John Lister, London Health Emergency Anyone who thought that Cameron's Tories were somehow different from the Thatcher, or that the ConDem coalition would be in any way mellowed by the admixture of Liberal Democrat toadies has been cruelly disabused. Andrew Lansley's White Paper - outlining the definitive denationalisation of the NHS in England, transforming it from a National Health Service into a National Health Market funded (at least for now) from taxation - typifies the brutal politics of consigned to the role of servile hod-carriers, sharing the blame for policies which will doom them to decades of well-deLansley's plans are a root and branch attack on the NHS as a public service. The White Paper proposes to scrap not only all ten Strategic Health Authorities but also all 150 Primary Care Trusts, the local budget-holders, latter-day incarnations of local 'health authorities. Between them these organisa60,000 staff, at least half of whom seem destined to lose Instead, Lansley proposes to entrust 80% of the NHS budget commission a range of services including hospital care, emergency services and mental health to GPs - few of whom are actually employed by the NHS, and most of whom have accountable to it, let alone to local communities. The other slimmed down NHS Commissioning Board, which will commission specialist care and The catch for GPs is that they will not be offered the lucrative incentives of Thatcher's 'GP Fundholding' experiment of the 1990s, which enabled many of the most prosperous GPs to hold on to a total of tens of millions of unspent 'surplus' allocations rather than spend them on patient care, even while local Trusts faced massive debts and soaring Instead GPs will now be compelled to join one of around 500 local 'consortia', which will be allocated a severely reduced management allowance to buy in expertise on how to spend the budget: this may include re employing former employees of PCTs and SHAs, or may well include private sector management consultants from firms like McKinsey, who have been scooping up fat fees in the last Labour's expensive effort to create a health care market. As local commissioners of services, GPs will have no PCT bureaucrats to hide behind: so they themselves will have to take the lead in forcing through the £20 billion of so-called 'efficiency savings' which the White Paper insists must be achieved by 2014. They will face financial penalties if they fail to meet financial targets and balance the books. This means that GPs will have to take responsibility for rubber-stamping unpopular hospital closures, the rationing of local services, and massive job losses among nurses and their fellow medics working for hospital Trusts. Indeed while GPs are offered the illusion of new powers, hospital staff face a succession of brutal attacks, not only from the unprecedented spending squeeze (heralded already by huge packages of spending cuts and job losses up and down the country but also from the forced march of NHS Trusts into Foundation Trust status. Every NHS Trust will have to become a Foundation or be taken over by a Foundation no later than 2013. The White Paper proposes to remove the 'cap' on the share of Foundation Trust income that can be raised from private medicine, with Lansley hinting that they should aim for 25% or more of revenue to be generated this way. Foundations are being urged to break from Lansley has made it quite clear that he also intends to push through additional changes, to put Foundations 'off balance sheet' for the NHS. This would in effect take us back to the 1930s, completing the reversal of Nye Bevan's revolutionary 1948 reforms which created the NHS by nationalising the hundreds of hospitals that were struggling in a failing 'market. The White Paper refers explicitly to the objective of creating a social market in health care. The consequences are enormous: if Lansley gets his way, Foundation Trust staff would no longer be NHS employees, or entitled to such benefits as pensions, terms and conditions or national pay scales - or possibly even the national career structure and systems of training, which were part of the lure which persuaded hospital doctors to sign up in support of the NHS back in 1948 In other words by 2015 the NHS in England could have been completely carved up, and reduced from employing around 1 million staff to employing a mere handful in a new NHS Commissioning Board. Services (paid for at least initially through taxes) would be commissioned by GPs as independent contractors - advised by private companies - and provided by a mix of 'social enterprises' and for-profit private providers. The proliferation of separate employers delivering services would mean that the power of the health unions would be definitively smashed. The only way back to an NHS would be another bold 1948-style nationalisation of the various elements. Consultants and hospital doctors have everything to lose from this new arrangement, * Britain which widens even further the gulf between commissioners and providers of services, gives the commissioning powers to GPs, and gives absolutely no power whatever to hospital staff, who face an increasing workload, alongside declining staff numbers and a year-on year cut in budget. However the BMA, which only months ago was campaigning against market reforms under the slogan of Look After Our NHS, has abruptly changed course to look after (some of) themselves instead, and opted for 'critical engagement. This breaks what should have been a solid front of opposition, making it more difficult for the TUC health unions and the reactionary reforms. It is vital that the campaign press ahead seeking to involve any GPs or hospital doctors who recognise By contrast Labour leaders, whose policies in government Lansley's fresh onslaught, are now rather awkwardly grasping for phrases to oppose the Tory launching a 'Save Our NHS' The pace will hot up into the autumn, with local cutbacks in jobs and services taking shape and the 'consultation' on the White Paper ending in October, and local health chiefs already beginning to implement aspects legislation is even drawn up. increased activity and awareness in UNISON and Unite, the two main unions involved, and increased support for Keep Our It is vital that local campaigns and a national fightback are launched to unite the majority who value and want to keep our publicly funded and provided and keep the profiteers' hands • www.keepournhspublic.com • www.healthemergency.org.uk
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Shock doctrine and popular resistance Greek workers are in revolt over attempts to make them pay for their country's economic collapse with massive cuts in public spending. Popular resistance in Greece can inspire progressive forces across Europe battling the neo-liberal onslaught. Much depends on whether the left in Greece can offer the popular movement a genuine perspective of how to move from resistance to radically Crisis in Greece: changing society. Stathis Kouvelakis explains • There is a shadow of something colossal and menacing that even now is beginning to fall across the land. Call it the shadow of an oligarchy, if you will; it is the nearest I dare approximate it. What its nature may be I refuse to imagine. But... you are in a perilous position. Jack London, The Iron Heel Greece is the first Western European country to be subjected, as part of a neoliberal purge, to what Naomi Klein has called 'the shock doctrine'. It is a doctrine which has already been tested, of course, many times in other parts of the world including Eastern Europe, with results that are now very familiar.
The idea of the shock doctrine is that it is impossible for a neoliberal onslaught of this depth to be implemented and at least tolerated by societies without an 'exceptional' situation, a situation of emergency, being created. The major crisis unfolding in Greece is precisely an event of this type. It involves something close to the collapse of the country's entire economic, social and political system. It is, to use the term of Antonio Gramsci, an organic crisis. No one is prepared; not the top layers of society, nor those at the bottom - the popular forces and all those who will suffer the main consequences of this hurricane.
What is specific to Greece is the Photograph: Jess Hurd /reportdigital.co.uk weakness of the political structures and of the state itself. According to left economist Costas Lapavitsas the failure of the Greek ruling class can be understood in two ways. The first is the immediate failure to deal properly with the contradictions of the Greek capitalist system. The whole recent cycle of economic growth relied on a very fragile and even unsustainable basis. But there also is a more long term failure.
One of the key ways within the Marxist tradition of dealing with the state is to talk about its 'relative autonomy', , a concept elaborated by Nicos Poulantzas. It means that the state has the capacity to be at a distance from the different factions of the ruling class and of the balance of class forces in society. The state intervenes to constitute the overall outcome of those class forces and it is constituted itself as the condensation of that balance between class forces and class relations.
The characteristic of the Greek state is precisely that this relative autonomy, for reasons that go very deep in Greek history, has been much weaker, much more limited than in other cases. The Greek state, indeed, has been in constant war with the popular classes and with its own people for many decades.
What lies at the root of the weakness of the Greek state is the very failure of the popular classes in Greece to reach a permanent form of representation and regulation of their interests within the state itself. Popular Phenomena such as the spread of corruption 'from below', clientelism etc, are just ways to compensate for this sort of weakness. This affects an essential part of the popular classes who are deprived of a more institutionalised, stable form of social compromise that has been reached in other parts of Europe in the context of the so-called welfare state.
These classes therefore have to find some particular or fragmentary way of fulfilling certain immediate interests and the ruling classes and the dominant groups even more so. What we call corruption in Greece refers to the obscene and incestuous relations between fractional capitalist interests and the Greek capitalist state as such.
How are we to understand now the 15