Offering nurses a pay raise of just 4 percent seems like an almost provocative act of parsimony. It’s half the average wage increase, about a third of inflation. And yes, we all know that the social value of jobs tends not to match their financial reward: if it did, the average nurse would have an annual package close to £50,000. But can ministers really argue that, with their own tax collection that will soon be in a recordwhat nurses deserve now is the biggest pay cut in real terms in NHS history?
Until now, ministers have tried not to argue at all and to present all strikes as a dispute between employers and unions. In doing so, they have missed the opportunity to put things in context. I’m not sure I’ve ever heard it explained, for example, that the average nurse actually has a £50,000 package: it’s just split up in a weird way, with about a third in pension and a good chunk in other benefits. . Given the options, nurses can choose a different combination: a little more salary, a little less pension. But they are not given the choice.
In a dysfunctional healthcare system, the staff suffer as much as the patients. Overwork, late deliveries, often appalling conditions: it’s all the product of a lack of reform. The BBC’s televised version of Adam Kay’s This Is Going to Hurt shows an exhausted doctor working horrifying hours with at-risk patients. Nobody doubts that it is based on scandalous facts, but there are two possible reactions. One is to denounce the underfunding of the NHS. The other is to ask why such practices occur in one of the best-funded healthcare systems in the world.
This is what the Tories have done to the NHS: give it more money, comparatively, than ever before. Tony Blair angered Gordon Brown by declaring on a BBC couch that he wanted Britain to catch up with the European average for health spending. But Boris Johnson’s four-year NHS Funding Act boosted UK healthcare spending ahead of high-tax countries like Sweden and Switzerland, with only France, Germany and Austria spending more money on healthcare. So we are spending: but we still have about 10 percent of the population on a hospital waiting list.
The lead in the wage negotiations comes from Mark Drakeford, the First Minister of Wales. Giving nurses more pay, he said yesterday, means “less treatment, fewer nurses, less money for the health service.” If a Labor leader can speak candidly about compensation, why can’t the Conservatives?
Sunak could, of course, give the nurses the 19 percent they their unions are asking. But you could also share with the public what this would mean. They have given you the figures. Each additional 1 per cent pay increase for the NHS workforce is the financial equivalent of hiring an additional 16,000 nurses or 500,000 operations. The different health boards, who know all this, were asked what their priorities were: treatment or payment? Most said: both. Only 4 percent said they paid. The nurses deserve a raise, but the patients deserve care, and quite a few are now dying for lack of it.
By voting to strike and rejecting the Scottish government’s offer of 7.5 per cent, a figure higher than the average private sector pay increase, nurses are playing hardball. So the government could try to properly participate in the argument. £50,000 worth of a typical nursing pack, for example, was produced by the Government Actuary’s Department. But why do the ministers never cite it, to contextualize all this debate? Why not research and publish similar comparable figures for teachers, railway staff and private sector workers?
Sunak can argue that, in total, nurses are reasonably cared for – who else has a pension plan where members can expect to receive £3-6 in benefits for every £1 they contribute? How many more have a regime that can be activated from the age of 55, allowing staggered retirement? It’s a fair argument, but one that ministers should have the confidence to make public.
That being said, there is no excuse for underpaying nurses. I have advocated, in this space, for nursing homes and Next stores to pay a lot more, and stop calling in more immigrants if supermarkets start to outbid. The NHS has also been doing its part: recruiting abroad and offering jobs at £9.65 an hour when Lidl was paying £10.10.
The low wage game must end in Britain – this is part of why people voted for Brexit. But a system that operates with generalized increases will end up hurting those at the bottom, because those increases are unaffordable for those at the top.
Private clinics, which are growing as more patients leave the NHS, tend not to pay more. But the working conditions are better, with more flexible hours. Working in a healthier, less stressed environment would be important to NHS workers, barely a quarter of whom are brave enough to say there are enough staff to do their jobs properly.
Given the lives that depend on their work, it’s an alarming statistic. But there is no money to hire more staff if wages go up 19 percent. It would perpetuate the cycle of understaffing, excessive workloads, and unacceptably poor patient care.
A man who has spoken more candidly is Sajid Javid, a former health secretary. He has plans to start talking and saying the unspeakable: that the NHS can only be saved by comprehensive reform. So it’s time to talk about copays and organize this aging leviathan into manageable chunks, for the sake of the staff and their pay, not just the patients and their care. But it’s pretty important that it takes a Tory not running for re-election to start the conversation.
Years of running away from this discussion has not served the Conservatives or the NHS very well. We are in a crisis largely because no one wanted to talk about the impending crisis. It was the cowardly route, and it has led to this unwinnable salary battle. Now we end up with a series of bad options, with worse ones (and more strikes) to come. So when the Prime Minister thinks about what to do next, he might try some candor. Everything else really seems to have failed.