Will we ever confront this sacred cow?

Published by The i paper (8th March, 2021)

Could there be a more righteous battle? On one side stands the nation’s nurses, the best-loved workforce even before becoming heroes of the pandemic, pleading for a decent pay rise. Union leaders warn thousands may quit after the ‘insulting’ one per cent offer for staff in England, exhausted medics weep as they bemoan feeling undervalued on radio shows, panicking Tories join the clamour for “justice”. Set against them is Boris Johnson, so ready to clap for carers who saved his life, so reluctant to support this cause. Meanwhile he is spending a reported £200,000 doing up his Downing Street flat while whining pathetically about being skint on his £157,372 prime ministerial salary despite perks such as free accommodation and chauffeur-driven car.

It is not a great look for a populist politician. A weekend poll found overwhelming support for a more generous deal, even among Tory voters, while the floundering Labour party has leapt with relief on this bandwagon. Anneliese Dodds, the shadow chancellor, blasted the flint-hearted Government for turning its back on “our NHS heroes”, arguing that newly qualified nurses, who earn £24,907 a year, would be worse off in real terms. Former Conservative health minister Dan Poulter said that from a moral perspective this is the wrong time to be applying restraint. One nurse told the BBC it seemed the Government was happy to have them risk their lives in the pandemic but not to pay them properly.

Johnson is desperate to be liked, so prepare for another of his trademark U-turns. His case is not helped when his party has ditched fiscal rectitude while doling out dodgy cash to their own constituencies and handing hefty state contracts to pals. Regardless, this dispute should give pause for deeper thought. Clearly nurses, like so many NHS staff, have been superb over recent months. Few would begrudge them a better deal. Yet things are never quite as simple as they seem with this sector, which is why placing even these dedicated public servants on a pedestal in our sanctified system is storing up future problems.

Nurses are the advance force in a wider struggle on NHS pay after the Government backed a similar pay rise across staff. Other public sector workers had pay frozen while parts of the private sector remain in pandemic-induced meltdown. Yet why does a top-earning consultant far from the virus battle zone, let alone a well-paid health manager or spin doctor, merit a fiscal bump from taxpayers when lower-paid staff on other frontlines get nothing? Many workers elsewhere can only look with envy at their job security and fat pensions.

Bear in mind one big problem is medical staff quitting after hitting the £1,073,100 pension allowance limit, with their leaders warning failure to raise this cap will have “catastrophic” consequences on numbers. Union bosses threatening strikes fail to mention that nurses’ pay has risen recently, with those at bottom seeing a 22 per cent jump over the past three years after the setbacks of austerity. The Centre for Policy Studies showed that even during that grim period, the pay ‘freeze’ delivered a rise in NHS salaries averaging 2.7 per cent a year due to systemic quirks.

Others argue the issue of staff shortages due to constraints on training is a more pressing problem, since it leads to waste on recruitment and reliance on costly agency staff, including medics in their fifties and sixties returning after collecting those chunky pensions. Also, some past injections of cash have been soaked up by better-paid staff and reduced productivity rather than benefited  patients.

The Government has, in the words of one well-placed source, been ‘clumsy and silly’ with a tight-fisted offer that pleases no-one. It should have stood firm – arguing that for all the appreciation of doctors and nurses during the pandemic, the entire country must share the economic pain – or stuck to the 2.1 per cent rise anticipated under its long-term funding plan. Instead, this derisory offer, combined with chilling silence over the collapsing social care system, shows ministers fail to understand the tricky reality of health politics, let alone the true lessons of this crisis. They tried childishly to have their cake and eat it.

Now consider this: the salary bill for the NHS, the fifth-biggest employer on the planet, is above £64bn. Since clinics and hospitals rely on human beings, wages account for about half total cost. Yet it is always hungry for more, with surging demand in an ageing society and constant scientific advance. Westminster celebrated the NHS’s 70th birthday three years ago by chucking in an extra £33.9bn by 2024.  Yet health was already accounting for one pound in every four spent by the state as its largest single item of expenditure – soaking up more than double its share of public spending at the turn of the century and nearly four times more than when I was born in the 1960s. At some point, this is unsustainable.

Britain’s collective worship of the NHS has covered up multiple failures on safety, patient outcomes and less glamorous areas such as mental health. Yet such is the sanctification, no-one dares ask how we are going to keep on paying for its upkeep. The cost of this denial is seen elsewhere with an ever-shrinking army, inadequate public housing stock and, most especially, a crippled social care sector that suffered so terribly during both austerity and the pandemic.

The Government, having lied about having a plan to fix the care crisis, just kicked this issue into the long-grass again by claiming to be seeking cross-party consensus. Yet where is the outcry, let alone the fury over low-paid staff with insecure jobs and poor pensions?  It is always easier to focus on “angels” than to confront the most devilish problems in society.

Categorised in: Health, home page, Public policy