long enough, now it’s their turn.

A growing coalition including Plan C, Action for Trans Health, NHS Uncut, Free Education Manchester and Manchester Solidarity Federation are calling for pickets against companies profiting from the privatisation of the NHS during the next round of doctors’ strikes on 26-27 April. Join them on Facebook or on the hashtag #PicketProfiteers.

Photo: Roger Blackwell/Flickr

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Published 14th April 2016

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