FFor the first time in its history, the Royal College of Nursing has taken strike action on pay Next week, ambulance workers and other members of the NHS workforce will join nurses in England on the picket line, and they may soon be joined by young doctors. We must be clear that a strike of this scale is unprecedented in the history of our NHS.
As a doctor, I would never go on strike, because I am concerned about the impact on my patients. But it is important to recognize that many National Health Service workers are experiencing real financial difficulties due to the rising cost of living, and the fact that the government has not made a sensible wage offer is not helping. So how has the government gotten into this mess and what can be done about it?
In February of each year, the independent NHS pay review bodies meet to consider evidence, including the likely rate of inflation, in order to make recommendations on annual increases in pay for NHS workers. The government claims that it is simply following the advice of independent wage review bodies should be treated with some skepticism.
In the recent past, the government has chosen to ignore the advice of the independent pay review body and offer less than recommended pay arrangements to NHS staff. Therefore, it is quite disingenuous for the government to now accept the recommendations because it is economically convenient for it to do so.
Wage review bodies made their recommendations for this year before the war in Ukraine, which has had a significant impact on inflation and the cost of living. In other words, the recommendations were made without reference to the single most significant factor affecting take-home pay.
The government is certainly right about one thing: inflation makes everyone poorer and a payment offer 4-5% makes nurses and other NHS workers considerably poorer. Inflation alone justifies revising the recommendations of salary review bodies to ensure that nurses get a better deal.
The government must also properly consider the health care economics of the dispute. There are already a large number of nursing and other staff vacancies in the NHS, as a result of which around £6 billion a year is being spent on temporary staff costs, a bill that has doubled from around £3 billion in 2015.
The cost and reliance on temporary staff is bad for patients but, despite being unacceptable and financially unsustainable, it seems to lack ministerial care.
The government’s decision to cut nurses’ wages will push more nurses to vote with their feet, leave the NHS and earn more money working for NHS temporary staffing agencies or private healthcare providers. This could even lead to the perverse situation where reductions in pay in real terms mean that the same nurse could leave her NHS job and go back to work for the NHS, perhaps even in the same hospital department, as an agency nurse. The NHS will foot the bill for the agency’s costs and the increase in salary paid to the nurse.
This is bad health economics. Pay needs to be set at a level that helps recruit and retain the NHS workforce and the time has come for some joint government thinking. Investing in better pay for nurses and other NHS staff would help improve staff retention and reduce the bill for ever-increasing temporary staff.
Nursing union demands a closure of 20% salary increase they are unreasonable, but it is equally unreasonable for the government not to recognize that the current independent wage recommendations were made without taking into account the runaway inflation caused by the war in Ukraine.
The Scottish government has recognized this and has made a enhanced pay offer to NHS staff of about 8%, funded by the addition of a extra penny at the highest rate of income tax. The UK government should consider a similarly improved pay arrangement for NHS staff in England. This would cost around £2bn and could be found without the need for tax increases if the government looked for NHS efficiencies such as improving procurement practices and recognized that investing in better staff recruitment and retention would itself deliver savings. significant.
This is the worst time for industrial action in the NHS. There is an increasing backlog of care as a result of the Covid pandemic, with 7 million people on waiting lists and growing, and the pressures of winter. Unless the government and NHS workers can come to an agreement quickly, patients will be the real losers in this dispute.
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