Since the beginning of the year, not a day has gone by without a new announcement on far-reaching cuts to the National Health Service (NHS). Overall cuts to the NHS budget will amount to £20 billion by 2014 despite the Conservative/Liberal Democrats claim that the health service was “ring-fenced” from its multimillion-pound austerity cuts.

What is underway is a cull of public services, which are to be turned into a source of profit for global corporations—a process that began under the previous Labour government.

A report by the Royal College of Nurses (RCN), which represents nurses, gives a flavour of what is happening. “Frontline First” describes the situation in 21 Primary Care Trusts (out of 152), which are threatening to cut nearly 10,000 jobs.

The RCN estimates that total job losses will reach nearly 40,000, but this is bound to be an underestimate. Its last report, only a few months ago, estimated that the total would be just over half that number. Amongst the cuts in its most recent report the RCN lists:

• £20 million to be cut from the budget at Basildon and Thurrock University Hospitals NHS Foundation Trust, leading to the loss of 218 posts including 107 nurses and midwives.
• The shedding of 700 jobs, including 300 nurses at County Durham and Darlington NHS Trust, in a £60 million “savings plan”.
• 149 posts “under review” at Barnet and Chase Farm hospitals NHS Trust despite an £8 million surplus this year.
• The imposition of £11.3 million in cuts at Barts and the London NHS Trust Foundation, leading to the loss after “consultation” of 635 jobs, including 248 nurses.
• Reports from the University Hospital of North Staffordshire NHS Trust that is proposing to cut 1,349 full-time posts—22.3 percent of the workforce—by 2015. A spokesman said that a “significant number” of employees were being relocated elsewhere.
• Mid-Yorkshire Hospitals NHS Trust has identified 131 clinical staff at risk in their medical department workforce of 431.
• Christie NHS Foundation Trust is cutting 95 clinical posts.
• Kent and Medway NHS and Social Care Partnership Trust are cutting 560 posts, including 264 clinical staff by 2015, a 15 percent reduction.

The RCN report also lists thousands of jobs to go at London’s Kingston Hospital (486), Hertfordshire Primary Care Trust (2,678), West London Mental Health NHS Trust (454), West Middlesex Hospital NHS Trust (261), Countess of Chester Hospital NHS Foundation Trust (461), Salford Royal NHS Foundation Trust (389), Heatherwood and Wexham Park Hospital NHS Foundation Trust (470), Ashford and St Peter’s Hospitals NHS Trust (272), Sussex Partnership NHS Foundation Trust (75), Coventry and Warwickshire Partnership NHS Trust (191) and George Eliot Hospital NHS Trust (257).

Some of the most deprived areas and some of the most seriously ill patients are going to suffer as a result. But the RCN report barely touches the surface of what is happening to the NHS.

Not included in the report is the loss of 890 posts in the London ambulance service, involving 560 frontline posts such as paramedics, in order to save £53 million over the next five years. It is expected to lead to an increase in paramedics working alone. Anyone dialling the 999 emergency service will be subject to more stringent questioning before an ambulance will be sent.

Also in London, the St. George’s Healthcare NHS Trust is to axe 500 jobs on top of the closure of three wards. The Queen’s Hospital (part of Barking, Havering and Redbridge Hospitals Trust), which opened in 2006 under a £261 million Private Finance Initiative (PFI) agreement, is operating with an entire floor unused. At the same time, the Trust is trying to close most of the 18-year-old King George’s Hospital in Ilford in order to stem its continued yearly deficits.

Two PFI hospitals at Wakefield and Pontefract, which only opened last year, face a cut of £38 million this year and £17 million in 2012. Five hundred jobs are to go. The York Hospital foundation trust has announced cuts of £30 million in the next three years.

For many Trusts that have built PFI hospitals, the financial crisis will only get worse as they struggle to repay the exorbitant costs of construction for decades to come. The Wakefield and Pontefract rebuild cost £331 million. Unions say the repayment costs will be £40 million a year for the next 35 years.

At NHS North West, which covers Greater Manchester and Liverpool, £2 billion in savings is being proposed. The Accident and Emergency unit in Rochdale is being restricted to daytime-only opening hours in preparation for its final closure next year. Central Manchester Hospitals NHS Trust alone has announced 1,400 jobs are under threat over the next four years.

The East Lancashire Hospitals NHS Trust said it expected to shed 1,013 full-time employees between 2010 and 2015, including almost 50 doctors and dental staff, and 270 nurses, midwives and health visitors. The Wirral University Teaching Hospital NHS Foundation Trust is said to be cutting 682 posts by 2013, and Aintree Hospital is planning to cut 300 jobs in addition to asking 5,000 staff to consider voluntary redundancies or work more “flexible” hours.

In the south of England, Plymouth’s Derriford Hospital has announced plans to cut £27.5 million from its £370 million budget. In Portsmouth, the brand-new £256 million 1,200-bed Queen Alexandra Hospital has announced 700 job losses and the mothballing of 100 beds. Royal Devon and Exeter NHS Foundation Trust estimates that 1,307 posts will be eliminated. The Royal Cornwall Hospitals NHS Trust will shed 200 jobs this year.

Reading’s Royal Berkshire Hospital is to cut £60 million with 600 job losses, and 170 nurses will lose their jobs in the Cambridge University Hospital Trust. Vacancies are being left unfilled, which could result in hundreds more jobs going.

Further job losses have been announced at Morecambe Bay NHS Foundation Trust, where 704 posts—16 percent of the total—will go in the next four years. Over the same period, Sandwell and West Birmingham Hospitals NHS Trust aims to slash 899 jobs, and Hull and East Yorkshire Hospitals NHS Trust 560 jobs. The list goes on and on.

In a symbolic event, Trafford General, where the first patient to benefit from free and comprehensive medical health care was treated in 1945, now faces either total closure or being sold off to the private sector.

In the face of such a full frontal assault, the RCN, along with the other health trade unions and professional bodies, oppose a serious struggle to defend jobs and the right to free health care. Indeed, they accept cuts but say they should fall on non-clinical staff first. It is this policy that has emboldened the government and health trust management to cut vital services.

Last year, Dr. Peter Carter, chief executive and general secretary of the RCN, declared “It’s no secret that the NHS needs to save billions of pounds across all four countries of the UK, including at least £20 billion in England alone by 2014—that’s one fifth of its entire annual budget”.

Stressing that these cuts were inevitable, he said, “We want to make sure these savings are achieved in the best possible way—so they don’t affect patient care.”

“We’re also aiming to identify waste and innovation in the NHS”, Carter added. “That way, we can find potential savings and efficiency improvements that would reduce the need for cuts, preserve nursing jobs, and increase the quality of patient care”.

The RCN’s “Frontline First” has been compiled in order to urge government and health authorities to carry through their attacks in “consultation” with the trade unions. Otherwise, they warn, the deep discontent built up by health workers over many years of absorbing cuts and creeping privatisation threatens to erupt into a national political struggle against the government, out of the control of these bodies and the trade unions.

At the recent RCN conference, an emergency motion on the government’s “reform” saw a 98.76 percent vote of no confidence in Secretary of State for Health Andrew Lansley. This followed an inflammatory speech by health minister and former nurse Anne Milton, who suggested local pay freezes would protect jobs, a proposal already rejected by nurses.

The RCN is now balloting for strike action, but the union sees this as a safety valve for members’ anger rather than a fight against privatisation. Responding to the emergency debate, General Secretary Peter Carter said it was “vital” the government engage with the union, insisting that “Nurses need to have a pivotal role within the new NHS structures” (emphasis added).

If health workers entered into a political struggle to resist privatisation and to bring down the coalition government, they would win mass popular support. To do this, however, they have to break from these bodies that are not only hostile to any struggle but hope to prosper from the privatisation of the health service as their counterparts have done in other privatised former state-run corporations.

Everything depends on working people breaking from the Labour Party and trade unions and building new democratic organisations of working class struggle to unite all sections of the working class. Public works and utilities must be brought under democratic control so they satisfy social need, not private profit.