A-Infos (en) Uk, ACG, Jackdaw #23 - NHS: Managed Social Murder - by an NHS worker (personal capacity) (ca, de, it, pt, tr)[machine translation]

As an NHS worker there is an anguish, grief and melancholy in what I 
write about the NHS. It's certainly the best (least worst!) place I've 
contributed to with some of the finest, most admirable staff and 
personable people in the many varied places of employment I have 
endured: finance, government agencies, education, multinational firms 
and small consultancies. ---- In recent times the NHS is often discussed 
as one would of a great sporting hero debilitated by age, illness and 
increasingly unsuited to the contemporary world; or as suffering a 
pitiful and fatal descent as a direct result of self-destructive 
behaviour due to the inherent nature of the beast. To stretch the 
credulity of the analogy, it is seen apart from its social and political 
context as the sports person is from their team.
But the NHS is no such thing. The myth of what sort of organisation the 
NHS is, as well as its purpose, appears more durable than the 
organisation itself. Despite the myth of the NHS, it is part of the 
social and economic landscape as any other distended arm of government: 
it is a beast which fulfils its master's needs in the same way any 
organisation of the state does under the guise of securing its citizens 
welfare.
Even at a superficial level, the NHS's fabled commitment to healthcare 
as being "comprehensive, universal and free at the point of delivery" 
has now been revised as provision to be delivered by "limited 
circumstances sanctioned by Parliament".
Consider recently proclaimed values and behaviours such as: Working 
together for patients, Commitment to quality of care & Compassion. One 
would think these were pretty obvious and implicit requisites of the 
health service and then wonder why such obvious things require to be 
explicitly stated and what they were prior to explicitly defining them.
But they are required for a couple of important reasons:
1/ to convince staff & patients the NHS is their friend and a beneficent 
organisation.
2/ to give the political veneer of its raison d'être to care.

And this deception obscures the NHS raison d'être: to manage the health 
of the national workforce in accordance with its disposability; it is to 
commodify health provision by identifying particularly 
profitable[care]and fully corporatise the institutions itself (internal 
markets, commissioning, etc) and the value of its workforce 
(productivity, efficiency measures such as bed occupancy).
Some consideration of a sample of recent scandals of either service 
provision or the way the NHS treats whistleblowers reveal the nature of 
the beast. The most recent to surface is the corporate manslaughter 
investigation of whether maternity care provided by the Nottingham 
University Hospitals NHS trust had been grossly negligenti - the same 
Trust recently announced a bid to cut hundreds of jobs.
In one sense it's unfair to highlight one Trust after decades have 
witnessed a surfeit of awful mismanagement and wilful skullduggery 
across the NHS, whereby cover ups of care so below the required 
standards is, even in the eyes of the law, tantamount to manslaughter. 
The Francis report of 2013 highlighted similar deliberate delivery of 
substandard care and resourcing at the core of the often-fatal 
consequences. And yet on it goes: Morecombe Bay, Ockenden, Sturrock, 
Kirkup. And on and on....
There have been a myriad of other examples of dissembling and cover 
upsii which NHS management have orchestrated including manipulating 
waiting times, inaction over repeated staff concerns and rampant and 
unchecked bullying of staff. Even the apparently straightforward Lucy 
Letby affair now stinks of cover up after an internationally acclaimed 
panel of experts have refocussed the causes on poor practice and 
resourcing, throwing serious doubt on the conviction.iii
It's the NHS treatment of whistleblowers that is truly revealing about 
the nature of the organisation. The case of Dr Chris Day is an exemplar 
of the lengths and depths the NHS will go to crush those championing 
adequate health care provision and the political and legal 
establishment's desire to either ignore or hide the malfeasant nature of 
the NHS.
Over ten years ago Dr Day pitched up to a busy shift at Queen Elizabeth 
Hospital's intensive care unit (ICU) at Lewisham and Greenwich NHS 
Foundation Trust. He escalated issues of staff shortages as per the 
required practice. The Trust refused to act upon his complaints and Dr 
Day then utilised his right to publicly raise his concerns through the 
whistleblowing policy.
This started a long and tortuous legal campaign and a series of court 
and employment tribunal appearances which are still ongoing. Aside from 
the obstinate determination to destroy Dr Day professionally, 
financially and personally, the revelations are shocking even to 
hardened observers and include:
    * the collusion between the Trust and Health Education England to 
backlist Dr Day from professional development
    * the deliberate destruction of 90,000 emails relevant to the legal 
and employment case
    * the refusal of the legal system to hold those who withheld or 
destroyed evidence in contempt
    * expending at least £700,000 on legal provisions on a case when 
the Trust knew it was in the wrong and was forced into an admission of 
wrongdoingiv
This is one admittedly extreme case. There are many other more 
pedestrian examples (though no less destructive and outright hateful) of 
NHS whistleblowers who have had to defend their careers from being 
destroyed by the NHS for trying to do the right thing: Martyn Pitman, 
Consultant obstetrician and gynaecologist at the Royal Hampshire County 
Hospital; Psychiatrist Dr Jane Hamilton NHS Livingston; Mental Health 
Nurse, Rab Wilson; even Orthopaedic surgeon Shyam Kumar, special adviser 
on hospital inspections for the Care Quality Commission - it was his 
actual job to identify poor quality service!v
This is only the stuff we know about - the tip of the iceberg. And yet, 
after decades of this sort of stuff creating news headlines, the 
Government is only now seriously considering sacking and excluding from 
future employment in the NHSvi
Despite the undoubted commitment, skills and care the frontline and 
supporting staff, theirs is not the culture that predominates and not 
the type of organisation that materialises.  Why is NHS culture and 
conduct like this? It is because the NHS is in the service of those who 
wish to privatise the profit opportunities and socialise the costs.
There is an abundance of material which documentsvii governments 
constructing pathways for the private sector to increasingly corporatise 
the NHS with Labour in particular being an enthusiastic facilitator of 
marketising health care.
Current Health Secretary Streeting has trousered almost £200k from 
private health care companies "while advocating for the NHS to pay 
private firms for use of their resources"viii while one of his 
predecessors, Alan Milburn, was paid over £8m (yes, million!) for 
"consultancy roles in the private healthcare sector"ix. These companies 
do not part with this sort of cash without an expectation of significant 
return.
Together the sole aim of their Mutually Agreed Resignation Scheme aims 
to "slash the budgets, stand back and let the service fight itself for 
survival; forcing a reduction in headcount, without wasting time on 
analysis or permission[it's]just a way to 'get rid of people'". MARS is 
"more expensive than statutory redundancy, but the key benefit, it 
avoids consultation[and]MARS is arbitrary and open to favouritism"x. 
Their strategy is to force the way open to expensive, profitable but 
inefficient and disinterested privatisation of back office services
Other benefactors to Labour, the Health Sector trade unions, are often 
muted on Labour on the take and obstinate in refusing to frankly 
criticise the organisation they created and fund. They are silent, 
posted missing or implicated in NHS bad behaviourxi. This is no surprise 
on a number of counts: trade unions are notorious in putting their 
union's interests before their members; they have a long track record in 
working with employers to police, discipline or even victimise union 
activists and campaigners; in the NHS in Scotland the unions work in 
partnership with the NHS and the most senior union representative in 
each is employed by the Board with title of Employee Director - no 
possible conflict of interest there then...
In addition, many of the big trade unions such as GMB and UNITE have 
been exposed as cultivating toxic environments and fraudulent 
practicesxii. Trade unions are moribund in terms of engagement with its 
membership - for example, union general secretaries are often elected by 
around 10% of their membership on turnouts so low as to undermine their 
legitimacy.
The wilful ineffectiveness of the unions and cravenness to Labour is 
therefore no surprise and, despite many union activists providing 
valuable support and service on the ground, they cannot offer any hope 
of mustering any turnaround for the NHS's fortunes.
It is a conscious strategy by the trade unions in the same way austerity 
is the choice of their masters in government. The NHS is the integrated 
mechanism by which to manage the inevitable effects of austerity.
The result is that a hateful culture is at large in the NHS. Consider 
the tale of an employee collapsing in the workplace and having their 
line manager shout at them, while passed out on the floor, "Get up! 
What's your fucking problem?"; and after it was discovered the colleague 
collapsed as a result of having a miscarriage that same manager 
commenting "Yeah, well, its over now, get back to work". xiii
Not a tale from an Amazon like employer but an illustrative tale from 
former midwife turned journalist Pavan Amara on an example from a 
midwifery department. She notes that the myth of saintliness on the 
frontline has been exposed as a febrile and feral workplace environment 
nourished by toxicity feeding down from the top.
Further anecdotal evidence from long time health professionals note 
career advancement at the expense of care quality of contemporary 
training and trainees - a less confederate approach to teamwork in the 
interest of climbing the greasy career pole.
It is the patient who also endures the blunt consequences. With reports 
of services being overwhelmedxiv, where is demand for healthcare coming 
from?  Public Health academics, Walsh and McCartneyxv, identified that 
"health inequalities are entirely political in nature and therefore 
require entirely political solutions".
The consequence of political choices - irrespective of political hue - 
has resulted in increasing avoidable deaths and even a reduction in life 
expectancy. Saliently, they conjure up the analysis of Engels to 
characterise government policies:
When society places hundreds... in such as position that they inevitably 
meet too early and an unnatural death[and]places them under conditions 
in which they cannot live ... its deed is murder[even if]the offence is 
one of omission rather than commission: social murder.xvi
As NHS employees our motivations are important but not significant in 
its role in supporting government policy of social murder - it 
facilitates the managing of it. There is a danger that criticising the 
NHS puts you on the side of the health hawks. With the weight of 
statistical, documented and anecdotal evidence, it should be clear the 
NHS is masquerading in plain sight. The NHS is an agent of 
neo-liberalism with its central tenet of austerity
What can we do...? A response could be: well, you've made your bed, now 
die in it. But there are examples of what can be achieved and offer a 
better way of providing healthcare.
Union members have often forced the officers to put aside their tribal 
hatred and work together to represent (sometimes successfully) their 
interestsxvii. But this can take years and often means Trusts and Boards 
robbing peter to pay Paul. Many have come together to form grass roots 
movements within unions to try to democratise them and make them more 
representative e.g. UNISONs Time for Real Changexviii.  While there are 
some measures of success, these groups are often outflanked by their own 
organisations by, for example, disbarring members from standing for 
officexix.
During the COVID pandemic whereby healthcare workers in Greece, Germany 
and France ignored their respective ministries and unions and organised 
themselves to provide the resources and care requiredxx.
Mutual assistance became a byword and hinted at previous grand social 
experiments in the last century. The NHS does not exist in a vacuum - it 
is integrated into the social and economic system which is why - 
especially as the last fifty years of government in the UK has 
consistently and particularly demonstrated - that in a world of 
unfathomable wealth, the political will, competence and capability does 
not exist.
In order to formulate a health service, we first must decide what sort 
of society we want to live in. Historical - anthropological! -  evidence 
suggests that mutuality is the most successful way for civilisations to 
develop healthily and successfully. We can only do it ourselves, or 
allow them to carry on regardless and by doing so, facilitate managed 
social murder.

https://www.anarchistcommunism.org/wp-content/uploads/2025/06/jackdaw23c.pdf
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