5 NHS Demands We Must Not Compromise On

by Peter Pannier

20 October 2014

Last week saw the first NHS strike over pay in more than 30 years. While soldiers were deployed to undermine striking ambulance staff, nurses were joined on the picket lines by midwives following their monumental decision to undertake industrial action: the strike was the first in the history of the Royal College of Midwives. As political parties left and right fight for the mantle of being ‘the party of the NHS’, disputes over pay are continuing: today marks the first NHS radiographers’ strike in more than 30 years.

Here, Peter Pannier offers five NHS demands we should refuse to compromise on:

1. Pay all NHS staff at least a living wage and ensure wages rise at least in line with inflation.

Ambulances drivers are currently on salaries of £16,271.

As Rachael Maskell of Unite the Union wrote last week, “About 40,000 staff in the NHS are paid less than the living wage, and many now revert to in-work benefits and food banks for bare essentials”. In addition, “many low-paid jobs have now been outsourced, so the NHS can deny its responsibility to those staff”.

We all deserve wages that at least enable us to live. That this is seen by anyone as a radical demand is a sad indictment of the present state of things. Introducing a living wage in the NHS would cost the Treasury “as little as £5m,” but we should be pushing for more – should those who care for us from before we are born and whose task is to keep as much distance as possible between our birth and our death really be paid as little as £7.65 an hour?

Why aren’t all NHS staff currently paid the living wage or more? Basically because private providers can only make profits if they can cut the wages and conditions of staff. In Doncaster, 50 NHS health workers transferred to Care UK have been taking strike action against attempts to cut their wages by “up to 35%… and the £7-an-hour wage paid to the 100 new staff replacing some of those who have walked away in disgust.”

2. Institute mandatory minimum staffing ratios.

Last week Jeremy Hunt made a neat, if transparent, attempt to deflect blame, claiming “14,000 nurses would be sacked if we agreed to 1% pay rise”. He has again raised the spectre of understaffing at Mid Staffs.

This Hobson’s choice can be avoided: it’s perfectly possible to demand both that the NHS is staffed with enough workers, and that those workers are paid well enough to focus on their jobs. Indeed, to argue – as Hunt does – that pay must be sacrificed in order to hire or retain staff, is to completely ignore not only the high levels of experienced staff leaving when wages and salaries are too low, but to undermine the entire purpose of the focus on staff numbers.

You cannot solve a staffing crisis by underpaying staff any more than you can solve it by understaffing. The 4:1 campaign, organised by health-workers, seeks mandatory staffing ratios: “There would be no more than 4 patients to 1 nurse, with variations according to your hospital ward’s or unit specialty”. Beginning with a petition, the campaign hopes “to generate groups of nurses who are willing to campaign locally in their hospital, and link them into a national movement able to create the change we need to see in our NHS.”

The 4:1 campaign points out that “Several countries and states have implemented mandatory nurse-to-patient ratios, with great improvements in care, job satisfaction and health for patients and staff.” Why hasn’t the Francis report led to mandatory staffing ratios already? Basically because if they can’t cut wages and conditions further, private providers make their profits by cutting staff numbers. At Hinchingbrooke hospital, now run by Circle Healthcare, for instance, just 27% of workers feel there are enough staff “to do their job properly.”

3. Deal with PFI.

We do not need to be drawn into technical debates about the precise level of additional funding that is sufficient to deliver ‘an NHS with time to care’, inclusive of sufficient rations and decent wages. However, there are obvious sources of funding available.

First, Drop the NHS Debt is exploring different options for dealing with the £79.1bn total repayments associated with 118 Private Finance Initiative (PFI) projects. The combined projects have a capital value of just £11.6bn. Drop the NHS Debt says, “According to one calculation, two hospitals could have been built for the cost of just one, had public sources of finance been used.”

The campaign and lobby group Medact has organised a conference for 1 November which is set to debate various approaches to the ‘The People vs PFI. Defaulting on debts, of course, has hardly been a rare occurrence in recent years. Indeed, there is a case to be made that PFI debts are ‘odious debt’ that could, via a ‘Citizens’ Audit’ process, be repudiated on those grounds.

4. Care Not Nuclear.

Second, as the Rethink Trident campaign argues, when “Britain faces the deepest public spending cuts in living memory, the country can ill-afford to be spending in excess of £100bn on replacing Trident with a new generation of nuclear weapons.”

Of course, the campaign against replacing the UK’s Trident Nuclear weapons system is worth supporting on its own merits, but it is also a campaign with clear potential to make explicit links with NHS funding in particular. The current budget for the NHS is around £115bn. With the money saved, we could institute not only a free and comprehensive National Care Service, but probably even a universal National Veterinarian Service too.

5. Remove any market from the NHS.

Finally, the ‘Campaign for an NHS Reinstatement Bill 2015’, a proposed bill drafted by health sector academic Alyson Pollock and colleagues to “stop the NHS becoming simply a memory“, provides a legal route-map for legislation to remove all elements of the market in the NHS.

Again, this is a demand absolutely worth supporting on its own merits – competition in health services creates perverse incentives and undermines care, and it’s unclear why there should be social or moral license to make profits from healthcare. However, given that is has also been estimated that the internal market currently diverts £10-20billion from patient care, it’s certainly worth supporting as a means to ensure sufficient well-paid staff.

We need to unite around supporting this comprehensive bill – and avoid being distracted by the plethora of more limited, short-term suggestions for dealing with the fallout from the Health & Social Care Act.

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Donate one hour’s wage per month—or whatever you can afford—today.