Escape routes exist

Let’s get productive!

At least 100,000 NHS employees will lose their jobs if the government carries through the health reforms Tony Blair wants as a lasting monument to his premiership, according to a report today from the pro-market thinktank Reform. Under the reforms, the benefits of a more efficient service, with greater productivity and a more highly skilled workforce, would be accompanied by severe unemployment, says the report by Nick Bosanquet, professor of health policy at Imperial College London.

Professor Bosanquet, who is an adviser to the Commons health committee, blamed Department of Health planners for pushing up staffing costs. Since 1999 the NHS workforce had increased from 1 million to 1.3 million, and was on course to reach 1.6 million by 2010, he said. But the reforms being pursued by the health secretary, Patricia Hewitt, would make trusts think harder about productivity; foundation hospitals would negotiate local pay deals, and as more trusts gained foundation status, national pay agreements would become less important.”It is likely that productivity gains will mean that staff numbers are reduced by at least 10%,” Prof Bosanquet said. This would cut the workforce to below 1.2 million.

Professor speak with forked tongue. “Productivity” is one of those words that does a lot more work than it lets on. The measure of “productivity” is, essentially, how much work is done by each person employed. If you sack 10% of your staff while the overall workload remains the same or increases – and, in the NHS, we can reasonably expect that the overall workload is not going to go down – then productivity will go up by 11%; to put it another way, everyone who’s left is going to have to do 11% more work. Note also that if the 10% of staff who are sacked are disproportionately un- or semi-skilled, the result will inevitably be both greater productivity and a more highly skilled workforce – albeit a skilled workforce which has achieved greater productivity by doing the dirty jobs as well. In practice calculating productivity is slightly more complicated than this, as the key metric is money: if the payroll costs of the 90% of staff who remain go up – perhaps because they want more money for doing more work – you won’t see the full 11% increase. But that’s where the local pay deals come in.

“NHS trusts will save money by sacking workers and attacking the pay and conditions of those who remain,” says pro-market thinktank. It doesn’t take much decoding – but putting it in those terms might provoke resistance, and would certainly raise the question why. Productivity, though – who could argue with that? Who wouldn’t want to be more productive? (We feel bad when we’re not productive, says top shrink.) And above all, who wouldn’t want the workers to be more productive, lazy blighters?

Mario Tronti, as ever, is the man:

Capitalist society has its laws of development: they have been formulated by economists, applied by governments and endured by the workers. But who will discover the laws of development of the working class? Capital has its history and its historians to write it. But who will write the history of the working class? … We ourselves have put capitalist development first, workers’ struggles second. This is wrong. We need to reverse the problem, change its sign, begin from first principles: and the first principle is the struggle of the working class.

In 1964, when Tronti wrote these lines (from “Lenin in England”), he was an Autonomist – one of the first – and a communist rather than a socialist. (That’s ‘communist’ with a small C, although Tronti was also a Communist. Long story. Never mind.) Socialism, for the Autonomists, offered no more than collective self-exploitation and the rational redistribution of surplus value. Social democracy, for an Autonomist, would barely be worth defending: it would leave the bosses in place, merely fencing off a few areas which should be run for the common good rather than for profit (sanitation, education, health, that kind of thing). When we look at Tronti’s communism now, it seems like a distant echo of a much more radical era – but, ironically, the long retreat of social democracy has left us few alternatives to a Trontian reversal of perspectives. What is the NHS, after all, or where is it – in a constellation of autonomous groups of managers who cost the human resources required to deliver a service, or in the nurses and the doctors to whom many of us owe our lives?

(And who the hell are the former to talk to the latter about being productive?)

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