Friday, February 16, 2007

NHS caught in debt trap

By Daphne Liddle

THIS YEAR has seen NHS trusts throughout England facing huge deficits and resorting to drastic cuts in jobs and services that match those of the Tory years in the early 1990s and lost the Tories the 1997 election. It has also seen unprecedented levels of local demonstrations against these cuts. People from working and middle classes who normally take no interest in politics have been driven to take to the streets with banners and placards by the threat to their local services.
The cause of these cuts is in the capitalist system itself and the need for capitalism to continually find new sources of profit and in particular the revival of the most extreme monetarist policies under the Thatcher government in the 1980s. The reasoning behind this theory is that the market should rule every aspect of life; to allow anyone so much as an aspirin without them paying for it is immoral and leads to idleness and sponging off of others who work hard to pay for everything they use or consume.
It is an economic policy that values money above people. The market serves the rich; their every demand stimulates a supply along with innovation and invention of new products. But it totally ignores the needs of the poor who have no money to bring to the market.
The monetarists believe that ideally the role of government – both central and local, is to meet once a year to hand out contracts to the private sector to actually deliver all public services – at a cost of course. The decisions as to which companies will get the contracts will be based on advice from private sector finance consultants.
The monetarists regarded the NHS and all forms of state welfare with horror. NHS inefficiencies were ascribed to an inexhaustible source of demand, which would eat up more and more taxpayers’ money as work-shy workers thought up more and more health problems to suffer from.
For the workers, the NHS was the crowning glory of modern post-war society, where anyone who needed healthcare would get it regardless of ability to pay. Banished forever was the nightmare question: “Can we afford the doctor?” that blighted every working class sickbed. It was created just after the Second World War when the organised working class (mostly just demobbed) was strong in Britain and in the world with the Nazi-defeating Red Army high in prestige. The ruling capitalist class at that time preferred to concede state welfare rather than risk revolutionism. But they begrudged it and when the organised working class in Britain became weaker – after the defeat of the 1984 miners’ strike and the decline of the Soviet Union – they decided to withdraw it, but stealthily.
This is the policy of the capitalist ruling class and is not dependent on any particular political party. Whoever sits on the front benches of the Palace of Westminster, the capitalist class dictates the important policies.
The first stage of the assault came in the 80s with the closure of many hospitals, especially those for long-term patients and the transfer of those patients into “the community”. The idea sounded fine, releasing people from institutionalisation to be cared for in their own homes by visiting doctors and nurses. But of course the extra funding for those community services never materialised and people were left to sink or swim. Many with mental health and addiction problems ended up as a part of the growing army of homeless people in cardboard boxes on the streets of our cities.
Then in the early 90s under the Major government, NHS hospitals were pushed into acquiring “trust status” – becoming independent of local health authorities. The role of these local health authorities – who were accountable to elected local councils – was diminished. When the NHS trusts were founded, each with a board of trustees which included senior medical staff and local business people, they formally had to buy the land and buildings of the hospitals from the Government, with the aid of mortgages. This meant that they all came into being in deep debt and with a drain on their funding.
At the same time the Tory government, under Health Secretary Virginia Bottomley, set about a new and drastic round of hospital closures, especially in London, which was deemed to have far too many hospitals. This ignored the fact that the big London teaching hospitals took patients with difficult health problems from all around the country for the best specialist care. The cuts in the number of hospitals and hospital beds led to fast growing waiting lists.
At the same time hospitals were compelled to privatise their cleaning and other ancillary work – brining in private companies to do the work. These companies made their profits in the only possible way by employing fewer people on lower wages. Standards of cleanliness in hospitals dropped and diseases like MRSA started to take hold in the wards. This infection is easy to pick up and many hospital patients get the germs on their skin without knowing. But if this infection gets inside the body, for example through an open wound, it is a killer because it is resistant to most of the antibiotics that doctors can prescribe.
The Tories also set up an internal market within the NHS. Trusts were funded according to how many treatments were carried out. Each episode in a patient’s total care was logged as a separate treatment – for example an x-ray was regarded as an extra treatment to an operation. This called into being an army of administrators, accountants and pill counters – another useless drain on the trusts’ budgets.
It also encouraged trust managers to try to cram in as many treatments as possible, with patients being speeded through their care and discharged to make way for new patients as fast as possible. People were sent home to be cared for “in the community” far too fast. Many had to be re-admitted quite quickly with complications that developed from lack of care. But the managers were happy because it led to more treatments for them to notch up.
The standard time in hospital after childbirth was reduced from 10 days to six hours. Patients who had major heart surgery were discharged within a couple of days to terrified families who did not know how to cope with loved ones who clearly needed highly expert care. This was supposed to be supplied by visiting doctors and nurses; sometimes they came, sometimes not; it depended on communications between the hospital and local doctors. Some elderly and helpless patients were discharged to homes where they lived alone with no one to care for them. If the local support teams were notified, they were cared for, if not they were left to suffer alone and unaided, sometimes for days. All this happened while the local support teams were suffering cuts, reorganisation and privatisation of home-help services.
Commercial finance consultants (their huge fees yet another drain on trusts’ budgets) were brought in to advise hospital managers. They saw extremely expensive intensive care beds and infant cots standing empty and unused most of the year, so they reduced the numbers to save money. Then in mid winter the regular and predictable rise in need for intensive care beds and cots rose; desperately ill patients and premature babies started to be carried from one end of the country to another to find the intensive care treatment they needed. Many did not make the journey. We began to see the regular winter horror of hospital corridors full of patients on trolleys, needing urgent admission but with no beds available. Waiting lists for elective surgery grew even more.
The Tories also dreamt up the Private Finance Initiative (PFI) – a system of financing the building of new hospitals or major reconstructions of old ones using money put of by a consortium of financiers. To the Government the advantages were that this scheme avoided large capital expenditure being made from the government funds for public facilities like schools and hospitals – a form of financing that was outlawed by the European Union. Instead the repayments to the PFI companies appeared as smaller regular yearly costs – along with maintenance and so on – which was acceptable to the EU. It also provided great opportunities for capitalism to make profits. It meant that total costs over the period of the PFI contract – usually 30 years – multiplied dramatically. For example, the former military Queen Elizabeth Hospital on Woolwich Common in south east London was due to be restructured as a major NHS hospital (the last remaining open NHS hospital in a borough that used to have eight). Costs were estimated at £26 million when the project was to be funded by a central Government grant but at £90 million when PFI was introduced.
PFI contracts were binding on the NHS trusts for 30 years or more. The contracts were kept very secret for “commercial” reasons so that on occasions the NHS trust managers did not even know what companies were involved in the PFI consortium. Anti-PFI campaigners were denied any detailed information and to this day do not know who, at the end of the contract, ends up owning the buildings and land. Are the contracts a form of mortgage with the property belonging to the NHS at the end or a form of rent, with the private sector owning it all at the end? That is a commercial secret.
This state of affairs played a large part in the Tories losing the 1997 general election. The ruling class was pushing the destruction of the NHS too fast and backed off a bit. When Blair began his premiership he stopped the internal market in the NHS and put a lot more public money into the NHS. It began to recover slightly and services improved.
But Blair embraced PFI gladly – it solved Government budgeting problems by turning big lump sum grants into yearly instalments, thus pleasing the EU – and allowed a vote-winning expansion of hospital building and renovation. One of the first Acts passed by the New Labour government was a guarantee that any risk taken by PFI companies would be underwritten by the Government. The capitalists could not lose.
But PFI hospitals invariably have fewer beds than the old hospitals they replace – the number is determined by the PFI companies – by businessmen, not by medical staff. The actual work of putting the buildings up has been to sub-contract and sub-contract again, leading often to poor quality work. The buildings are unlikely to last much beyond the length of the PFI contracts; healthcare practices are changing so fast now they will probably be out of date by then anyway.
Since then many PFI companies have sold their contracts on to other companies and the contracts have been rescheduled so the trusts have to pay much more interest.
The Government claims that not so many hospital beds are needed now because techniques such as keyhole surgery mean shorter stays in hospitals. Also from time to time the Government comes up with new initiatives for people with chronic conditions such as asthma, some heart conditions and so on to be treated in their own homes by community doctors and nurses instead of being admitted to hospitals.
Meanwhile, the local doctor services had been undergoing a transformation into primary care trusts (PCTs). Doctors were encouraged to work together in small groups and to include practice nurses, who would deliver routine care for minor problems, carry out health screening tests and immunisations. The doctors were given large budgets with which they could buy hospital care for their patients.
This was supposed to give patients a “choice” in what care they received and where they got it from. The actual choice is made by the doctor but 90 per cent of patients prefer to be treated at their nearest hospital. The Government seems totally unaware of the fact that long-distance travel when seriously ill is very uncomfortable. A more distant hospital may have better facilities but the trouble of getting there, and subsequently attending out-patient clinics, outweighs most benefits.
Local doctors also benefit from the attentions of the sales teams from the major drug companies, who fund medical conferences in nice holiday spots like the Bahamas and many other perks. The drug companies realised long ago that when a doctor prescribed one of their drugs for a patient with an acute (short-term) condition – for example an infection – they make so much profit, the patient gets better, no longer needs medicine and the profit stops. But if the patient has a chronic condition (permanent), like diabetes, asthma, high blood pressure and so on, the patient has to take medicine for the rest of their lives and the profit goes on and on. Some medical experts believe that real cures for these chronic conditions could bankrupt big drug companies.
In China most of these conditions that are considered chronic in the West are considered acute in the East. Asthma is regarded as a childhood ailment that is completely cured by a combination of herbs and acupuncture but mainly by a change in diet – avoiding certain foods. Incidentally, Chinese visitors to the West are stunned at the volume of confectionary sold to adults. To them, sweets are only for children – and only then as treats – and people lose their taste for them as they grow up.
In the summer of 2005 the Government put forward a plan that would change PCTs from bodies that delivered direct care to patients into administrative bodies that simply bought care from private medical companies: the monetarist dream come true. The Government all the while has been urging doctors to use their spending power to send more and more patients to private hospitals and clinics.
In December 2004 the Blair government was almost defeated in the House of Commons by a backbench rebellion when it passed the Bill that would introduce “foundation” hospital trusts. These trusts would be freed from Government constraints to use their budgets as they chose. They would be able to borrow money from finance companies and engage in commercial enterprises to raise money. But they could also face bankruptcy if they got their sums wrong.
And this is what has happened. Most trusts eagerly went for foundation status but they had been set up to fail from the start. They began with deep debts from their very inception and by now invariably loaded with long-term heavy PFI commitments. But they drew up business plans and expected to be able to cope by increasing their rate of operations and other treatments and reducing waiting lists by doing so.
But they did not take into account the growth of private sector hospitals and clinics, with the Government putting heavy pressure of PCTs to use them wherever possible. So the private sector took a large volume of routine operations, leaving the more complicated – and therefore expensive – cases for the foundation trusts. Within a year the foundations trusts had run up serious deficits. Foundation status had also reintroduced the internal market into the NHS, making hospitals compete against each other and against private sector hospitals and clinics.
They hoped the Government would bail them out but it flatly refused, telling the trusts they must sort out their own financial affairs.
The effects of this were felt earlier this year as trusts throughout England (Scotland and Wales are lucky enough to have democratic control of their own health services) realised they had to make drastic economies – cutting thousands of jobs and reducing services and provoking a storm of protest. The health service unions are playing a leading role in organising this protest, which also involves patient groups, pensioner organisations and many local community groups.
But there is worse to come. Predictions are that next year’s deficits will be as bad if not worse than this year’s. Job cuts have led to big redundancy payments but the worst problem is the way the Treasury works. When any Government department cuts buildings and jobs, the budget to sustain those jobs and buildings is also cut. Furthermore trusts are still obliged to pay for PFI buildings even if they are no longer used. So we end up with empty wards that the trusts cannot afford to staff but which still have to be paid for.
There is only one way that trusts can make a dent in their huge debts – and a small army of Government financial consultants has been going round the country pointing this out to the trusts. They must engage in more commercial activity. Those empty wards could be used for private, paying patients, or subcontracted to private healthcare companies.
More extra services could be offered to patients – at a price.
So now cash desks are starting to appear near the reception desks in major hospitals. And services that were once part of standard treatment are now being offered as extras at a price. For example a seriously patient needing a room to themselves will be offered such a room “for £30-a-night” extra, when previously the decision would have been based on their need and the availability of single rooms. It is clear that very soon the standard of treatment will depend very much on the ability to pay – not just for extras but for basic care. The monetarists are winning.
Stopping this process depends entirely on the strength of the organised working class. This is a struggle that cannot be left to health service unions alone. Every union in the country must become actively involved in the struggle. The ruling class must again learn to fear the strength of the working class as it did in 1948.

Finding Sanity in a Mad World

By Daphne Liddle

Britain is currently suffering an epidemic of mental illness, especially depression and anxiety. NHS mental health services are desperately under-funded but the problem is not just the shortages – it is also the remedies that are put forward that do not work.
The first remedy offered by the NHS is invariably strong drugs which do help some but carry the risk of severe side effects. Then there are the “talking therapies”, in particular Cognitive Behavioural Therapy, in which patients are told to control their thinking, block negative thoughts and to think only positive thoughts.
This approach insists that the depression comes from inside the brain of the patient – not from the objective reality of the outside world. But in a world threatened by global warming and ecological disaster, by wars involving nuclear, chemical and biological weapons and by extremes of wealth and poverty, is it madness to be depressed? At a more personal level the working classes are now more exploited, more in debt and working longer hours while traditional community and social structures are disappearing. What is the sane response to living in a mad world?

THE NEW Communist Party Congress in early December 2006 gave rise to an unexpected level of interest on the topic of mental health issues in modern Britain, including rapidly rising levels of depression and anxiety. It seemed that nearly everyone in the conference room had been involved, either as a professional health worker in the NHS or prison service, or through a close friend, family member or themselves suffering through the inadequacy of help from official services.
The whole of the NHS over the last year has suffered drastic cuts and mental health services have not escaped. One typical south-east London NHS mental health trust, which opted recently for foundation status, has restructured its services and cut £300,000 from its budget. This means that most people who now turn up at their GP with depression or anxiety will no longer be referred to specialist services but will be treated by the GP, almost invariably with anti-depressant drugs.
These drugs, Selective Serotonin Re-uptake Inhibitors (SSRIs), include Prozac, Serotonin, Cipramil, Fluoxetine and others. They do help some people but many patients find the side-effects cause more problems than they solve. These side effects include kidney problems and water retention and they can be addictive or they can make the depression worse. These drugs have been linked with suicides and violent outbursts. Last year a senior executive of Glaxo-Smith-Kline admitted that most of their drugs are effective on only about a third of patients. Even when they work, the drugs do not address the root cause of the problems of depression.
Although all these SSRIs are chemically similar (the illegal drug ecstasy is the strongest version of them), a doctor will insist the patients try all on the names on the list before concluding that these drugs do not help them. Even then, the patient has to refuse to take any more of the drugs before being referred for other treatment. One very depressed patient, fresh from hospital after an overdose of pills, was asked: “Do you want to try the pills again?”
The next line of treatment offered by the trust, for those who are not helped by the drugs or who do not recover by themselves, is referral to specialists in Cognitive Behavioural Therapy, which sometimes is offered as “anger management”.
But there has been a marked reduction in these services, with many changes of location. Drop-in centres have been closed and an annual Christmas party for patients who live alone had been withdrawn.
But the trust has presented these changes in a pamphlet as “improvements”; new services were described operating from various locations and then on the last page, under the heading “Location changes”, all the locations of the new services were listed for closure with no new locations mentioned. This led to serious confusion in some patients and confirmation in others that what they are being fed is just bullshit.
One disgruntled patient succeeded in getting an interview with the director of the trust. This elicited an admission that the changes were indeed cuts rather than improvements and that although £300,000 had already been cut, further cuts of £900,000 were needed to balance the books. But the director was an intelligent woman, trying to do the best she could in impossible circumstances. She had gone out of her way to avoid the pitfalls of Private Finance Initiative deals; she had opted to close buildings rather than cut jobs; new locations for services had not been mentioned in the pamphlet because they were not yet definite, she said. The danger is that with a further £900,000 cuts to be made, they may never be.
It also became evident that her view of the services provided was quite different to those on the receiving end. When told that a call to the trust’s emergency response team for someone in a mental health crisis had been made on a Thursday and had resulted in a call on the patient the next Monday, she thought that was a good and swift response. All patients were supposed to have a “care co-ordinator” in charge of their treatment and an emergency contact number. Many patients were totally unaware and certainly did not have one. It was one of those all too typical situations where middle and lower management fear to tell the boss that their section is underperforming for fear of their job being cut – so no bad news ever reaches the top.
But in any case bad news is something that a service based on the CBT philosophy of relentless positive thinking at all times cannot acknowledge.
Last year Labour economist and peer Robert Layard suggested that millions of people suffering from depression could be helped much more effectively through talking therapies rather than taking pills. He proposed that the Government train a small army of counsellors capable of delivering Cognitive Behaviour Therapy (CBT). He claimed that 16-session course usually gets the patient well enough to resume work and would save the economy a fortune in rehabilitating most of the long-term mentally sick
It sounded good at first – better than the pills at any rate. The National Association of Cognitive Behavioural Therapists (based in the United States) described CBT: “It is a form of psychotherapy that emphasises the important role of thinking in how we feel and what we do. CBT therapists teach that when our brains are healthy, it is our thinking that causes us to feel and act the way we do. Therefore if we are experiencing unwanted feelings and behaviours, it is important to identify the thinking that is causing the feelings/behaviours and to learn how to replace this thinking with thoughts that lead to more desirable reactions.”
The NACBT claims links to stoicism and the Socratic method – continually questioning one’s own thoughts and assumptions.
In practice it comes across with patients being given work sheets with instructions on “How to challenge thoughts: You need to know what you are thinking to be able to challenge your thoughts. Thoughts occur automatically. They flash so quickly we are therefore not always aware of them, or their content. There may be an error in the way you are thinking about something.
“To challenge negative thoughts you must: 1) identify what you are thinking 2) challenge the thought 3) replace the negative thought with a positive one.”
Patients (no longer called patients, that is too negative, but renamed “service-users”) who report that global warming, ecological disasters, wars, injustice, poverty and exploitation make them feel depressed are told that they are thinking too much. “Thinking is the cause of your illness. You must stop thinking your way and start thinking our way. You must think positively about the world.”
This soon becomes close to the philosophy satirised by Voltaire in his book Candide, where the eponymous hero is told by his mentor, Dr Pangloss, who taught “metaphysico-theologo-cosmolo-nigology”, that there is no effect without a cause and that this is the best of all possible worlds.
“It is proved that things cannot be other than they are, for instance since everything was made for a purpose, it follows that everything is made for the best purpose. Observe: our noses were made to carry spectacles, so we have spectacles. Legs were clearly intended for breeches, and we wear them. Stones were meant for carving and for building houses, and that is why my lord has a most beautiful house; for the greatest baron in Westphalia ought to have the noblest residence. And since pigs were made to be eaten, we eat pork all year round. It follows that those who maintain that all is right talk nonsense; they ought to say that all is for the best.” Throughout wars and disasters Pangloss, at every turn, insists that everything they are suffering is “for the best”.
This perpetual optimism, totally at odds with objective reality, is likely to make depressed patients feel worse, not better. They are told that the world is as it is and cannot be changed but that thinking it might be changed makes you ill and depressed.
This of course consigns every social reformer and revolutionary, every member of a left-wing political party or progressive campaign to be labelled as mentally ill. History makes nonsense of this. If the CBT view of the world was correct we would still be living in slavery under the Roman Empire. We could list thousands of people, from Cromwell, Robespierre, Marx and Lenin, to Kim Il Sung, Mao Zedong, Fidel Castro and Hugo Chavez who have brought major change to the world – and millions of others who have played an active role in the process.
There is another school of psychologists who reject CBT. They include Dr John Read from New Zealand and Oliver James. They claim that mental illness is a natural reaction to a mad world.
James writes: “All too often, CBT tutors the patient to tell a relentlessly positive story, to ignore many of their true feelings, just as drugs do. Not surprisingly, the studies show that once the teacher is no longer there, the depressed or anxious truth of our crazy world reasserts itself within a few months.
“CBT comes from a stable of psychology that deems accurate negative thoughts about oneself as ‘depressive realism’, and health as living in a rose-tinted bubble of positive illusions. For, truly, emotional distress is a form of dissent – an important signal that early family experiences and adult society have been or are distressing.”
He has recently written a book, Affluenza, in which he depicts the values and pressures of modern consumer society as the root of the growing epidemic of mental ill health. “The Affluenza virus is a set of values which increase our vulnerability to psychological distress: placing a high value on acquiring money and possessions, looking good in the eyes of others and wanting to be famous. Many studies have shown that infection with the virus increases your susceptibility to the commonest mental illnesses: depression, anxiety, substance abuse and personality disorder.
“The virus values prevent you from fulfilling fundamental human needs which seem to exist in every society.” He lists the four most commonly identified fundamental needs as “security (emotional and material), connectedness to others, authenticity and autonomy, and feeling competent”. He says that urban societies are more affected by the virus than rural ones; that the epidemic is worst in America and Britain and that younger generations are more afflicted than older ones, “the young being especially influenced by America’s Affluenza-promoting cultural imperialism”.
He quotes the works of the German social democrat psychologist Erich Fromm who taught that being is more important than having and that anxiety about possessions leads to a transfer of our sense of identity into the things we own – a form of madness.
Bourgeois psychologists have wrestled long and hard with the problem of optimism. Statistical analysis shows that pessimists are usually better at predicting the future than optimists. Yet they insist that optimists have better mental health. They also say that those most in touch with objective reality are the sanest. Both statements cannot be true. They advocate the adoption of rosy illusions in the hope that these will become self-fulfilling prophesies.
CBT is taking the place of religion in persuading the exploited masses to resign themselves to their lot in life but it is grounded in an idealistic philosophy which ultimately claims that the material world exists as the creation of an idea (God’s) and is experienced through our ideas of it. This is the opposite of the Marxist-Leninist historical materialist view of the world which says that objective reality exists outside our own heads. And not only can it be changed but it is in a constant state of change in any case. For us, the sane method is to analyse that objective reality and the way it changes in order to be able to influence those changes – to think for ourselves and not be fooled by rosy illusions.
Dr Read, in his book Models of Madness, disputes the definition of schizophrenia, claiming that it a name for a collection of different conditions that result from bad experiences, especially in early childhood. He claims the idea of this as a genetic illness that should be treated by drugs is sustained by the drugs industry. He is part of what is known as the anti-psychiatry movement which began in the 1950s and 60s with psychologists like RD Laing. He advocates instead psycho-analysis and talking therapy of the type that looks into the patient’s past to find the events that have triggered the problem. Getting this high quality and effective therapy on the NHS can take years of waiting; properly qualified psycho-analysts are very thin on the ground – though there are plenty in private practice serving the rich.
James does not go quite so far. He agrees that some people are possibly more susceptible to mental ill health than others but that it is the circumstances of their life, and particularly their childhood, which determine whether the susceptibility is triggered. In other words mental health, or the lack of it, is produced by a dialectical process between nurture and nature.
But both Read and James look only at the immediate personal circumstances of the patient. They do not look at the wider class and political context. As soon as we do this we can pinpoint the things that make us depressed and anxious at a global and at a more personal level: social injustice, extremes of poverty coexisting with obscene levels of wealth, threats to the ecological future of the planet, the threat of nuclear war, other weapons of mass destruction, exploitation, being deep in debt, working excessively long hours, lack of time to spend with our families, lack of control over our own lives and general helplessness.
The root of almost all of these problems is the capitalist system.
If we take the view of the CBT advocates, we cannot do anything to change any of this but must adjust our minds to see it all through rose tinted spectacles. This leads some people to hedonism – escapism through refusing to listen to the news, being obsessed with the celebrity culture, drinking and partying as much as possible: “if there is no hope we might as well enjoy ourselves while we can”. This is one trend that has taken a large proportion of the working class away from active participation in anything political.
The other trend is despair, which has captured many of those who cannot turn off their minds, who cannot help but see what is happening around them. But feeling isolated and helpless they become paralysed by depression and or by suppressed anger. They become unable to function as part of a society which they can see is going mad.
The only sane and rational alternative is to ignore the CBT people and the pills, take stock of objective reality and set about trying to change it. And to do that we have to believe that it can be done – and we have the whole history of human society to provide the evidence that it can.
We recognise that the individual alone cannot change the world political situation. The great leaders of historical change: Cromwell, Robespierre, Marx, Engels, Lenin, Kim Il Sung, Mao, Castro and so on did not accomplish anything alone. They were leading millions of others who shared their views and worked together in an organised way.
There were many other movements for social and political change that did not succeed in their own time but made an impact on history long after they were gone, like the Chartists and the Irish volunteers of the 1916 Easter Rising. Even those who have made mistakes and gone off on the wrong path, who may seem to have ended their efforts in defeat and despair, have helped future generations to learn from their mistakes. It is never a mistake to try.
But we don’t have to keep repeating the mistakes of the past. One lesson that workers have learned over the last 200 years of struggle against capitalism is that unity and solidarity are key – that means we must be organised. If everyone is rowing in a different direction our boat can only go round in circles. This is why all working class organisations operate democratic centralism. Every member has a right and duty to take part in discussing policy and voting on it. But once the decision is taken all fall in line behind the agreed policy and work together.
This is why the bourgeois psychologists are no use. The root of all our depression is capitalism and the only solution is to join a fighting working class party to combat it. They would have to tell their patients to join the New Communist Party.

Thursday, February 15, 2007

The nuclear issue on the Korean peninsula

Speech delivered by Keith Bennett at a public meeting held on 5 December 2006 at Marx Memorial Library, London organised by the Coordinating Committee of the Friends of Korea.


The purpose of my talk this evening is to attempt to provide information and to set out some of the factual background to the present nuclear crisis which played a prominent role in the international news headlines over the last couple of months - to try and put that into some kind of historical and overall political context.
In setting out the background to the nuclear issue on the Korean peninsula, I want to say first of all that this represents three parts of unfinished business and one harbinger of possible future international development. The Korean issue represents the unfinished business of the national liberation movements against colonialism that played a huge part in the history of the 20th century; possibly the only part of the unfinished business of the World War Two struggle against fascism and Japanese militarism; and also the unfinished business of the Cold War. It also represents a harbinger of the possible future scenario for the development of international relations in the 21st century, namely a possible intensified rivalry or even clash between the United States and China in the future.

The Historical Context

In summary, Korea fell victim to imperialism like most parts of Asia, Africa and Latin America in the 19th century, with various imperialist powers contending to establish their domination over Korea - the Russo-Japanese war of 1904-5, for example, was largely fought over the Korean issue. At the beginning of the 20th century, Korea finally became a Japanese colony. The resistance to the colonisation of Korea by Japan was ongoing throughout history and the main form that it came to take was that of a guerrilla struggle under communist leadership led by Comrade Kim Il Sung. However as part of the post World War Two international settlement it was agreed that Korea would be divided, as was the case in Vietnam, except that this would be a temporary division pending the calling of democratic elections to form a united independent state. It was agreed that Korea would be temporarily divided into a Soviet zone in the north and an American occupied zone in the south. Those moves towards the reunification and independence of the whole country did not take place because as everybody knows the end of the Second World War was followed almost immediately by the onset of the Cold War by US and British imperialism, in particular, which froze the division of the Korean peninsula. In 1950 the Korean War broke out. The Korean War lasted from 1950 to 1953 - a war of unparalleled barbarity by US imperialism and its satellites. Some 4 million Korean people were killed in the course of this conflict. Every city and town in the whole of Korea was destroyed by US aerial bombardment. The US used chemical and bacterial warfare, and also threatened to use nuclear weapons against Korea and against China in the course of the Korean War [I will say more on this aspect in a minute]. It was also, and this has recently been confirmed by the opening up of official US documents, official US policy to fire on and kill any columns of refugees the US forces saw coming their way.

US nuclear threats against the DPRK since 1950

Nearly two decades after the fall of the Berlin wall, Korea, which was a victim of World War Two and not a perpetrator, remains the only country divided as a result of the outcome of that conflict. According to the Western media, the nuclear tests carried out by the DPRK a couple of months back are presented as being an unprovoked or inexplicable provocation carried out by an unstable or dangerous regime of some kind. That is what we have to cut through because for the DPRK and for the Korean people as a whole the nuclear issue is not something to be understood as today’s crisis. The nuclear issue is about a half-century and more of threat that the Korean people have had to live with every day.
In its September/October edition, an American academic publication, the Bulletin of the Atomic Scientists, identified four occasions on which they say that the United States has verifiably threatened the DPRK with nuclear attack. This publication states the following four threats:

Threat number one: “One of the first instances of a U.S. threat of nuclear use came just five years after the Hiroshima and Nagasaki bombings. With the United States mired in the Korean War, in November 1950 a reporter asked President Harry S. Truman whether U.N. forces might cross the Yalu River into Manchuria. Truman responded, ‘We will take whatever steps are necessary to meet the military situation, just as we always have’. Asked whether that included using atomic bombs, Truman responded: ‘That includes every weapon we have’. A few minutes after the press conference ended, the lead of the United Press wire story read, ‘President Truman said today that the United States has under consideration use of the atomic bomb in connection with the war in Korea.’ [7]”.

Threat number two this Bulletin goes on to say is: “Nearly three years later, Truman's successor, President Dwight Eisenhower, also wielded the threat of U.S. nuclear use. In May 1953, Eisenhower authorized an expanded Korean bombing campaign, prompting the North Koreans and Chinese to respond by increased ground action. As part of the heightened military activity, the Joint Chiefs presented six different scenarios for ending the war, ‘most envisioning the possible use of atomic weapons,’ according to an official Pentagon history. ‘After the NSC reached a seeming consensus on May 20 to employ atomic weapons both strategically and tactically - that is within and outside the Korean Peninsula - the administration communicated its resolve to the Chinese and North Koreans. . . . Both Eisenhower and [Secretary of State John Foster] Dulles believed the message had the desired effect’ of ending the war, the history reads. [8]”

The third incident identified here, they go on to say is: “In what later became known as the ‘Tree-Trimming Incident,’ U.S. forces in Korea again threatened the use of nuclear weapons when they were placed on DEFCON 3 on August 19, 1976. The alert, which was ordered in response to a fatal skirmish between U.S. and North Korean border guards over U.S. attempts to trim a tree in the demilitarized zone, involved deployment of nuclear and other forces in operations that signalled preparations for an attack on North Korea. [9] The U.S. display of force included nuclear-capable B-52 bombers flying ‘from Guam ominously north up the Yellow Sea on a vector directly to . . . Pyongyang,’ noted Maj. Gen. John K. Singlaub in his book, Hazardous Duty. [10]”
And the final threat listed in this article: “Most recently, during the 1994 North Korean nuclear crisis, the United States nearly launched a conventional strike against the North's nuclear production facilities. Although nuclear threats were not reported to have been part of the effort, U.S. Strategic Command (Stratcom) did apparently study the nuclear option in 1995. And during 1997 congressional hearings, Gen. Eugene Habiger, commander of Stratcom, confirmed that indeed the United States had threatened the North with nuclear weapons during the crisis. Asked what ‘sort of deterrence’ he thought U.S. nuclear weapons played in preventing WMD from being used by rogue states, Habiger responded, ‘In my view, sir, it plays a very large role. . . .[The threat of U.S. nuclear use] was passed to the North Koreans back in 1995, when the North Koreans were not coming off their reactor approach they were
taking.’ [11] Habiger subsequently explained that the message passed on to North Korea had been explicit. [12]”

Personally, I think that one can identify considerably more than these four occasions on which the US clearly threatened the use of nuclear weapons against north Korea, but those are four examples from an impeccable establishment US source. It is also worth noting that the Quadrennial Review adopted by the Pentagon in 2002 singled out the DPRK, along with six other countries as being explicitly countries which are in US military thinking possible targets for a US first strike.

The Geneva Accord 1994

As we have seen, during what some people call the recent years’ history of the nuclear threat to Korea, the Clinton administration in the US actively considered the use of nuclear weapons against Korea in the first half of the 1990s. Instead, as we know, former president Jimmy Carter put himself forward as a mediator and went to Pyongyang and at that time secured an agreement with President Kim Il Sung for a resolution of what was called the nuclear issue. Some people say President Carter somewhat wrong-footed the Clinton administration by going live on CNN from Pyongyang and announcing it before the White House had had a chance to shoot down the deal, and putting them in a politically difficult situation in terms of being able to get out of it. As a result of that visit a series of discussions concluded with an agreement signed between the US and the DPRK in October 1994 - known as the Geneva Accord. The basic premise of the Geneva Accord was that in exchange for the DPRK not going ahead with its threats to withdraw from the International Atomic Energy Agency (IAEA), for permitting IAEA inspections and freezing the development of its own nuclear power facilities at Yongbyong, which used prior-enriched uranium, the US would first of all establish and lead an international consortium which would design, build and provide for the DPRK two light water reactors to meet its energy needs; in the interim period the US would supply fuel oil to the DPRK in order to make up for its energy shortfall; the US would progressively lift its sanctions which had been in place against north Korea since 1950; and the two countries would gradually move towards, firstly, the establishment of representative offices in their respective capitals, and finally to full normalisation of their diplomatic relations.
As a native American chief once noted, Americans never signed a treaty with another country which they did not immediately set out to try and break. Predictably enough the Geneva Accord was no exception. The US took no substantive measures to improve its overall relations with the DPRK: the delivery of the fuel which they were committed to provide was late and in short supply, and they totally dragged their heels on the building of the light water reactors so that several years after the starting date and just before what was supposed to be the completion date there was little more than two holes in the ground. Apart from the obvious reason that the US always does this, there were essentially two specific reasons why the US did this.

1. Particularly in regard to the delivery of fuel, the Clinton administration lacked a majority in the Congress and in the Senate and the Republicans were (a) opposed to this agreement in principle which they saw as appeasement, and (b) wanted to use it in their domestic political game against the Clinton administration.

2. More fundamentally, as several leading members of the Clinton administration have openly said, the US calculation at the time was that the DPRK regime was going to collapse within a few years, therefore they could afford to drag their feet because they would never be in a position where they were held to account for their broken promises. Imperialism has continually longed for the collapse of the DPRK, but this hoped for collapse has singularly failed to materialise, which gives the imperialist a kind of dilemma as to what they should do.

As a result in October 2000 Vice-Marshall Jo Myong-rok, the vice-chairman of the National Defence Commission of the DPRK which is chaired by Comrade Kim Jong Il, paid a visit to the US for discussions with President Clinton. That visit resulted in a joint communiqué agreed between the US and the DPRK on 12 October 2000. The joint communiqué is a very interesting document. It is well worth reading in full. In order to save time, I will just read an example to summarise the points:

“Building on the principles laid out in the June 11, 1993, US-DPRK Joint Statement and reaffirmed in the October 21, 1994, Agreed Framework, the two sides agreed to work to remove mistrust, build mutual confidence, and maintain an atmosphere in which they can deal constructively with issues of central concern. In this regard, the two sides reaffirmed that their relations should be based on the principles of respect for each other's sovereignty and non-interference in each other's internal affairs, and noted the value of regular diplomatic contacts, bilaterally and in broader fora.

“The two sides agreed to work together to develop mutually beneficial economic cooperation and exchanges. To explore the possibilities for trade and commerce that will benefit the peoples of both countries and contribute to an environment conducive to greater economic cooperation throughout Northeast Asia, the two sides discussed an exchange of visits by economic and trade experts at an early date.”

This communiqué goes through a whole series of areas of concern to the US and the DPRK and sets out a constructive way of dealing with them. It concluded: “It was agreed that Secretary of State Madeleine Albright will visit the DPRK in the near future to convey the views of US President William Clinton directly to Chairman Kim Jong-il of the DPRK National Defence Commission and to prepare for a possible visit by the President of the United States.”

A visit by Secretary of State, Madeleine Albright, to Pyongyang took place very shortly afterwards at the end of October 2000, and again in the course of that visit a considerable consensus of views was reached between the two sides. At that time it was proposed that after further rounds of discussions between experts from the two sides, President Clinton would, at the close of his presidency, make a visit to Pyongyang. Towards the end of Madeleine Albright’s visit she gave a press conference in the Koryo Hotel [the transcript of the press conference is still available on the US state department web site which I looked at this afternoon]. This transcript bears careful reading. I will quote just a couple of examples of what Madeleine Albright had to say at that press conference:

“I explained to Chairman Kim America’s vision for relations between our countries free from past hostility, relations which contribute to peace and stability throughout the region, and which support the process of reconciliation between the North and the South. …
“Chairman Kim and I had serious, constructive, and in-depth discussions of proposals on diplomatic relations, missile restraint, and security issues”.

Towards the end of the press conference she was asked: “You told us that you had lengthy discussions with our Chairman Kim Jong Il. I’d like to know what are your impressions of the Chairman, and also what kind of discussions did you have?”

To which Secretary Albright replied: “I have to say that I was very gratified by the length of our discussions, by the fact that we took up all the subjects of importance to our side and presumably to his, and I found him a very practical and decisive listener and interlocutor.”

One can say that that point was the high point of any prospect for any positive relationship between the US and the DPRK and we were looking (which seems strange now in the present situation) for a possible visit by President Clinton and a full normalisation of US-DPRK relations. That visit did not take place because of the chaotic last days of the Clinton administration with the Appeals in the Supreme Court etc, and also because Clinton took a decision that he would prioritise trying to kick-start the Israel/Palestine talks rather than go to the DPRK. In an interview she gave to the Financial Times a few months ago, Madeleine Albright said that in retrospect she considered this to have been a mistaken decision by herself and President Clinton not to proceed with the Pyongyang visit.
The reason I have laid a considerable amount of stress on this is because we tend to lose sight of the process through which US-DPRK relations have been, and the willingness that the DPRK has shown to move towards a resolution of these problems for so long as they had a dialogue partner in the US that in some way can be defined as reasonable.
All this takes place against the background of the fact, as I have said, that the US in a period of three years murdered 4 million Koreans and then a period of the occupation of south Korea with constant nuclear threats against north Korea subsequently. So, it is not surprising that there is a huge and deep feeling of mistrust and hatred of the US in north Korea; therefore to build the momentum towards any kind of resolution of the issues that are faced is a complicated and a difficult process. It is one which is characterised by lack of trust, and that trust can only be very painstakingly built up. To reach the point that was reached in the last days of the Clinton presidency in US-DPRK relations was not easy. You have to understand the difficulties of reaching that point in order to put into perspective exactly how the DPRK side and the Korean people feel about the policies that were adopted towards them by the Bush administration. The Bush administration took office when there had been the best ever, not easily secured, prospect for normalisation of the US-DPRK relationship, which for the Korean people is important because it is the normalisation of that relationship that opens the way to the peaceful reunification of Korea and for the Korean people to be allowed to get on with what they want, which is to build up their own modern independent state on the basis of self determination.
The Bush administration comes in. And, although Colin Powell at first showed some indication of wanting to continue with the line of the Clinton administration, he on this as on other issues was largely isolated by the neo-cons - the Rumsfelds, Cheneys and so on. The first thing the Bush administration does is freeze and rip up every piece of the agreements that the US and DPRK had reached. It placed the whole process of the US-DPRK dialogue in the deep freezer. Then for about a year we get a situation where the only US policy towards the DPRK appears to be the uttering of puerile personal insults by Bush and others against Kim Jong Il and the Korean leadership, culminating in the now world famous, notorious “Axis of Evil” speech. The “Axis of Evil” speech was then followed by the invasion and occupation of Iraq. In other words the US picked out three victims - Iraq, Iran and north Korea - and then began to tick them off with the Iraq war. It was against the background of having a carefully built up relationship reduced to nothing, of being insulted, of then being threatened, of seeing the US put its threats into practice in the case of Iraq, and of assessing this prospect, that the DPRK decided that it had no alternative but to resume developing its independent nuclear deterrent for self defence.

Six parties sign Joint Statement September 2005

Once the US-DPRK bilateral process had been completely sabotaged, the Chinese put forward a proposal to organise six-party talks which met in Beijing periodically. These talks proceeded very fitfully without making any particular progress until September 2005, when the fourth round of the six-party talks resulted in an agreement to which all six parties signed up on 19 September. Essentially this Joint Statement, which bears careful study, took us back to more or less what had been already agreed in the Geneva Accord of October 1994. In other words, eleven years had gone by and we were simply back to where we were. Besides outlining a way to deal with the nuclear issue, there are other clauses in it, for example, as follows, the significance of this I will come back to in a moment, “The Six Parties undertook to promote economic cooperation in the fields of energy, trade and investment, bilaterally and/or multilaterally”. On paper this Joint Statement dealt with more or less all the aspects of the nuclear issue. The problem with the Statement was, as we have seen, that there is a complete lack of trust between the DPRK and the US. Essentially this Joint Statement contains a set of aspirations on the part of all sides. In this situation of a lack of trust, there was verbal agreement of what the ultimate outcome should be, but there was no agreement on the order and sequence of events - who would move first.
In fact the US was very reluctant to sign the agreement at all - they hesitated for about two days after all the other parties had signed and it was only after some very heavy arm-twisting by the Chinese Foreign Ministry that the US agreed to sign at all. The person who signed the agreement for the US was the US chief negotiator in the six-party talks, Christopher Hill. Immediately after signing this agreement, Hill came under quite strong attack from neo-cons in Washington having allegedly given away too much to the DPRK. The day after the agreement was signed, the White House press spokesperson, Sean McCormack, made a statement in which he basically, talked down the agreement that the Americans had signed and really went back to the position the Americans had been pushing for before. He said the US would only do this when the DPRK completely, verifiably and irreversibly, etc. give up all its nuclear programmes. This was emphatically not what the Joint Statement said. The agreement may not have spelt out the sequence or the timing, but it emphatically did not say what McCormack said it said. It was in response to McCormack’s US press statement that the DPRK Foreign Ministry the next day issued its statement in which it reaffirmed its position that it would not unilaterally give up its independent nuclear deterrent. Here the western media always, 999 times out of 1000, presents it by saying ‘north Korea signed the deal and the next day it ripped it up’. This is not what happened. The agreement was signed and it was the Americans who ripped it up. And it was in response to that that the DPRK outlined its position.

US instigates new economic sanctions against the DPRK

However, as the Americans were not happy at signing the agreement, less than one month after that they manipulated the international banking system to force a hitherto rather obscure bank in Macao, called the Banco Delta Asia, to freeze all the accounts of DPRK businesses and foreign businesses doing business with the DPRK or banking there - one of them is British American Tobacco (of which Kenneth Clarke is a director - not anybody in the DPRK!). These accounts were frozen using the excuse of one of the hoary old DPRK scare stories that bubble away in the media for year after year. This one being about the DRPK’s supposed ‘manufacture of counterfeit currency’. The point about this US action has really nothing to do with the counterfeit issue. What has to be understood about this action is (a) the timing - coming less than a month after the hard won agreement that had essentially taken eleven years to get back to square one, and (b) it goes against the spirit, and I would argue also the letter, of the agreement, namely, the point that I previously quoted from the six-party agreement concerning the promotion of “economic cooperation in the fields of energy, trade and investment, bilaterally and/or multilaterally”.
Instead of doing that, the US instigated new sanctions on the DPRK’s international trade and finance and indeed on people doing international business with the DPRK. The US then proceeded to pressurise a whole series of other countries, banking institutions in east Asia and elsewhere to follow suit and to impose their own sanctions on the DPRK, using a threat to those countries and institutions that they will freeze them out of the US economy and the international banking system if they did not follow their diktat. As a result of this pressure, since those sanctions were brought in (October 2006) all the DPRK international business and foreign trade has either been frozen or has been seriously circumscribed. However since the US made the allegation, more than one year ago, they have declined to offer any proof whatsoever. They have declined to offer it bilaterally to the DPRK. After the US imposed these sanctions, the DPRK asked to have discussions with the US and sent its representatives to the US. The Americans in their typical way said: we won’t negotiate with you, we will give you a list of demands of what you should do. On that occasion the DPRK even said: allow us to open accounts with US banks in the US and then you can supervise the money that comes in and out and you can see whether it is honest or not. The US refused to negotiate, refused to present any evidence to the DPRK and, needless to say, refused the DPRK’s proposal. The US has never offered a scrap of proof either bilaterally or in the wider public domain. The US has however persistently offered contradictory accounts of the reasons for its actions against Banco Delta Asia and other institutions. On the one hand the US sometimes says it is a ‘policing matter’ or a ‘matter for the treasury’ with no bearing on other sections of the government or on the six-party talks. On the other hand they openly say that this is an excellent method of trying to bring about ‘regime change’ in the DPRK. The US sometimes says that the place to discuss this is at the six-party talks - the very same six-party talks that they say it has nothing to do with! At more or less the same time, the US says it can and cannot be discussed.
Certainly what the US has said is that these sanctions have been more effective than even they anticipated, and the US increasingly hopes to use these as a model for further sanctions. For example, there is a law going through the US Congress which will make illegal (and they seem to think that their law should be applied in every country of the world) for any bank any where in the world to have any financial dealings with the government of the Palestinian Authority for so long as the PA is led by Hamas. They are also attempting to bring in a similar law with regard to Iran. In the last couple of months they have put pressure on the Union Bank of Switzerland and a number of Swiss banks, as a result of which the Swiss banks have frozen their business dealings not only with Iran but also with Cuba on the grounds that the Swiss banking system is not safe from US pressure unless they take these measures. Since the sanctions on Banco Delta Asia were brought in, the DPRK has made it a pre-condition for its return to the six-party talks that these sanctions be lifted.
Finally, after the nuclear test there were private talks in Beijing between the US, the DPRK and China where it was agreed, although there is as yet no publicly announced date for their resumption, to resume the six-party talks soon within the context that this issue of the sanctions will be discussed and resolved within the first session.

DPRK Nuclear Test October 2006

We have seen the long history of US hostility, and nuclear threats, to the DPRK and the eleven years of attempting to normalise the DPRK-US relations which the US has consistently sabotaged. This brought us finally to some prospect of a resolution of the situation with the Joint Statement last September which the US immediately sabotaged, just as they have sabotaged everything else in the past. Then, to bring us up to date, we come to the missile tests in the summer carried out by the DPRK and finally the nuclear test. Two days after the nuclear test the spokesman of the Foreign Ministry of the DPRK made a statement which was reported on KCNA (Korean Central News Agency) in which he said: “Although the DPRK conducted the nuclear test due to the U.S., it still remains unchanged in its will to denuclearize the peninsula through dialogue and negotiations.

“The denuclearization of the entire peninsula was President Kim Il Sung's last instruction and an ultimate goal of the DPRK.
“The DPRK clarified more than once that it would feel no need to possess even a single nuke when it is no longer exposed to the U.S. threat after it has dropped its hostile policy toward the DPRK and confidence has been built between the two countries”
(11 October 2006).

Hence the nuclear test carried out by the DPRK is a huge setback for the US, and in particular for the foreign policy of the Bush administration. It arises from more than 50 years of nuclear threats by the US against the DPRK; it could have been avoided if Bush had carried on from where Clinton had left off; it could have been avoided if the US had not sabotaged last year’s agreement; and it could still be solved if the US lifts its sanctions and returns to the negotiating table in good faith. This is the point that has been reached now and we are waiting to see what will happen. Bush in his “Axis of Evil” speech and elsewhere says that states like Iran, Iraq and north Korea must be prevented from developing nuclear programmes. As he said in his “Axis of Evil” speech: “We will not allow the world's most dangerous regimes to threaten us with the world's most dangerous weapons”. As a result of Bush’s policy: Iraq, no longer has a nuclear programme and is destroyed and in chaos and the Iraqi resistance is entrapping the US army; Iran, a few days before the DPRK carried out a nuclear test, refused the UN Security Council demand to suspend its own uranium enrichment programme and Iran described the DPRK nuclear test as “a reaction to America’s threats and humiliations”. Finally the DPRK itself has clearly demonstrated that it is a nuclear power.
In completing my speech tonight, it is interesting to refer back to the article from the Bulletin of Atomic Scientists, quoted from earlier, which ends with the words of a former defence minister of India, who concluded that after the 1991 Gulf War: “Never negotiate with the United States unless you have a nuclear weapon”.

REFERENCES given in Bulletin of the Atomic Scientists
7. David McCullough, Truman (New York: Simon and Schuster, 1992), pp. 821-822.
8. Richard M. Leighton, Strategy, Money, and the New Look 1953-1956, vol. III of the History of the Office of the Secretary of Defense (Washington, D.C.: Historical Office, Office of the Secretary of Defense, 2001), p. 2. The same message was conveyed to Soviet Foreign Minister V. M. Molotov on June 3. The armistice was signed on June 27, 1953.
9. Richard A. Mobley, ‘Revisiting the Korean Tree-Trimming Incident’, Joint Forces Quarterly, Summer 2003, p. 110, 111. Mobley states that the August 1976 DEFCON 3 was "the first time it was changed in response to activity in North Korea."
10. John K. Singlaub, Hazardous Duty: An American Soldier in the Twentieth Century (New York: Summit Books, 1991), as cited in Richard A. Mobley, ‘Revisiting the Korean Tree-Trimming Incident’, pp. 111, 113-114.
11. U.S. Air Force Gen. Eugene E. Habiger, Stratcom commander, statement before the Senate Armed Services Committee, Authorization for Appropriations Hearing for Fiscal 1998 and Future Years Defense Programs, Senate Hearing 105-37, 105th Congress, March 13, 1997, p. 654.
12. Habiger, conversation with Hans M. Kristensen, August 12, 2004.