An obtuse government refuses to discuss pay as 100,000 nurses strike on Thursday in 53 English NHS organisations. That’s despite an offer from the Royal College of Nursing (RCN) to lower its opening bid. Ambulance drivers follow next week, the most severe threat of all the strikes, as this struggling service already fails to reach people experiencing heart attacks and strokes.
Labour’s shadow health secretary, Wes Streeting, tells me an elderly close relative who just fell and broke a hip and shoulder was told to wait eight hours for an ambulance: it may be hard to separate the effects of the strikes from the “normal” austerity-stricken NHS. At a follow-up hospital visit recently after removal of a cancerous kidney, Streeting couldn’t get his test results: he blamed not the “lovely” staff who “really care”, but the plight of the NHS.
From now on, expect all such events to be blamed on strikes, rather than the “decade of neglect” outlined in Monday’s devastating King’s Fund report into NHS dilapidations caused by years of underfunding. Before any strikes begin, the Guardian set a baseline with yesterday’s frontline report on 33 hours in the NHS, graphically depicting exhausted staff struggling with too many severely ill people and too few beds, nurses and doctors. Everyone in the NHS I speak to echoes the certainty of Alastair McLellan, the editor of the Health Service Journal, that “people have died needlessly due to the state of the NHS”, but expect front pages about the first named case the Tory press can blame on the strikes. One human case is worth a welter of statistics.
NHS England headquarters is braced – it is well-used to rightwing onslaughts about the very concept of the NHS, with Telegraph columnists claiming “Patients are getting nothing for extra NHS spending” or “Our feckless NHS is squandering Rishi Sunak’s tax raid”. NHS leaders are trapped, unable to set fair pay for their staff, caught between a won’t-pay government intent on political “victory” and attacks from rightwingers using this crisis to proclaim the death of the NHS idea. More nurses have quit this year than ever before, says the RCN, not just over-50s retiring early but alarming numbers leaving after four or five years, exhausted by over-work, under-staffing and pay they can’t live on. “Victory” against the strikers would be pyrrhic, as more would walk away.
In every interview ministers hide behind the sanctity of the “independent” pay review bodies, claiming they set public pay. They don’t and nor are they “independent”. The government decides on pay, using PRBs as camouflage. The 60 or so members of these eight bodies covering public sectors are picked by ministers, as is their Office of Manpower Economics secretariat. I tried to speak to some members – no luck. Only two of those 60 people come from the employees’ side, says the TUC: one from the army, with no affiliated union. (The Tory press protests at the armed forces standing in for some public staff paid more than them. That’s because, banned from striking, they get short-changed by government; a recent report says Met police, likewise banned, are increasingly forced to use food banks).
These opaque PRBs are nothing like the Low Pay Commission that sets the minimum wage, whose membership is shared between academics, employers and unions: the TUC says it works well. PRBs have two main criteria to consider, both bogus. What are the current financial circumstances, and what may be needed to recruit, retain and motivate staff? But they are given a fixed spending envelope, with a set pay rise baked in. Any extra pay comes out of the departmental budget, causing cuts.
This year, for some health service workers including nurses, the NHS pay review body did recommend a pay rise of 1% more than the 2% budgeted, with no other room for manoeuvre, apart from dividing a set sum between staff of different grades. It has no leeway to consider what the state could afford, if it chose. Plainly recruiting and retaining was conveniently ignored; the NHS has never needed to motivate staff more, with an accelerating 133,000 vacancies in England and 8% fewer people applying to nursing courses. Why have there been no public resignations from those rubber-stamping inadequate pay?
Labour’s welcome policy is for fair pay agreements across every sector, public and private, with a tripartite set-up like the Low Pay Commission. That ends the PRB sham.
Expect more of this pretence as the health secretary, Steve Barclay, preposterously tells BBC Breakfast: “We do have an independent pay review body and it’s important both sides respect that independent body.” But only the government can negotiate. Streeting calls the RCN’s readiness to halt strikes immediately for pay talks an “offer the government can’t refuse”, but Barclay wrongfoots himself with what the RCN calls the government’s “belligerence”. Nor, as the Institute for Fiscal Studies confirms, does public pay – far behind private pay, let alone top pay – cause a “wage-price spiral”. The government did intervene to stop rail employers settling at 10%, so let interviewers take no more pay humbug from ministers.
There are two big truths about the NHS. This is its worst ever crisis, says everyone inside it that I talk to. NHS England will privately point to the obvious reason why, with Covid not the biggest cause: beds have been cut, running hot at a dangerous 95% occupancy; in 2019, the OECD average was 76%. Look, they say, at pre-Covid years 2010-19 to see the UK spending 18% less per head than the EU’s 14 richest nations, 21% less than France, 39% less than Germany. That’s a gigantic shortfall year after year, as baby boomers age fast, pressing on the NHS.
But here’s the other big NHS truth. I have just finished breast cancer treatment that was kind and efficient and I am not alone in my appreciation: last year saw the highest level yet, almost nine out 10 cancer patients pleased with their treatment, as cancer survival rates keep rising.
For all that is going badly, a million people a day have appointments at GP practices in England, 40% on the same day, 70% face to face. But the IFS reports this week that post-Covid there are 5% fewer available beds for non-Covid patients and more beds blocked for lack of social care. The government ignores the one quick fix for the NHS: good funding and decent pay for social care.
NHS England is firing up its Help Us to Help You campaign, urging people to come forward with cancer symptoms, not to leave it too late, not to be deterred by fear that the NHS is overwhelmed. Out there it’s a political battleground and inside staff are often ground down, yet still surveys show most people most of the time encounter good treatment. Amid outrage at this government’s 12-year neglect, the NHS remains in need of stout defence against its perennial enemies.
Polly Toynbee is a Guardian columnist
