WHEN the NHS was founded after the second world war, this country was in approximately £27 billion of debt.

The Labour Party had been voted into power overwhelmingly by a working class who were determined not to be poor any more.

The NHS and other social welfare reforms were demands that were conceded under pressure. The people demanded a decent standard of living for themselves and their families in a post-war world.

The NHS provided prompt, first-class care and treatment for absolutely everyone who needed it. Suddenly working-class families were no longer reliant on patchy or non-existent provision provided by the churches, a handful of benevolent individual doctors or charities.

Despite attempts to dismantle the NHS, it remained a very good organisation in 1990 when I started my nurse training. Student nurses enjoyed subsidised accommodation and we were paid a wage to train as nurses. Young migrant workers like me had a fighting chance to make something of our lives and go into a career.

The domestics and porters were all directly employed by the NHS, and they also enjoyed full NHS Whitley council terms and conditions and they had the opportunity to train as nurses themselves if they choose to.

The NHS wasn’t completely perfect — the system was hierarchical, and the work was hard for junior staff. However, delivering the highest standard of patient care was at the heart of everything and we had the staffing levels and the resources to do it. We looked after patients and the NHS looked after us and gave us a wealth of interesting opportunities, decent pay, conditions and pensions.

Cuts and privatisation have constituted the policies of every government since Thatcher.

The public were gradually stripped of the right to have their say over the running of their hospitals. The principles of the free market and competition started to take root across the NHS, but it was still very difficult for those intent on making money to openly shut down wards and hospitals.

The executive teams of NHS trusts and councils had to make a case to reduce services, shut down wards and hospitals and tender out parts of the NHS to the private sector.

But stories were spun by the profiteers that the NHS was too lumbering, old-fashioned, bureaucratic and not fit for purpose. Lies were told that there was no more money to invest in front-line services as hospital estate was flogged off to be converted into expensive residential flats.

Patients were said to be misusing accident and emergency services, some of which were gradually downgraded, merged or shut down. Under the banner of “choice” patients were told that they could get their own pot of money, “personal budgets” that would enable them to buy and pay for their own care.

This allowed councils to shut services like day centres and discharge their duty of care to some people with chronic disabilities. Patients were told they were too old or too fat and given the title of “bed blockers” when they required hospital care.

Care in the community was the holy grail to achieve for everyone, even if their living conditions were substandard and the impact of poverty was a causative factor in the development of illness.

Services that were used and valued by patients, now called “clients” or “service users,” were pulled from underneath them. I witnessed the closure of the psychiatric emergency clinic based at Maudsley Hospital.

In the same NHS foundation trust the inpatient addictions unit was shut down and the contract was handed to the private sector. These brutal cuts caused a great deal of upset to patients and their families at that time and there was not a whimper of resistance from any of the trade unions.  

Patients and families didn’t even realise what had been taken away from them until it was too late, and this tragedy was replicated up and down the country as NHS services were either contracted out or lost forever.

Claims were made that the old hospitals were falling apart and instead of investing in repairs, building and finance companies were commissioned to roll out rip-off PFI schemes to build new far smaller hospitals which created business and a cash windfall for the private sector.

Outsourcing of contracts went hand in hand with PFI as the ancillary services including portering, catering and cleaning were carved out and sold to the highest bidder.

Yet the drop in standards and the suffering of the outsourced hospital workforces because of outsourcing are denied by NHS chiefs.

They bury their heads in the sand and continue to work hand in glove with exploitative private facilities management companies. The profiteers don’t care that the outsourced workers struggle to get access to pay for hours worked, sick pay, and holidays as “wild west” working conditions take root across the NHS.

Outsourcing, combined with years of pay restraint, is a deliberate tactic to force the skilled and experienced workforce out of the NHS. The resulting drop in standards is the recipe for failure that provides an excuse for the private sector to come in and cash in even further and at the expense of patients.

The race to the bottom for the working class is multifaceted. The mantra of “reform” used by every government for the last 40 years is barely disguised code for cuts and privatisation.

The resulting degradation of pay, terms and conditions for workers, and the drop in standards and accessibility to healthcare will prove to be devastating unless we organise effectively to build power and mount a co-ordinated fightback.

What has happened up to now, horrendous as it has been, in terms of the theft of wealth from the working class and the accumulation of power because of that theft, will not match the consequences of the full privatisation of the NHS. The ruling class will press on and go even deeper and further, that much is certain.

As more than a hundred striking outsourced ISS workers from South London and Maudsley NHS Foundation Trust marched to protest outside ISS offices at Canary Wharf last week, an observer was overheard asking, “Who are these people?”

This comment neatly sums up the class struggle in this country. “These people” are those who during the pandemic, kept the country going, the cleaners, the porters, the catering staff, the low paid and the so-called “working poor.”

In fact, these are the people who produce the wealth, keep the country going and always have done. These are the working class: they have the most to lose from the race to the bottom and the most to gain from fighting back against it.

It was workers like these, who in the late 19th century, rose and built the big general industrial unions we know today. It was they who struggled hard to secure all the rights many of us enjoy today. The same rights that are now being rolled back and stolen by stealth in the pursuit of profit.

The working class are once again stepping onto the pages of history and this time fighting, not just for their own rights and conditions, but to save our NHS and public services. The working class will be at the forefront of the struggle to stop the slide into barbarism.

But if we are to achieve this, our movement will need clear objectives and the most important is clear opposition to all cuts, all privatisation and for all outsourced work to be taken back into public ownership.

This will directly challenge the profiteers and the political class in this country. This will mean unions will need, as a matter of necessity, to co-ordinate their campaigns in defence of the public sector and to take those campaigns into our communities and social movements.

We have to build the widest possible resistance if we are to make a serious attempt at providing an alternative in the interests of working-class people.

Helen O’Connor is a trade union organiser and former nurse. Follow her on Twitter @HelenOConnorNHS.