My intuition tells me that nurses should be paid more. But intuition is not the basis for politics. And I wonder if an objective answer can be given to the question: how much should nurses be paid? In fact, there is a feeling that the value of someone saving lives is infinite and cannot be expressed in financial terms. There is a Jewish saying that whoever saves one life saves the whole world.
In the private sector, remuneration is determined by the market. In the public sector, by contrast, someone must decide how much nurses and other health care professionals will be paid.
Who should that someone be? In the past was the minister. But the minister had to make an impossible judgment. His decision was bound to be, in a sense, arbitrary and “political”. Therefore, many argued that the health service should be taken out of politics. That is why the nurses’ wage review body was established in 1983, at a time when nurses had a no-strike policy.
Review bodies, made up of independent members, were supposed to be able to develop criteria by which salary could be determined, a bit rough and ready to be sure, but untainted by politics. It was hoped that even if their judgments were not binding, the awards they recommended would be generally accepted by both the government and those in the public services.
Of course, wage review bodies must work within a mandate set by the government of the day. In the case of the health service, that mandate required a review to take into account what the NHS could pay for. All governments have to pass judgment on the distribution of public spending between health and other services.
The nurses, however, rejecting the recommendation of the reviewing body, ask the minister to solve the strike by increasing the award. If he did, he would be bringing politics back to health. The minister reportedly does not have access to any information denied to the salary review body, whose award was based on a forecast inflation rate of 10 percent, about 1 percent below the actual rate.
If the review body’s recommendations were to be overturned when the government or unions don’t like them, they would be considered not as independent expert judgment, but as a single opinion that can be overturned at will. To be sure, a minister could always overturn the review body’s decision by persuading his colleagues to provide more money, either through higher taxes, loans, or cuts in spending for other services such as education or defence. But the health secretary, like other ministers, has to weigh the consequences of invalidating the review body for other services and for the economy, considerations that inevitably weigh less with health service professionals suffering from the cost crisis. of life. Significantly, the Labor Party, which in opposition often supports strike action, has been reluctant to fully support raising nurses’ pay.
The strike, then, is aimed at decisions on the distribution of public spending made by a democratically elected government. However, it is not the members of the Government who suffer the consequences, but vulnerable patientswho trust the skills of health service professionals.
Some unions are now seeking the abolition of the pay review system and the resumption of direct collective bargaining with ministers. But would nurses really benefit from that? In that case, ministers’ decisions on remuneration would be based not only on evidence, but also on the relative bargaining power of public sector unions. The resulting free-for-all situation is unlikely to benefit low-paid workers like nurses. Nor would it be in the interest of health care workers whose professional obligations make them reluctant to use the strike weapon.
The problem is, of course, inherent in determining fair rewards in a nationalized service, which introduces an inherently antagonistic relationship between government and those who work for it. That adversarial relationship feeds the whining and complaining culture, which has been a feature of the NHS since its founding. Grievances and complaints disappear only when it is suggested that a different model of healthcare could lead to better conditions for healthcare professionals, as well as being more efficient and patient-friendly. We are then told how wonderful the NHS is, or would be if only governments weren’t that greedy.
If the nurses’ strike leads to informed research into alternative methods of medical care, it will have helped.
Vernon Bogdanor is Professor of Government at King’s College London. his book, The strange survival of liberal Britainwas recently posted by Biteback