When the mighty Royal College of Nursing walked out on its first ever national strike, there was never a doubt that the government would fold and offer a pay increase to NHS staff. Nurses could never be conveniently branded as “militants”, though at first, pathetically, the Tories tried it; nor did that epithet stick to the ambulance staff, physiotherapists and the rest who went on strike. Why did ministers waste all this time, with all those lost appointments and operations, inflicting extra suffering on patients while lengthening the politically damaging waiting lists?
It was blindingly obvious that NHS staff would require a better offer for this year when inflation topped 11%, as well as for next year. After the Covid clapping, after the nightly scenes on television news of staff struggling heroically in dangerously hard-pressed A&E corridors and understaffed wards, their case was undeniable.
Fourteen unions, well chaired by Sarah Gorton of Unison, end up round the table of the NHS staff council, representing more than a million employees. They have won a one-off 6% for this year instead of the 3.5% originally on offer, and 5% next year when inflation will fall, but it’s still less than the private sector’s average 7% pay rise.
But it isn’t over yet: when striking Scottish nurses were balloted, they rejected the deal struck by their unions. But as workers on strike can lose more in the days’ pay deducted than they gain, the government will hope weariness and the sheer unaffordability of any more lost days wins out.
There is a risk that repeated awards, giving most to the lower grades, undermines NHS quality as valuable senior experienced nurses fall behind and are easily wooed into jobs outside the health service. Remember that part of their reason for striking was a protest about the deteriorating state of the NHS, as well as their own terrible working conditions as they cover for 47,000 nursing vacancies. With no new money for the NHS or social care in the budget, they will return to exhausting 12-hour shifts in the same conditions.
Already, capital funds have been devaluing: those phantom “40 new hospitals” will remain just that, despite some roofs falling in on existing sites. And a hefty sum has been diverted from crucial digitisation, reports the Health Service Journal. This is not a second order matter, as ancient computers take half an hour to fire up and remain unconnected to a wider network, so scans and notes are not shared, and the prescriptions necessary for discharging patients fail to come through. That’s the dilapidation caused by a decade of the lowest ever NHS funding increases.
This deal covers NHS staff on the Agenda for Change framework, which is all except doctors. It is good that lowest paid healthcare assistants are included too, but as Anita Charlesworth of the Health Foundation warns, this will add to the crisis in social care. Care workers were already paid £1 an hour less than healthcare assistants and denied NHS pensions and an NHS career path. Now more will flee from social care to join the NHS. That’s why it’s such an error not to put them all on the same footing within the health service.
Other damage will have been done: the sight of indignant NHS strikers will not have encouraged others into the nursing profession, after entrants fell by a record 9% last year. Since nursing bursaries were axed, students clock up as much as £50,000 debt, though they spend half their time working, theoretically “supernumerary” – but inevitably, actually caring for patients. Though Brexit stopped the flow from the EU, 48% of new nurses last year came from abroad, including from Nepal, which the World Health Organization says should not be targeted for recruitment by the rich world.
As chancellor, Jeremy Hunt seems to have forgotten everything he demanded a few months ago as chair of the health and social care select committee: he was the great advocate for a 10-year NHS workforce plan. Where is it? Forgotten, too, is the book he wrote, Zero, demanding zero needless NHS deaths. He now oversees the budget of an NHS that has been letting more than 500 people die a year waiting for ambulances.
Yet he found another £6bn to ease the cost of driving – enough, says Paul Johnson of the Institute for Fiscal Studies, to cover an inflation-matching pay rise for the whole public sector. All that Hunt found for the NHS was that £1bn to give not just to some senior doctors but all high earners to boost their already over-subsidised pensions.
These strikes would have been so easy to avoid. Now we need rapid settlements for all the hundreds of thousands of other striking public servants.
Polly Toynbee is a Guardian columnist
