Featuring 12 essays by authors working in health and social care, the introduction for Sick Of It All states that its aim is to effect analysis of Britain’s health and social care services and look at the potential for radical change and non-capitalistic healthcare models.
Edited by AWW & ACG
2022, PM Press
Following on from the 2019 pamphlet Our NHS? Anarchist Communist Thoughts on Healthcare. It states it has been produced for both workers in the sector and also for anarchists seeking to gain a greater understanding. In addition to the essays, there are three “class hatred” bulletins interspersed between essays, relaying stories that elicit empathy and provide added context to the essays.
It begins with what the NHS actually is, how it is resourced, and how it all fits together. It explains who works in the sector (what they do and how they are paid), looking at the NHS both as an organisation and also as an employer. It finishes by reviewing contemporary shifts in healthcare policy and legislation and how this is shaping the future of the NHS.
It then moves on to how our healthcare provision came to be how it is and why. The author examines how those in power came to be interested in public health and provides a history of 18th century changes to healthcare (with an interesting reference to de-hospitalisation movements). There is analysis here in terms of the examination of social problems and their solutions and how they are derived from contemporary material conditions.
Next are the thoughts of a worker in the system, covering the emotional and physical toll of working daily in the domestic care side of the sector, how everything together can wear down the workers, and discussing the de-personalisation this can cause. But there are also descriptions of militant chats in the canteen and feedback on reformist institutions such as the sector union Unison.
A piece on the history of industrial action in the NHS notes that there appeared to be little industrial action in the first 20 years of the NHS but that declining wages compared to other professions saw this change, particularly in the 1970s. The author reminds us that the NHS has always been a poor employer, “offering low wages for long hours …” despite high union membership.
In post-pandemic Britain, an essay argues that capitalism produces plagues. The author takes us back to look at early industrial capitalism, outbreaks of disease, cholera riots and 19th century conspiracy theorists. It looks at what provokes certain feelings in society when it comes to mass events and how panic provoked by contagion threats is more likely to favour reactionary activities.
There is a report from a worker in a residential care home which looks at the current quality of social care and how workers are treated. We all know care workers are undervalued and underpaid, and I don’t think we need to guess the logical conclusion. The words of the author will resonate with many of us: “Until social care is valued by society, and not just in the sense that everyone is glad someone else is doing it, things are unlikely to change.”
A chapter on mental health under and after capitalism begins with a short history of mental health services, with private asylums, for example, first appearing in the 15th century. This chapter looks at popular narratives on mental health stigma, but also our understanding and stance on mental healthcare as anarchists.
The book then moves on to look at the deeper reasons why the social causes of illness are not given the attention or examination they clearly require. We get to ponder on what a human being is in terms of society’s historical understanding and whether this stands in our way of caring for each other.
How we care for each other in age and infirmity, how capitalism views ageing, sickness and death, and what we can do now and in the future (including lessons from abroad and a chapter on struggle in Greece) are all discussed as the book nears the end.
The publication brings this collection of stories, thoughts and experiences to a conclusion, hoping to have provided a useful look at where we are in terms of healthcare, how we got here and what can be done. It concludes that from an anarchist point of view, to bring an end to capitalism, we need to “understand work and the relations it encompasses and produces’’.
Sick Of It All states that we don’t just need an analysis of work in the NHS itself but also an analysis of the potential for struggle and resistance in the workplace. And this is certainly true.
Gaining insight and understanding is essential to both what can be fought for and won right now (as current events show), but also how struggle, mutual aid and better understanding point us towards how it can all be done better in a post-capitalist world.
This article first appeared in the Summer 2023 issue of Freedom anarchist journal.