Thanks to David Ellis for this.

Back in July this year, the Nuffield Trust, an influential health service think-tank, published a report suggesting that NHS Trusts should become a business in the John Lewis mould. This, they claimed, would boost staff engagement and raise productivity by 4 or 5 per cent. It is, in fact, privatisation.

It is believed that this suggestion, one of several of its type in the snappily named report `NHS Mutual: Engaging staff and aligning incentives to achieve higher levels of performance’, is almost certain to make it into the New Labour manifesto in time for next year’s general election.

The department store John Lewis is held in trust for its employees who are then entitled to a share of the profits. This incentivises its staff to take an active interest in the business and to sell more merchandise. However, the NHS is free at the point of delivery. It is funded by National Insurance Contributions. The type of pressure on NHS staff to maximise their profits will be somewhat different to those experienced by John Lewis workers.

By turning workers involved in publicly-funded care services into profit hungry mini-capitalists they will be incentivised not to provide a better service but to deny service, to deny medicines, to not make referrals, to diagnose the cheaper illness, to close that ward, that wing, that hospice, that hospital. All in the name of an annual dividend paid out of that part of the budget that remains unspent. Obviously, you could circumvent that problem by making the customer king. That is, make them pay then the staff would have to earn their profits. That, however, would be the end of health service delivery at the point of use and in reality the end of health service for the ordinary worker.

It will be necessary to oppose to this manifesto policy during the election with a socialist policy. Such a policy would demand workers’ control of the NHS Trusts. If demoralisation and lack of engagement really are endemic amongst NHS trust staff, as the mainstream press have suddenly and conveniently discovered, then not privatisation but workers democracy is the only solution for both them and the communities they serve.

Whilst remaining socially owned and publicly funded either by national or local governmental forms, Trust board members and managers at every level within the Trusts need to be elected by the workers they manage. Elected staff bodies should be responsible for appointing junior managers and setting their pay whilst managers at senior level should be elected directly following a short campaign in which they outline their plans and the remuneration they are seeking. These elections would be scrutinised by the staff body and the victors should be instantly recallable and subject to re-election perhaps every four years though obviously it will be up to the staff themselves to set the rules and time limits. This would act as instant anti-dote to the endless and meaningless staff consultation that currently poses as workplace democracy in the NHS.

Patients and their relatives must of course be given a more powerful voice in the day to day running of the hospital. Their input and advocacy will do a great deal to keep both managers and staff on their toes and prevent any bureaucratism or cynicism from creeping in. It would, in that sense, help a great deal if workers had a genuine work/life balance, provided they’ve got a job, which allowed them to take a more active approach to the institutions that care for their sick and for their children.

Of course, the Tory manifesto won’t be proposing anything quite as coy as this backdoor version of privatisation coming as it does clothed in the language of staff productivity and morale. For that reason the Tories must be immediately stopped at the ballot box. They are looking for a political mandate that will allow them to go much further, much faster. Labour will find it much more difficult to finally destroy the NHS. Either way, however, before, during and after the election NHS workers must prepare to resist privatisation, defend social ownership and prepare for workers’ control. Naturally this campaign could be greatly advanced if it could gain the support of the Health Service unions.