For the first time in its history, the Royal College of Nursing has taken strike action over pay. Next week, nurses in England will be joined on the picket line by ambulance workers and other members of the NHS workforce, and junior doctors may soon join them. We should be clear that strike action on this scale is unprecedented in the history of our National Health Service.
As a doctor myself, I would never strike, because I worry about the impact on my patients. But it is important to recognise that many NHS workers are experiencing real financial hardship owing to the ever-rising cost of living, and the failure of the government to make a sensible pay offer is not helping. So how has the government got into this mess, and what can be done about it?
In February every year, the independent NHS pay review bodies meet to consider evidence, including the likely rate of inflation, in order to make recommendations about annual uplifts in pay for NHS workers. Government assertions that it is simply following the advice of the independent pay review bodies should be treated with some scepticism.
In the recent past, the government has chosen to ignore independent pay review body advice and offer lower than recommended pay settlements to NHS staff. So it is rather disingenuous for the government to now accept the recommendations because it is financially expedient for it to do so.
The pay 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 pay offer of between 4% and 5% makes nurses and other NHS workers considerably poorer. Inflation alone justifies revisiting the recommendations of the pay review bodies to ensure nurses get a better deal.
The government also needs to properly consider the healthcare economics of the dispute. There are already a large number of nursing and other staff vacancies in the NHS, as a result of which about £6bn a year is being spent on temporary staffing costs, a bill that has doubled from around £3bn in 2015.
The cost and reliance on temporary staffing is bad for patients but, despite being unacceptable and financially unsustainable, it appears to lack ministerial attention.
The government’s decision to squeeze nursing pay will push more nurses to vote with their feet, to leave the NHS and earn more money by either working for temporary NHS staffing agencies or to work for private healthcare providers. This could even result in the perverse situation where reductions in real-terms pay mean that the same nurse could leave their NHS job and return 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 costs and the increased salary paid to the nurse.
This is poor healthcare economics. Pay needs to be set at a level that helps to recruit and retain the NHS workforce and the time has come for some joined-up thinking from government. Investing in better pay for nurses and other NHS staff would help improve staff retention and reduce the ever-growing temporary staff bill.
Nursing union demands for a close to 20% pay rise are unreasonable, but it is equally unreasonable for the government to fail to acknowledge that the current independent pay recommendations were made without consideration of runaway inflation caused by the war in Ukraine.
The Scottish government has recognised this and made an improved pay offer to NHS staff of close to 8%, financed by adding an additional penny to the higher rate of income tax. The UK government should consider a similarly improved pay settlement for NHS staff in England. This would cost around £2bn and could be found without the need for tax rises if the government looked to NHS efficiencies, such as improving procurement practices, and recognised that investing in improved staff recruitment and retention would in itself deliver significant savings.
This is the very worst time for industrial action in the NHS. There is the ever-growing backlog of care resulting from the Covid pandemic – with 7 million people on waiting lists and growing – and winter pressures. Unless the government and NHS workers can come to terms quickly, patients will be the real losers in this dispute.
Dr Dan Poulter is the MP for Central Suffolk and North Ipswich, a former health minister and a practising NHS hospital doctor
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