Andy Burnham, Manchester Mayor.
(Picture: Amanda Searle)Earlier this week, when talks between the Health Secretary and NHS unions broke down, my mind went back to a conversation I had just over a decade ago with an A&E nurse from Bristol. I relay it here as it might just help shed a bit of light on the current stand-off.
I was shadow health secretary at the time and down in the South-West because the region had been chosen by the coalition government as the pilot area for new regional NHS contracts, including regional pay rates. David Cameron clearly believed Labour had left behind an overly-generous national NHS pay framework which needed to be broken up.
The nurse worked at the Bristol Royal Infirmary. She told me how a manager had already been around her ward putting new contracts in front of the staff, seeking to replace their 37.5-hour week with a 41-hour week.
“What did you do?” I asked her.
“I signed it,” she replied, quick as a flash.
“Why?”
“Because I currently do a 45-hour week, with seven and half hours unpaid, but the management don’t seem to understand nor appreciate that. However, if they want to play it that way, then fine — I’ll just work 41 hours from now on.”
This conversation has always stuck in my mind. The NHS is more than the sum of its parts because of the goodwill of its staff. If you take staff for granted, you erode that goodwill. If you lose too much goodwill, you lose the NHS.
This is why the current situation is getting so dangerous. Just like the A&E nurse in Bristol, embattled staff on trolley-lined corridors are not going to respond well to anyone in charge who reveals a lack of understanding of what they do and why they do it.
Work harder if you want more pay? A tone-deaf Government line like that simply burns straight through the remaining goodwill of burnt-out staff.
So, from here, how do we avoid a major crisis?
Not easily: the point-of-no-return feels close. The row is escalating, positions are entrenching and the consequences will soon be extremely serious for everyone — including the Government. I beseech them to pull back before it is too late. It was a less serious situation than this but I can remember when the Labour government was at risk of losing NHS staff in the 2006/7 period. I was a junior minister at the time and set off on a back-to-the-floor exercise shadowing staff at every level of the NHS.
It was only by walking in the same shoes as cleaners, porters, nurses and paramedics — and truly listening to them — that I managed to break out of the rigid Whitehall lines-to-take which were grating on them so badly.
As a result, we reset the relationship and rebuilt goodwill. This Government urgently needs to do its own version of the same thing. First, it must set up a genuinely independent process of negotiation on pay, covering this financial year and the next. That’s a given.
Next it needs to show it is listening seriously to what NHS staff are saying about working conditions. That is fast becoming the biggest issue in this dispute. Ministers could do worse than set up their own shadowing programme.
Legislating for minimum service levels on strike days, while ignoring unsafe staffing levels on non-strike days, is a selective, self-serving and unsustainable position. So, in parallel to pay, we need a separate negotiation with unions, Royal Colleges and professional bodies on a timetable to deliver safe staffing levels.
These two things are the minimum required for de-escalation. But on their own are not enough to keep the NHS’s head above water.
My final point is one for all parties. For a long time, I have warned that a broken social care system will eventually drag down the NHS. That is exactly what we are witnessing right now, a process accelerated by Brexit and the pandemic. All parties share culpability for not acting sooner.
One-off cash injections to social care, as we have seen this week, acknowledge the issue but are a sticking plaster.
I see only one solution: make health and care a single system with all of it provided on NHS terms. Only that will stop the NHS being overwhelmed by demand and allow it to get serious about prevention.
Is anyone in Westminster prepared to make the case for it — and save our NHS?
