The human body is a very resilient thing. An average adult can lose about 30 per cent of their blood – three out of the nine pints that flows in their system – before their blood pressure would show any significant drop. This is possible because the body is designed to “make do” in situations of temporary stress. Your body compensates in a whole host of ways – your kidneys, your capillaries and your heart all try to pick up the slack – which allows us to weather brief spells of blood loss without even noticing it. But if the blood loss is not stopped, then these changes – which are so helpful in the short term – become problems in themselves. Our kidneys stop working properly, our capillaries stiffen, and our hearts grow thick with overwork. In medicine, such stretched-beyond-its-limits maladaptation has a name: decompensation.
For years now – decades, really, but particularly since the undemocratic introduction of the damaging Health and Social Care Act in 2012 – our healthcare workers have been trying to compensate for cracks in the system. Those of us who work for the National Health Service are, almost constitutionally, programmed to “keep calm and carry on”; the kind of people who are not afraid of hard work, and who want to give our patients stellar treatment, no matter what is going on around us. We try to cope, but eventually, we reach our limit – our nurses are sick of being undervalued and threatened with redundancy at every round of cutbacks; our doctors are “burning out” after being made to work like robots; and nearly all of the hundreds of thousands of my colleagues who work so hard to make the health service tick are fed up with underfunding and the introduction of market principles in their beloved NHS.
So, there has been a lag, a period of seeming calm, since the Health and Social Care Act began its privatisation agenda in full force. But, inevitably, we are now seeing the vital signs flicker – the first audible cries of a system overstretched, saying: “Stop!” This October is a historic landmark in the history of the NHS, marking the first in what may be a series of strikes by healthcare workers who, as insiders, know first-hand that the system has well and truly decompensated, and now teetering on the brink of collapse. So far, UNISON, UNITE, the Royal College of Midwives, radiographers and some paramedics – together representing about half a million health workers – have all agreed to take part in strike action. Predictably, the BMA (the doctors’ union) has been slow on its feet.
The strike aims to challenge the real-terms pay drop affecting NHS staff – a third of whom do not get paid enough to live on. But it is also a symptom of a deeper concern about the future of the health service. Believe me, the kind of people who work in the NHS are not the kind of people who would opt for a strike lightly (this is the first NHS strike in 32 years, despite plenty of reasons to get angry in the meantime), so we must take their decision for the serious warning that it is. A warning telling us that – unless we commit to the founding principles of the NHS, and unless we make good on the conviction that health is not a commodity to be profited from, but a human right that must be guaranteed and defended – our patients will soon feel the uncushioned hammer-blow of the neoliberal agenda. In short, it is going to hurt – quite a bit. But is a healthcare strike the answer? Certainly, there is a strong moral case for such action. But has it ever worked?
In 1998, El Salvador was facing a similar set of problems to the ones confronting the UK right now. Firstly, it also had a right-wing government in power, with financial links to private health companies. A second similarity was that, like here, the media was intentionally used to undermine public services, in order to stoke the public’s interest in “modernisation” via privatisation. Thirdly, it too was being threatened by damaging policy and international trade agreements that planned to open up the health sector to profit-driven corporations. In the case of El Salvador, it was the impact of the World Bank, the IMF (International Monetary Fund) and GATS (the General Agreement on Trade in Services) that was dangerous; whilst today in the UK it is PFI (Private Finance Initiatives) and TTIP (the the Transatlantic Trade and Investment Partnership) that we ought to be scared of. Despite having all this stacked against them, five years later El Salvador was celebrating a victory for the social movement opposing privatisation. How did they pull it off?
One key factor was the strength of their unions: STISSS (the general workers’ union, similar to UNISON and UNITE) and SIMETRISSS (the doctors’ union, equivalent to the BMA). Even though SIMETRISSS, much like the BMA, lacked a strong history of radical activities, by pairing with the STISSS, they were—together—able to able to achieve gains that probably neither would have been able to manage alone. First, they began an indefinite, escalating national strike. There were occasions when healthcare workers walked out of hospitals, handing them over to their administrators. This was a powerful demonstration of what we all know—that our health workers are the health service, and that their managers are unable to run hospitals and clinics without them.
Second, they produced a document stating their aims, called No to the Privatisation of the National Health System. This solidified their demands, raising awareness and getting the public on their side. Third, they ensured that the law was changed to protect the health system from privatisation attempts and prevent its future dismantlement. After many months of pressure, congress approved Decree 1024, which guaranteed that healthcare would remain in public hands, and forbade public institutions from transferring contracts for health services to private corporations. Fourth, the unions used the growing public support for the strikes as leverage when their government was acting obstructively to their demands. For instance, at one point then-President Francisco Flores’s conservative ARENA party threatened to repeal the decree, but pressure from rallies, petitions and protests forced him to leave this important bill untouched. Some demonstrations in San Salvador (the so-called “White Marches”) attracted a quarter of the capital’s population onto the streets, many wearing all-white in solidarity with health workers. We cannot win without the public on our side.
It certainly was not an easy route to victory. The ARENA government responded aggressively to the demonstrations: tear gas, rubber bullets and water-cannons were all used against protesters; healthcare workers sometimes had to sell their belongings in order to pay bills during long strikes; and many of the doctors and nurses were summarily fired and replaced. However, after 4 years of intermittent strike action (some strikes lasting up to nine months in duration), the forces of privatisation finally gave up: the World Bank rescinded policies that encouraged privatisation in El Salvador, the government agreed to work under Decree 1024, and a commission was set up to ensure that the healthcare system would remain in public hands. On 13 June 2003, the strike action finally ended, and all members of STISSS and SIMETRISSS were allowed to return to their jobs as usual. Perhaps more remarkably, the people of El Salvador were still very much on their side—proud of their bravery and relieved that the tendrils of marketisation had (at least for a few years) been kept away from their cherished public health service. To this day, the National Health System in El Salvador is surviving and thriving, and each of the thousands of patients who benefit from it every day is living testament to the importance of the strike action which began fifteen years ago.
Despite the parallels, Britain is not El Salvador, and it is impossible to predict how today’s strike and this week’s industrial action will pan out. Based on my years working in the NHS, a few things are likely: the government will try to fob us off with flimsy promises; the media will make loud the voices reading off the corporate auto-cue; and those brave enough to strike will be demonised and silently punished by hospital administrators. It is to this last group—the over-worked, under-appreciated and under-paid healthcare workers who (I assure you) will not enjoy a single minute of the strikes, fearing for their jobs and missing their work—that I address my last comment.
When striking for a pay rise (even if it is long-deserved and necessary to keep staff and the service running), you will feel guilty. Of course you will: striking will keep you away from your workplaces, unable to serve the patients you stay overtime for, and who make your job worth doing despite its downsides. After all, it is our job – our privilege – to serve those people. But it is also our job to speak up, for we at the frontline know better than anyone that if we do not act soon, the NHS will decompensate and fail – and then fall, broken, into the hands of the corporate sector. It is right to act before such a disaster occurs. It is right, at times like these, to cause controlled inconvenience to the patients of today, if it means preventing an impending catastrophe that will endanger many more lives tomorrow, and to ensure that our NHS is alive in well for generations to come.
Neil Singh is a British doctor, and a member of Keep Our NHS Public