Today’s strike by nurses may indeed be the biggest action – or inaction – of its kind in NHS history. But there is a distinct sense of having been here before.
The nurses’ grievances been a daily theme of news broadcasts for weeks, as though, as a group, they are uniquely affected by the double-digit inflation rate, and uniquely deserving of a commensurate pay rise. Not only that but their complaints about low wages, long hours, intolerable working conditions and the general hardheartedness of government replicate many of those heard back in the spring of 2021, when the then-Chancellor (a certain Rishi Sunak) drew their ire.
Back then, Sunak made the mistake – in the context of a generally tax-raising budget – of announcing a 1 per cent increase for NHS staff across the board. He was rewarded with an angry chorus saying the government’s offer was mean, measly and a slap in the face to ‘our heroes’ of the Covid pandemic. The same objections are being heard now, with the added accusation of sexism from the head of the RCN, Pat Cullen, who suggested she and her union’s members might have been treated differently by the Health Secretary if they had been men.
Well, the pandemic threw up many heroes and heroines, including supermarket staff, rubbish collectors and a great many people on lower wages than nurses who received far less recognition for their efforts. Now the nurses are demanding a rise of ‘inflation plus 5 per cent’ in place of the 3 per cent recommended by the NHS pay review body: a demand which is so far from reality as to discredit their whole claim.
If anyone deserves a substantial pay rise, it is social care workers
But Sunak’s mistake as Chancellor, and arguably his government’s mistake now he is Prime Minister, is to treat the NHS in general and the nurses in particular as a special case. But the time for ministers and the public to genuflect before the NHS’s singular sense of ‘vocation’ is over. The nurses now on strike, and the junior doctors – who are balloting for strike action next month – have only themselves to blame for this.
Some may retain the picture of nurses as the ‘angels’ on the ‘front line’ working all hours for a pittance. But this picture is long out of date. The average annual salary for a nurse is around £32,000; not a fortune, but not bad – and augmented with cost-of-living allowances in London and the South-East. Senior nurses can earn much more – indeed, they were mentioned as one of the groups that could be ‘caught’ by the freeze on the higher income tax rate threshold contained in Jeremy Hunt’s Autumn Statement.
As in most of the public sector there are grades and increments that are paid regardless of any freeze. As for benefits and pensions, these are off the scale compared with what most lower-level private sector employees will receive – yet this difference is rarely mentioned when salaries are in the frame.
The other ‘fact’ used to tug at our heartstrings over nurses is their gruelling 12-hour shifts. But let’s get this clear: they are not working 12 hours five or six days a week. The 12-hour shift system was amicably agreed with many trusts a while back and gives most nurses a three- or four-day week. Employers like it because it is relatively simple to administer; (most) nurses like it because it leaves days free for child-care or second jobs.
The chief losers from this are not the nurses, but the patients, who face an ever-changing cast of nurses, tired out before their working day ends. Some other countries have tried this system and abandoned it for this very reason; not so the NHS, where patients come a poor second.
But back to pay. I am not one of those who argues that nurses should be motivated by vocation alone and that pay does not matter. Rigid national pay-bargaining, however, has led to a big disparity in spending power between nurses in different parts of the country and higher turnover of staff in high-price areas. This suggests that more could perhaps be achieved by addressing the principle of national pay bargaining rather than by offering a rise across the board. The pay settlement in Scotland (for a lot less than the RCN is demanding for England, by the way) might be evidence for that.
But many other arguments are spurious. There is the talk of a mass exodus from the profession, with a job in the local supermarket cited by phone-in callers as a preferable option. This suggests, if nothing else, an extraordinary level of ignorance on the part of NHS staff about how other people live. At around £10.75 an hour, supermarket staff are paid less than all but the lowest-paid nurses; they have nothing like the job security, the predictability or the pension provision of an NHS nurse. It also reflects a selective approach to the numbers, and a scant regard for productivity. Vacancies may stand at a record level, but there are more nurses now working for the NHS than there were before the pandemic. But still they are treating relatively fewer patients overall.
If anyone deserves a substantial pay rise, it is social care workers, who are indeed paid a pittance, often minimum wage (or less, if you calculate unpaid travelling time). They enjoy little job security, work irregular hours, may not qualify for sick pay, and have no public-sector pension to look forward to. It is lack of carers and care packages that is at least partly responsible for the shortage of spare beds in hospitals and the difficult working conditions nurses describe. Any pay award for nurses beyond that recommended by the pay review is likely to widen the gap between the two groups still further – when the opposite needs to happen.
Fairness would demand that social care workers receive the equivalent pay and conditions that pertain in the NHS. It is high time the two groups made common cause.
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