Unions have a struggle on their hands to reverse the privatising, AI–driven, centralising trends in Scotland’s NHS, writes Drew Gilchrist.
The NHS stands as the last great bastion of the post-war consensus. It is the proverbial Theodosian wall of British social democracy, and like the Byzantine defences, it has sustained decades of attacks and bombardments that have withered the organisation down to its bones. A plethora of cost saving measure and ‘modernisation’ initiatives made failures in delivering consistent and appropriate healthcare in Scotland an everyday reality for communities now left without crucial services. The latest of these initiatives is the introduction of technologies that use Artificial Intelligence to remove staff from communities and replace health workers with machines that automatically monitor patients’ health needs.
The devolution of health to the Scottish Parliament should in theory allow for us to better organise resources, provide every Scottish Health Board with what it needs to serve the interest of communities above all else, and protect NHS Scotland from cuts and privatisation. ‘At least it’s not as bad as down south’, the idiom goes. But in reality, the SNP pushes forward a failed policy of service centralisation, depriving both working class and rural highland communities of much needed services. Whether it be it GPs, radiography, or cancer care, workers have been left with a postcode lottery of health services.
Labour, smelling the SNP’s blood in the water, has set its sights on NHS Scotland as a focal point for future election campaigning. But what is Scottish Labour’s ‘vision’ for healthcare, and through what means does it aim to ‘reform’ and ‘rejuvenate’? Will they emulate Labour’s strategy for the English NHS? Is the expansion of the use of private health providers a “pragmatic but principled one”, as argued by Labour’s Health Secretary Wes Streeting? And what kinds of service changes will a wave of private provision bring into healthcare?
With NHS Scotland facing millions of pounds in cuts due to a stagnated budget, health boards are not only looking at cost cutting measures, predominantly around procurement, staffing, and service provision, but also at the introduction of new technologies to ‘lift the burden’ of labour from staff groups. AI technologies have already either been implemented or are planned to be introduced within the next year, raising questions from staff and their trade unions around job loss and deskilling.
Boards are making links with English tech companies to implement AI technologies into wards, A&E, and patients’ homes. Virtual wards have been heralded as a way to decrease the time spent in wards by patients recovering from major cardiac surgeries. This entails supplying the patient with a tablet that monitors vital data and would prompt the patient to contact emergency services if required. The faults are all too glaring to everyone except the board directors. Who monitors this equipment to ensure it is working properly? In acute sites staff are on call constantly to ensure equipment is functioning; will these tablets be monitored by private suppliers? Will their technicians require entry to patients’ homes? Will they just shift the burden from wards onto an already struggling ambulance service, as a means of treating patients who should rightfully be treated by on-site nurses and specialists? Those who are certain to benefit are private companies like UK start-up Doccla, ‘medicine optimisation’ company Spirit Health, and Roche UK that is working with NHS England to develop AI-driven data collection tools.
Definitely Not Centralisation
At the 2024 Scottish Labour conference in Glasgow, the big announcement for health was the plan to deconstruct Scotland’s 14 health boards down to three. Jackie Baillie has spent the subsequent months travelling Scotland and talking with unions trying to convince staff side and partnership that this move “is definitely not centralisation”, much to the disgruntled scoffs of union reps who have seen first hand the consequences of squeezing services togeth- er across different regions.
Trade unions appear to be sleepwalking into such changes. Most employee directors, who represent trade unions at board level, have become defenders of them as “a necessity to keep services running”. Only a few have put up any resistance to the implementation of these changes, and even fewer have taken seriously the connection between centralisation and the introduction of new AI technologies that depend on gathering masses of data.
A gap is beginning to form between staff – fearing for patient safety, job losses, deskilling, crumbling services, and poorer working conditions – and the trade union representatives who are
elected to represent staff but, enticed by the appeal of standing as equals of higher management, lap up the promises about the latest technological fixes. As this gap has grown, apathy about unions has ingrained itself into the workforce. It has become more and more common to be a member of a union “because it’s useful” rather than because it is a vehicle for workers to build collective power and protect themselves from the growing workloads that AI tech- nologies, privatisation and the centralisation agenda in the NHS are bringing.
Trade unions must go back to the basics in terms of organising members, and move away from the service model that has dominat- ed public services unions for over two decades.
Efforts must be made to encourage department – and services – based growth and an organising model with the political backbone to develop staff understanding of the nature of the cuts, attacks on their pay and terms and conditions, and the connection between centralisation and new technologies.
Steps have already been taken down this path with the most recent STUC Congress passing a motion to develop a report on NHS privatisation in Scotland and list the names of companies and individuals profiting from health. Although this will be a slow process, it will give reps and activists the tools to build an understanding in their workplaces and communities of how the government is selling the NHS. The hard task will be building confidence in workers that collective action can be successful not just in fighting for better wages but for protecting job quality and the founding principles of the NHS.
Communities will need this industrial backing when organising to protect the services they need. Across Scotland groups are already coming together to try and build this broad front. In North Lanarkshire, an anti-cuts campaign has grown from the grassroots to fight against local authority cuts. It is involving staff across different industries worried about the impact job losses will have on the community, including in the NHS. Trade unions need not just vocally support the campaign; they must also incorporate it into their organising strategies and campaigns to win the argument with politicians and put pressure on health boards who have been left to implement the cuts. Shop Steward committees could form the basis of
this link. Acting outside the partnership model, rank and file committees would allow united health unions to go directly to communities, and enable members and communities to bring union representatives under a much-needed system of accountability that ensures they do not become compliant with managers.
The growing health emergency in Scotland, the ongoing cuts, and a slow-moving trade union movement is the perfect storm that could bring down the NHS. The development of technologies is a crucial part of the fight to build a healthy nation, but not when the main priority of those controlling that technology is to increase profits. Against the cuts and the profiteers, we need a broad united front of political, social, and industrial struggles to keep the NHS alive.
Drew Gilchrist is an NHS worker and staff side rep, delegate to North Lanarkshire Trades Council, and anti-cuts campaigner in the community.