Martin Shelley –

The World Health Organization (WHO) recently declared 2020 to be the International Year of the Nurse and Midwife, encouraging members of these two professions to expect, not unreasonably, that ‘This is our Time’ (the strapline of the WHO campaign). In the middle of the ongoing covid-19 pandemic, it’s therefore difficult to imagine a better time to reward the contributions of frontline NHS staff in the UK with more generous pay and working conditions.


The current government has certainly put the NHS at the heart of its messaging, as well as its strategy, throughout the pandemic, but is the Tories’ enthusiastic – some say cynical – endorsement of state-funded healthcare now reflected in the way it rewards healthcare workers?


Judging from a recent agreement, designed to address the historic injustice of unpaid overtime in the NHS, you could be forgiven for thinking maybe it is. Overtime, paid or otherwise, has become an endemic feature of working in the health service.


A report last year from the independent NHS Pay Review Body acknowledged that the health service had become increasingly reliant on unpaid overtime. And NHS staff surveys bear this out.


Analysis of a 2018 survey revealed that staff were working more than a million hours a week in unpaid overtime, work which has been valued by the TUC at £1.6bn.


Successive surveys in 2015 and 2016  surveys also showed that nearly 75 per cent of staff were working extra hours, and almost 60 per cent were working additional unpaid hours each week – and the latter figure was largely unchanged three years later.


So the new agreement – announced in late May between 15 trade unions and the NHS Staff Council, to ensure staff are paid properly for every hour worked, is a step forward, but the government have stopped short of making the agreement mandatory, offering  “guidance” comprising optional, locally negotiated and time-limited provisions, with no mention of backdating any payments.


Those provisions are initially “for the duration of the covid-19 period” only. They still require agreement with local NHS trusts before they are adopted, and “are not intended to replace existing arrangements”, say the guidelines.

Commenting on the new agreement, UNISON head of health Sara Gorton said: “Health workers and the public will expect ministers to remember the applause long after the clapping has stopped – and especially when they sit down with unions and employers later in the summer to agree the next NHS pay rise.”

It’s an odd approach for the government to take at this stage, when the country depends so much on NHS staff. Much has been made of how it values the work being done by nurses during the pandemic – not least in statements from covid-19-survivors Boris Johnson and Matt Hancock – but funding policies adopted since last year’s general election undermine these protestations of support.

Take the issue of nurse bursaries. Scrapped in England back in 2015/16 by George Osborne, and worth up to £16,454 a year, this decision led directly to a sizeable drop in applications from first-time students for nursing degrees and a rising number of unfilled vacancies – currently more than 40,000. Johnson and Hancock may have re-introduced grants for nurses earlier this year, but these are worth no more than £8,000 annually, leaving graduates with debts of up to £60,000 when they qualify.

Abolishing tuition fees and wiping out student debt entirely would surely be a more admirable route to show the government’s appreciation for the 26,000 students currently on placements to assist frontline healthcare workers.

In April more than 80 MPs signed a letter calling on Matt Hancock to adopt exactly this approach, with a similar appeal following a month later, jointly mounted by the Royal College of Midwives, the Royal College of Nursing, the National Union of Students and the trade union Unison. At the time of writing there has been no response to either of these appeals from the Department of Health & Social Care.


Waiving minor professional fees would be another way to support nurses financially too. Nearly 90,000 people have signed a petition to persuade the Nursing and Midwifery Council to drop its £120 annual registration fee during the pandemic, so far to no avail, and a parallel petition to the Tory-controlled Commons on the matter last month was rejected, despite registration being a statutory requirement.


Onerous fees are, of course, a serious issue that needs to be addressed, but the more pressing question of basic pay in the NHS has been a stumbling block for coalition and Tory-led governments over the past decade. When it comes to public sector pay the Tories certainly have something of a reputation to live down.


Never mind the virtue-signalling ‘we’re all in this together’ displays outside Number 10 on Thursday nights in recent weeks. Who can forget the cheering in the House of Commons back in June 2017 when 313 Tory MPs, including Boris Johnson, voted down an amendment aimed at lifting a cap on public sector pay rises?


Although the Budget later that year ended the pay cap and cleared the way six months later for an increase of 6.5 per cent over the following three years for most NHS staff, inflation in the intervening years has rendered that sum less generous than it first appeared.


At the time the cap was lifted, after years of below-inflation annual rises of 1 per cent, it was estimated that – by 2021, the end of the three-year deal – a band 5 nurse would be less than £2 a week better off, and actually more than £3,000 a year (that’s 10 per cent) worse off in real terms than a decade earlier.


Average nurse pay has actually fallen by 7.4 per cent in real terms since 2010, the year the Tory MP George Osborne became chancellor of the exchequer. Yet health secretary Matt Hancock went on national TV in early April this year, at the very height of the pandemic, to tell viewers that “now is not the time to discuss a pay rise for nurses”.


Clearly misjudging public opinion, as demonstrated by the results a month later – after more than 65 registered nurses are thought to have died as a result of the pandemic – of a YouGov survey showing 77 per cent of the public support a 10 per cent pay increase for nurses.


Around the same time as the survey was released, Hancock went on social media to reassure nurses “just how valued [they] are”, a sentiment undermined somewhat by the near-simultaneous leaking by the Daily Telegraph of a Treasury document suggesting a two-year public sector pay freeze – amid other ideas – to help recoup the £300bn bill for covid-19.


The health secretary’s subsequent claim at a press conference the following day – that some nursing staff had already received a “very significant” pay rise of more than 15 per cent – was widely derided in the health sector, and we have yet to see this claim substantiated. In response, the Royal College of Nursing said, “the majority of nursing staff will not recognise the 15 per cent figure quoted”.


Of course cash isn’t the only form of remuneration for workers in the NHS. The provision of adequate safety equipment and staff-to-patient ratios could reasonably be considered part and parcel of any recruitment and salary package, especially in an organisation like the NHS, where more than 245 covid-19-related staff deaths have been recorded so far this year. Yet several months into the pandemic nurses are still struggling to get personal protective equipment (PPE) good enough for them to do their job properly, and staff shortages persist.


Only last week nurses were forced to protest outside Downing Street calling for adequate PPE, as well as demanding a pay rise to match that recently promised to their counterparts in France for the latter’s efforts during the pandemic.


The protest was organised by Nurses United UK, which claimed that Public Health England is “directly responsible for the lowering standard of PPE that NHS staff use daily”, restricting most staff to wearing surgical masks and thin gowns when dealing with covid-19 patients, rather than using full gowns and FFP3 respirators recommended by the WHO.


As for staffing, a poll conducted for the Institute of Public Policy Research’s Care Fit for Carers earlier this year found that, with a reported 40,000 nursing vacancies in England, increased pressure was negatively affecting the physical and mental wellbeing of healthcare workers.


And last year Southampton University, in a report funded directly by the NHS, found that one in four NHS wards routinely operated with staffing levels that threaten patient safety, and that the government was reluctant to impose mandatory minimum staffing levels to solve the problem. Later in 2019 came a survey reflecting the same concerns, conducted by the NHS Confederation, showing that nine out of 10 NHS bosses considered ward staffing shortages were endangering patient safety.


This is despite news that the NHS Health Careers website has seen a 220 per cent rise in people expressing an interest in becoming a nurse amid the global pandemic. If the government really is serious about protecting the NHS – the health service is a central plank of its pandemic strategy, after all – then exploiting that online interest to make good on the Tory election manifesto pledge to recruit thousands of extra nurses would be a good start, and echo the WHO pledge to nurses to make 2020 ‘their time’.

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