In the Nov/Dec ’80 issue of Socialism & Health‘ we published an interview with Stan Orme, who, at the time, was the shadow health minister. Since then Michael Foot has become the party leader and Gwyneth Dunwoody has taken over Stan Orme’s job. We felt that it would be interesting to see what her views were on broadly the same areas as those we asked Stan Orme about, so we interviewed her in early March.
This is a summary of that interview:
Alison: Which Tory policies are you most concerned with, with regard to health?
G.D.: It’s their general attitude to health care that worries me, their intent to undermine the N.H.S. from the inside & particularly a 75/25 division of health care between the N.H.S. & private medicine.
Graham: What do you see as the next Labour government’s priorities for both reversing changes introduced by the Tories and in other ways?
G.D.: The economy is going to be in a bad way & we’ll have to fight for spending on the N.H.S. The particular priorities should be a) capital expenditure and b) how to restore the personal social services, as community care is a mess at the moment. This will be made worse by the proposed reorganisation, and the ‘cinderella’ disciplines will need particular help.
Graham: How would you link that with the Royal Commission & the Black Report?
G.D.: I’m wary of stating detailed priorities partly because the Black Report hasn’t been sufficiently analyzed. Doctors must be given incentives to go into neglected areas and an immediate boost should be given to N.H.S. morale. Current management techniques are thirty years out of date. H’s also important to defend existing NHS structures. The Labour Party must work out what it feels priorities are by the next election and give up sloganizing and substitute it with more concrete policies
Alison: How would a Labour Government tackle the tobacco industry?
G.D.: I think there has to be a total ban on advertising. There’s no evidence that the present government is planning to do this. Tobacco industry profits should be creamed off into the NHS. Stop business practices that British companies practice in the Third World which would not be allowed here.
Alison: The Black Report advocated ‘phasing out’ the British tobacco industry within ten years, how do you see that’?
G.D.: Workers in the tobacco industry must be consulted & redeployed, with public money being used to create Jobs. If the companies won’t diversify, they should be told that the state won’t tolerate their activities.
Alison: The last Labour Government didn’t do very much..
G.D.: I think there’s been a shift amongst the public in attitudes towards smoking & smokers – the Labour movement has always been aware of the effects. Predictably, it’s the middle classes who are changing their habits & classes IV & V who aren’t. The press don’t campaign against the industry and the Sunday Times appears to have been ‘nobbled’ by a section of it recently.
Graham: Do you think a Labour Government could stand up to the tobacco industry? that’s what the real issue is, it’s very different producing educational material from tackling multinationals.
G.D.: “I think that all governments are able to withstand attacks where the majority of the people actually understand what they ‘re doing and why. I believe it now is something in which a Labour Government would have to lead.
Graham: The Black Report uses the tobacco industry as an example of how health may be improved by political action & they later suggest that we need a ‘food policy’ in much the same way as we need a tobacco policy. This would presumably involve education, food subsidies and tackling the food industry.
G.D.: This would be a long term proposition. While I feel that nutrition should be made political and food policy become a priority for the Labour Party whether enough work has been done or enough real political thought has been given to that sort of development I doubt . This sort of stuff is not yet a high priority for the party. Rickets may well soon appear, the school meals service is getting worse. This may make nutrition more political.
Alison: Shouldn’t we be making it political before we get these problems?
G.D.:Yes, but I’m trying to avoid a commitment to such policies when there will be enormous problems. We should have a limited set of proposals that you’ve got to do & can do, & fights that you can defend. Nutrition is well up on my priorities but at the moment is low down on party priorities. That may change.
Alison: How would you like to see occupational health developing?
G.D.: I’m in favour of it developing as part of the N.H.S. Some Trade Unions want it more closely linked to the Health & Safety Executive.
Alison :How’s about private health care, in particular occupational aspects?
G.D.:I have always persuaded Trade Unions not to negotiate private healthcare as part of wages deals. Part of the problem is that many people have forgotten what private healthcare was like. They don’t realise all its implications in particular the exclusions for long term support.
Graham: How do you solve that; as part of the problem of how you project socialist health policies?
G.D.: That’s part of our responsibility in the House of Commons & part yours. Once people see the real cost of private health care they’ll swing back, but the N.H.S. may be damaged in the interim. What will safeguard the NHS in the long run is people unders tanding the implications of private treatment.
Alison: What about pay beds within the NHS.?
G.D.: I think they should be phased out very y quickly indeed; even if the insurance companies would like this, the NHS has to be a fully comprehensive health service & I think that private practice should be right outside it. There will be a growth of some kind of private medicine & it should be licensed. Private units use N.H.S. trained staff without any contribution to their training and I don’ t see why you should have, for example, private hospitals operating alongside NHS. hospitals that haven’t got sufficient nurses. Maybe private units that use N. H.S. trained staff should have to contribute very substantially to the N.H.S.
Graham: In the Black Report the abolition of child poverty is suggested as a means of combating preventable disease. This would involve taxation policy, child benefits & possibly an incomes policy. What do you feel about this?
G.D.: Incomes policies are very problematic. We do need an extended view of health care, but the implications of the Black Report have not been fully debated in the Labour movement.
Graham: Why has health had a lowish priority in the Labour Party for some years? It had always been a central issue for socialists.
G.D.: We’d got complacent ab o u t health care, t he problems were thought to be specific but overall things were O..K. Under this government it ‘s become clear t½h at the service is not good enough and the Black Report came at the right time. Michael Foot feels very strongly that health is one of the most important things that any socialist can ever be concerned about.
Alison: Inequaliti1es in health have been known for some time though.
G.D.: Yes but mainly to experts and not to ordinary Labour Party members. The Black Report was well written, very well argued & very cogently produced.’
Graham: What two or three areas of legislation would you like to see the next Labour Government enacting?
G .D .:Difficult because in the past we’ve been bound to priorities without flexibility but
- Improving management techniques t o get back some sense of purpose about the NHS among staff.
- Neglected areas like mental health should be given a boost
- I want to see the whole battle of private health care fought very energetically I really think that’ s one where we’ve got to stop pussyfooting about.
- Lots of other things including day care abortion facilities.
The next government must set out a simple set of steps & defend them in agreement with the workers, the party & the trade unions. That will mean hospital services & something constructive in relation to the personal social services . We’ve got to think about how to channel money, how to monitor things, where our priorities lie and other difficult areas.
Graham: Can health considerations be brought into other areas of policy making?
G.D.: Inevitably and it’s happening now, because in local authorities, cuts in their revenue has led to worse social services which has produced increased dependence on the NHS which is itself under attack. The personal social services need protecting.
Throughout the interview, Mrs. Dunwoody emphasised the need for the next Labour government to have a list of priorities for health & health-care legislation which could be both fought for & implemented. While those priorities, & the details of policy, have not yet been formulated, she intends to see that they are during the period before the next election. We felt that she showed a good grasp of the problems & was fairly sanguine about th e differences between her views & likely party policy. We left feeling relatively hopeful.
Graham Bickler
Alison Hadley