LDV editor Charley Hasted writes in a personal capacity on the reasons that dedicated NHS workers have voted to strike and the pressures that have led them to vote for industrial action.
Tuesday brought the news that Unison Members in North East, North West, London, Yorkshire and South West Ambulance Service Trusts have voted for industrial action. They were joined by their colleagues in the GMB Union where members in South West, South East Coast, North West, South Central, North East, East Midlands, West Midlands, Welsh and Yorkshire Ambulance Service Trusts. Unite the Union members in Ambulance trusts have also voted to join Unison, GMB and our colleagues from the RCN in threatening industrial action.
As an Ambulance Dispatcher and Unison member I spent a lot of time thinking about how to vote. I didn’t sign up to stop people getting help when they need it after all. Nor did any of my colleagues. The NHS has spent years being staffed on goodwill and our desire to help people. We’ve put up with underfunding, insulting pay rises and being alternately sainted and damned by the government depending on which way the wind is blowing on any given day.
I’ve watched friends and colleagues throughout the NHS in all sorts of roles and in a number of trusts work themselves to the bone – over the last two years especially. A medical librarian redeployed as a porter during Covid. Three weeks of shifts where everyone saw someone having to leave the room in tears. Reports of new starters in 999 call handling putting their headsets and ID cards on the desk within a week and walking out because they simply couldn’t take anymore, and much more.
I’ve seen my wages have to stretch further and further. This month my energy company put our direct debit up by £60 a month. My food shopping used to be about £70 a week. It’s now rarely less than £110 no matter what I do. My disposable income has all but been disposed of and friends are opting out of the NHS pension because they simply can’t afford the contributions – robbing their futures to pay for the present.
We’ve all seen and heard awful stories of people being forced to wait hours for help to arrive, sometimes too late. We’ll never know how many of those people might have died in any case but they deserved a chance to survive they didn’t get.
It was that which finally persuaded me to vote for Industrial action. Knowing that without better pay, better funding and better conditions patient care is only going to get worse. We will burn out and leave because this kind of stress isn’t sustainable, we will be too hungry or too worried about how to pay the bills to do our best work. We won’t have enough people to take calls, to dispatch ambulances, or to treat patients and the people we want to help will suffer for it.
A lot of trusts are already understaffed because the job we do is not the kind of job that works for anyone. It takes a level of resilience. A lot of people don’t have to deal with the great and small tragedies happening all over the country every day. To be abused day after day and to still be willing to take another call and risk being shouted and sworn at again. Now a lot of people who’ve had that resilience for years are using it up worrying about how to heat their homes, pay the mortgage or rent and feed their family.
Most managers have tried to keep morale up but there is only so much meditation can help and once it’s gone it’s hard to get back and there are plenty of jobs that pay much the same for a lot less stress.
For me that was what it came down to. Like nurses, we are going to get attacked by the government and probably the media. We will get called greedy, grasping, cruel, uncaring, selfish. In truth, the reason thousands of us will be going on strike is the government won’t negotiate is really very simple.
We know that if nothing changes then striking is our best, and maybe only, chance to help people in the long run and that doing nothing is not an option anymore. We will give up pay to try and make sure patients get the help they need when they need it if that’s what it takes because that’s the job we signed up for.
* Charley joined the Lib Dems in 2010, has stood in Local elections in Stoke on Trent and London and was PPC for Eltham in the 2019 General Election and a GLA list candidate in 2021. They have been a Youth Worker, Early Years Teaching Assistant and FE College Governor. They are currently an Emergency Services Worker in London and Chair of LGBT+ Lib Dems.
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27 Comments
I absolutely agree that we’ve reached the point where strikes are in the best interests of the patients and the NHS as a whole as well as essential for the staff themselves.
No-one wanted it to get to this, but it’s been apparent for a long time that things have not been working, and there have been more than enough clues for the powers that be to realise something, or rather lots of things, needed to change.
If strike action isn’t allowed or avoided for longer than would happen in any other profession, then what happens is as described – people leave.
It’s inevitable people will be anxious about the impact on services, and some people will worry that the impact is too great, but it’s not as bad as continuous decline in services as staff reduce their hours or go onto long-term sick leave or just leave forever without adequate replacements.
I hope the government take the strike seriously and we see evidence of a move to truly value those who work in the NHS and for that to be reflected in both pay and conditions.
There’s an independent body that takes everything into account. The government has accepted their recommendations in full. Putin’s war has made us all poorer. We’ll all be worse off if everyone gets inflation busting pay rises.
We’ll all be worse off if the wealthy continue to take more than their fair share.
There, fixed that for you.
It’s not just about salaries Russell. Yes, that has come into play more and more as real terms pay has diminished considerably over the last decade and is really biting with the state of current inflation.
NHS staff aren’t asking for inflation busting pay rises. They are asking, amongst other things, for fair pay rises.
The real, long-term damage to the NHS is the other things. It’s understaffing, so everyone routinely works extra hours. It’s the inability to have a proper lunch break. It’s the anti-social hours, and often the poor scheduling with last minute shift changes. There are problems with keeping up to date with training and CPD and under investment in IT and all of the things responsible employers understand to be essential.
COVID was challenging for everyone, but the already stretched NHS was expected to absorb that and keep on absorbing extra strain without adequate support.
The reality is that staff are leaving the NHS and there are vacancies we cannot fill with no plan to reverse it. A strike is very much the lesser of two evils here.
Solidarity and good luck, Charley! Does your branch have a strike fund I can donate to?
Fiona
If asking for 19% when inflation is 10% then I’m not sure what inflation busting would be.
“We’ll all be worse off if the wealthy continue to take more than their fair share.”
https://www.theguardian.com/news/2022/nov/30/uk-super-rich-less-charitable-than-decade-ago-charity-chief-orlando-fraser
“The head of England’s charity watchdog has berated the super-rich for failing to give enough money to good causes, saying the voluntary sector faces an “existential crisis” amid the social and economic turmoil facing the UK.
The chair of the Charity Commission, Orlando Fraser, said the UK’s top 1% of earners were giving less to charity than they were a decade ago, despite enjoying significant increases in their personal wealth over the same period.
He said: “On the whole, we have a vibrant culture of service and generosity. The sad fact, however, is that some of those in our country with the deepest pockets are not covering themselves with glory in philanthropic terms – and this matters.””
Russell, you are aware that pay for many NHS workers has gone down 20% in real terms in recent years? And I’m sure you are aware that MPs’ pay has gone up faster than inflation in the same time period.
But as I said, it’s not really about salaries (to a point). It’s about all of those other things that have been neglected. Nurses and paramedics aren’t resigning to get better paid jobs, they are resigning because they have reached physical and mental breaking points. Those who want to stick with the job are getting ill and are forced to take time off. Vacancies aren’t filled, in part because there are too many, but there’s been a habit of dragging out the process so there are deliberate breaks in staffing as a means of saving money.
Patients are often in pain and stressed, so less polite than normal is understandable, but patient facing staff have to put up with outright rudeness, sexism, snobbery and racism and have to suck it up day after day.
Then there are the buildings themselves. Often in a poor state of repair, with inadequate work, never mind break facilities. These things take their toll.
Its a choice between pain now or more pain later – the NHS is already understaffed & falling real wages just makes that worse.
That our once much admired NHS could find itself in such dire straights as it has now is deeply troubling, I know we all have faced tremendous pressures over these last years which continue today, but mismanagement, greed and incompetence has plagued the governance of the country for far to long and has given rise to the mess we are witnessing today, no wonder we have a massive mental health problem on top of everything else. We get our priorities so wrong sometimes?
Charley makes a compelling case for strike action, in the “we must do something” spirit, and who can disagree?
Equally lots of other workers in other sectors are in a similar position. Some have strike action open to them realistically as an option and many do not. And I don’t recall strike action ever leading to the pockets of the rich being successfully raided. The danger is that the gains of one group of workers falls as costs on another group who can afford it just as little but don’t have so powerful a lobby. (The left at this point will gaslight them for not being in a union.)
So really what we need, it seems to me, is a political solution. One that gets a fairer deal for workers across the economy and shuts down the loopholes enjoyed by a few, but one that is at the same time about growing the pie rather than fighting over the shrinking slices. I’m not sure that any opposition party has properly articulated anything like that as yet. And the government, well, they’re responsible for this mess.
“To be abused day after day and to still be willing to take another call and risk being shouted and sworn at again.”
I know people feel desperate when contacting the NHS but for all the big challenges facing our health services, for all the big questions (including “where does the money come from for pay rise to keep people working for NHS?”) that need an answer, this point seems the easiest to fix.
The people on the front line aren’t punching bags and aren’t in charge (that would be the politicians and private companies seeking profit over helping people) if you feel service is letting you down. No need to abuse them.
The 1970s saw the same issues with the NHS. Pay freezes, high inflation and catch-up awards only to be quickly eroded by even higher inflation.
The unavoidable truth is that an ageing society is going to have to spend a higher proportion of its income on health services. Ultimately, NHS workers will need to be paid a comparable wage to that of private sector workers and staffed sufficiently to allow some breathing space to cope with extra demands such as seasonal flu. That always has and always will come into conflict with central government budget constraints.
I think it likely that at some point we will need a model in the UK similar to that of Germany funded by insurance rather than general taxation. When it comes to funding, the model for medical insurance in Germany is a multi-payer system, funded by the government, employers, and private individuals. Most residents including foreigners are enrolled in the public healthcare system, but around 10% choose private medical care.
Public healthcare contributions start at 7.3% of your gross salary, which is matched by the employer for a total of almost 15%. Those in employment also automatically pay a compulsory nursing care contribution of around 2.5%, which is intended to cover the cost of care in later life.
“I think it likely that at some point we will need a model in the UK similar to that of Germany funded by insurance rather than general taxation.”
What difference does it make?
We already have a system of National Insurance which everyone agrees is a tax in all but name.
If we involve the private sector we’ll be moving towards a US style system. Do we want our trained doctors to be employed by insurance companies for the purpose of providing some medical justification for the denial of treatment or do we want them employed actually giving it?
So if it does make a difference it won’t be for the better.
@Russell we’ve spent years being taken for granted and years swallowing “there’s not enough money”. The simple fact is there are two options. Pay us enough that old staff will stay on because the money’s too good to walk away from and new people are attracted to the job or people will leave and we won’t be able to keep them.
The private sector and other emergency services pay better. (Paramedics can make up to 60k a year working privately. My direct colleagues at the Met and LFB can very nearly walk in the door there being paid more than I am with 5 years experience and we’re already losing staff to them.)
Unison Scotland are not recommending strike action to their members because their pay offer is nearly a grand a year more than we’ve been offered.
@Joe Otten: strike action with the explicit aim of directly changing government policy as you describe (as opposed to dealing with individual workplace issues in isolation) would of course be illegal in this country, even for workers like nurses who are employed by the government.
I don’t see any problem, even from a Liberal perspective, of workers organising collectively to improve their own conditions whether or not those benefits also get given to a different group of workers and in practice, of course, most union members would very happily see the benefits they win given to all workers (and the effect of resisting a slide to the lowest possible conditions for everyone is valuable regardless)
@Joe this is less ‘we must do something’ and more ‘there isn’t anything left we can do’. We’ve tried asking, pleading, marching. We’ve tried using bonuses, filling the gaps with overtime, retention payments. People are still leaving, industrial action is the only option left.
@cim not yet but if you keep an eye on the LAS Unison social media I’m sure something will go up sooner rather than later.
@Peter Martin
“We already have a system of National Insurance which everyone agrees is a tax in all but name.”
Up to a point – but not everyone pays it or pays as much as they could pay.
Ignoring employer NI contributions – I think that’s a problem for addressing later – if employee-type NI was incorporated into income tax then well-off pensioners would pay some and higher earners would pay more – via their top rate of income tax.
cim, it is the heart of the matter when you say “most union members would very happily see the benefits they win given to all workers”
But this looks very different depending on how those benefits are understood to work. If the benefit in question is higher pay funded by taxes on other workers, then mathematically this is a benefit that disappears altogether when shared with everyone.
There are a few other ways of raising funds, but taxes on workers is generally what happens in practice. If you do raise funds elsewhere, there is still the question of whether this should be used for some workers, all workers, or to improve public services.
None of this is to say the health workers are wrong here; I think they’re probably right, though I have no way of knowing for sure any more than anybody else. But full throated honest support would include a recognition that this means less for everybody else, and some of us are struggling even more than health workers.
The reason inflation is so high is because of Russia’s invasion of Ukraine. Making the rich pay 100% of the cost of Putin’s war seems unrealistic. If society wants a better funded health system and is prepared to pay for it then great. I’m just saying that giving everyone inflation proof pay rises will only prolong inflation which hurts everyone. Someone’s got to pay to help Ukraine defeat Russia.
Actually, the increase in energy costs is down to the increase in the energy required to extract it. So less is available to sell. Way back when you stuck a pipe in the gound and oil came out. Now you may need to frack, build a seagoing platform to drill, or dig up and process tarsands to get your crude.
As to the price of nurses – it’s funny how those who believe in markets seem to think it doesn’t apply to workers. With a shortage of around 10% / 130k positions, and a government that thinks it’s ok to immiserate the workforce and make them poorer over time – it doesn’t make much sense to spend the time and money to train to be a nurse. It’s quite clear that nurses are now being underpaid. Spare us the cod economics about wage push inflation.
Russell 1st Dec ’22 – 5:15pm…..The reason inflation is so high is because of Russia’s invasion of Ukraine……
Don’t forget the ‘B’ word…*
*Brexit has added £210 to food bills for the average UK household, with low-income families hardest hit, according to research from the London School of Economics.
And food production needs energy – to drive the tractors and the combines, to produce the fertiliser, to heat the greenhouses….
All wars see profits for some. Now this includes energy companies which are able to take profits from whichever part of the production – supply chain they want. The reality is there is no reason why people should be starving and cold in this country – and perhaps in any country.
Perhaps our priority should be to plan to do this rather than to enable a few individuals to take control of huge wealth.
The main difference between German health service and our own is that the Germans pay more for theirs. That’s the bit we need to get our heads around. Introducing more private insurance will only add a layer of beaurocracy with extra people needing to be paid and make a profit before the health care workers can get on with their work.
There is room for efficiencies in the NHS, but they will come from proper investment in IT and data management systems, and that includes paying something close to the market rate for the professionals needed to make them work properly.
@expats
I didn’t say it was all Ukraine. 80% according to the ST. Other 20: covid (China’s zero policy impact on supply chains) and Brexit. Most of brexit’s impact was in June 2016 (10% fx) and 2020 (when we left the EU). Of course the sterling hit in 2016 still impacts the cost of imported goods as the pound hasn’t recovered but it doesn’t contribute to inflation which is an annual figure.
Germany reportedly spends around 11% of GDP compared to about 10% for the UK on health care, a significant difference.
The German health care system is more or less in between the British and American systems. It is much more market-driven than the NHS. Where the UK has one insurer, the NHS, Germany has dozens of non-profit insurers as well as for-profit private insurers. Most German hospitals and clinics are also independent of the government; they are owned and operated by charities, churches, local governments, and a few private companies. Doctors generally are either sole proprietors or in cooperative clinics.
Everyone in Germany is required to buy health insurance from one of the insurance providers, and people can choose which one. By far most choose one of the statutory insurers or non-profit insurers, but some opt into the private system. The latter operates more like UK private health insurance. No one can be denied coverage for health reasons, and premiums are set based on income, not risk.
German health care does appear to be more bureaucratic and has more up-front costs like small co-payments, but it does seem to work quite well for the German population without the perpetual funding crises that have bedeviled the NHS since its creation.
Efficiencies like investment in IT and data management systems are a lot easier to deliver when you have autonomous regional health services run by local authorities with independent insurance funding rather than monolithic central government departments subject to central budget constraints.