In May the long-awaited and greatly feared industrial action by workers in the National Health Service began in South London. Hundreds of ward orderlies, cleaners, catering staff and hospital porters declared a one-day strike. Similar action was taken in Manchester, where three people were arrested after nurses clashed with NUPE pickets outside Oldham and District General Hospital. On May 19 over 600,000 NHS employees took the day off in various parts of the country; and on May 27 and subsequent Thursdays for several weeks two-hour stoppages by selected groups were staged. The action was stepped up in June.
In the months since the beginning of the dispute, hospital waiting lists have soared, admissions have plummeted and tempers have frayed. Rumours are rife that the strikes may be extended to accident and emergency services within the near future.
The aim behind this action is to improve the pay offer for 1982-3 made to nurses, midwives and ancillary staffs by the Department of Health and Social Security. Initially, the offer proposed an increase of 4 per cent on basic income for most ancillary workers, and an average increase of 6.4 per cent for most nursing and midwifery grades, “in recognition of their special skills”, with veiled promises from the Secretary of State for Social Services, Norman Fowler, of future additional payments to nurses “to be drawn from government contingency funds”. Ambulance workers, doctors and dentists and hospital electricians and maintenance staff, whose pay settlements are made separately, were offered average pay rises of 5, 6 and 8 per cent respectively.
In June, the offer to nurses and midwives was increased to 7.5 per cent; ambulance workers and hospital pharmacists were to receive 6.5 per cent and other ancillary workers 6 per cent. These offers were immediately rejected by all except nurses in the Royal College of Nursing, who have now also voted to turn down the offer.
The nurses' and ancillary workers’ claim was. and continues to be, for increases averaging 12 per cent on basic rates, with a reduction in hours of work and more annual leave, and future index-linked pay increases. For the first time, the ten TUC-affiliated unions representing health service workers were to co-ordinate the campaign for these increases through their membership of the TUC’s Health Services Committee. Of the ten, the most important would be the National Union of Public Employees (NUPE) with 300,000 technical, ancillary and nursing staff members in the NHS, the National Association of Local Government Officers (NALGO) with 100,000 NHS members and the Confederation of Health Service Employees (COHSE) with 150,000 members employed mainly in psychiatric and mental subnormality hospitals. The Royal College of Nursing, which is not affiliated to the TUC but has for some years flirted with the idea of limited industrial action by its 195,000 nursing and midwifery members, declared its support for the campaign in June, though without any change in its "no strike” policy. As it represents more nurses than any other union, the RCN’s support was of crucial importance to the success of the campaign.
Official union plans were to reduce the health service to an emergency service within a few weeks, beginning as early as possible after April 26, organisation being initially by local union branches. TUC policy prevented the withdrawal of emergency cover and there has been no change in this at the lime of writing, although spokesmen for individual branches have asserted that the policy is not sacrosanct.
Since the strike began to bite, with a lull at the height of the Falklands escapade (a propitious exercise for the government from more than one point of view), the propaganda war between unions and DHSS has been vigorous and almost unbroken. The government has naturally gone to great lengths to sugar the pill which its workers are expected to swallow, promising “new arrangements" (unspecified) for nurses' and midwives’ pay in the future, based perhaps on a "comparability scale” of the sort mooted on August 18, and talks on new arrangements for ancillary staff. It has also descended to the unusual tactic of publishing blatantly misleading advertisements to NHS staff in national newspapers (of which more below). But the DHSS campaign has concentrated on the message that, owing to the nature of their work, health workers are morally not entitled to strike or take other action which. in the words of Norman Fowler, "must damage patient services and lengthen waiting lists”.
This judgment has posed a considerable dilemma for health service workers. Indeed, it was thought at first that public outrage against the withdrawal of one of the most vital services — outrage assiduously stimulated by the national newspapers — might seriously weaken the strikers' resolve. In fact, unexpected support for the 12 per cent claim received initially from hospital employees in the National Association of Health Authorities of England and Wales, and from doctors of the usually very conservative British Medical Association and in Scotland and Yorkshire, have greatly improved the NHS workers’ public image. (The Lancet, one of the two most respected medical journals, on August 13 1982. actually called for Fowler’s resignation over the matter. But doubts remain among the strikers about the "justice" and efficacy of their action.
The NHS is the largest employer in Britain, with nearly 800,000 workers, and is the tenth largest employer in the world. NHS pay policy, while it is in the end controlled by the government, is influenced, for some groups of workers, by "independent assessors" like the Doctors' and Dentists’ Pay Review Board. (Senior hospital doctors also retain the archaic right to confer “merit awards" upon one another, which may add around £18,000 to an annual income of £21,000 at top consultant rates, without any party to the exercise being accountable to Parliament or the DHSS.) No independent bodies exist to assess the pay of nurses, midwives and the majority of ancillary workers; the nurses’ and midwives' Whitley Councils are merely negotiating forums. Pay increases in the NHS have not been index-linked and are consequently subject to the vicissitudes of government policy, and have tended to be very low.
The 1974-9 Labour government, pledged to rectify this situation, increased NHS wages and salaries in their first year of office. By October 1975 wage rates were approaching those in other industries, but in subsequent years they again fell behind. The present rate for an unskilled male worker in the NHS is about £65 a wreck. After a 12 per cent increase, the basic rate would still be below the net family income at which supplementary benefit becomes payable (currently £82 a week). So a high level of overtime working is necessary for ancillary workers with families — if it can be had. But there are still workers like the laundry attendant interviewed in the Observer of August 15, who earns £71 take-home pay for a 40-hour week plus 18 hours overtime, and who must support families on that. A first year nurse working full-time on the wards receives £63 (gross) a week, after working frequent night shifts and “unsocial hours" as part of the job contract. Board and lodging costs for nurses in hospitals have risen by between 18 and 33 per cent in the past year. According to COHSE, many of these people would be better off on the dole.
On August 6, the DHSS paid about £85.000 for an advertisement in the main national newspapers “to ensure that all NHS staff are aware of the facts". It stated that a ward sister’s “estimated weekly gross average earnings” would be raised by the current pay offer to between £132 and £170 a week. For a staff nurse, the increase would bring in from £107 to £131 a week; for a male ancillary worker (position unspecified) £91-£146 a week, and for a female ancillary worker, £82-£139.
The following day, health workers staged protest strikes in several Scottish hospitals, and COHSE announced that it would report the DHSS to the Advertising Standards Authority. For, as a NUPE official commented, the higher figure mentioned in relation to ancillary staff would apply to no more than 160 top-grade employees, and then only after working up to 20 hours overtime. All the other figures similarly assumed maximum rates of overtime and additional earnings. In fact, most ancillary workers in cleaning, catering and other general service fields are women working part-time, who would be quite unable to earn such amounts.
The DHSS has since admitted that surplus payments were included in its calculations, but insisted they were “statistically valid". Union statistics clearly show that this was not true, whatever “estimated weekly gross average earnings” may be taken to mean. Need we be surprised? Lies and distortions are constantly fed to us to try to persuade people to smoke cigarettes, to insure for private health care, to support the armed forces, so why should the government not use the same tactics in wage-bargaining?
The way in which the health workers’ scruples about striking have been used by successive governments to hold down wages is demonstrated by the recent awards of between 14.3 and 18.6 per cent to top civil servants, the judiciary and senior officers in the armed forces, of 9 per cent to gas workers and 7.5 per cent to public sector manual workers outside the NHS. For the health workers, according to Norman Fowler, 6 per cent should suffice and 12 per cent is "unrealistic" — as if 12 per cent on a pittance made for anything other than a slightly larger pittance.
The question of pay is not the only one to trouble NHS staff. In recent years the loss of small hospitals and the concentration of beds and ancillary services in large district general hospitals, the reduction in patient turnover time and the cut-back in recruitment have greatly increased the work-load on existing staff. In Brent Health District in London, it has been calculated that earlier discharge of patients (five days earlier, in some cases) and a reduction in the time for which a bed is left empty between successive patients have allowed a 25 per cent reduction in beds without affecting waiting lists. As there has been no increase in the number of staff employed in Brent, either in the hospitals or in the community where patients now do most of their convalescing, this has imposed a heavy extra burden on hospital workers. The day-to-day running of a hospital is very labour-intensive; it is difficult to reduce this by introducing machinery. And it must be remembered that 75 per cent of NHS employees are women who, besides their traditionally lower earnings, tend to have pressing commitments and a full job of unpaid work at home.
Women's average earnings now are 37 per cent lower than men’s; 87 per cent of part-time workers and 75 per cent of lower-paid workers are women. Promotion prospects for women in the NHS are poor, and many are forced to take on agency (private) nursing — a notoriously unreliable source of income — in their off- duty hours. On those precious days when they are not working unsocial hours and night shifts for the NHS, they may be doing so for the agency. In truth, they are a peculiarly exploited group of workers.
The long hours are made even more intolerable by the conditions in which they have to be spent. Many hospitals are still situated in old and wholly inappropriate buildings, particularly geriatric, psychiatric and mental subnormality hospitals and small general hospitals in underfinanced and inner city districts. Less than a quarter of existing hospitals have been built since 1948, as against half of the existing schools and houses; 40 per cent of hospitals in England and Wales were built before 1918. and 6.5 per cent before 1850 (In Sickness and in Health — David Owen). The task of caring for sick human beings in such decayed surroundings may be a particularly frustrating and at times a revolting one, and not without risks. Occupational accidents are by no means uncommon: orthopaedic injuries constitute a particularly grave risk for nurses, through proper lifting aids not being installed.
Even in the best-run hospitals workers may be exposed to infections, air-borne drugs, chemical toxins and radiation at a high level. Among the identified effects of this exposure are miscarriages, which occur twice as commonly among women with an occupational risk of inhaling low levels of anaesthetic gases than among others. Occurrence of tuberculosis is five times as common among microbiological laboratory staff in hospitals as in the general population (Hospital Hazards —leaflet produced by the British Society for Social Responsibility in Science, 1981). It is true that the NHS commonly gives its staff priority over other patients when they are in need of medical advice or treatment; but that can hardly be regarded as a perk. People clearly do not join the health service for the sake of their own health.
In an attempt to play down the penalties of employment in the NHS, Fowler referred to it in Parliament as a “service which enjoys secure and growing employment”. This hackneyed argument no longer holds water. It is true that the number of people employed by the service is expected to rise by around 10,000 in 1982-3 but it certainly is not true that individual employees arc secure in their jobs. In such a labour- intensive industry, the tightening of belts demanded by successive governments over the last two decades has meant lay-offs, either through hospital closures or as a result of the policy of reducing staffing levels by “natural wastage”. The resulting increase in work loads for remaining staff has been partially offset, at least in the short term, by the conscription of student nurses and police cadets, who can be made to work hard for little pay, and by steadily increasing numbers of voluntary workers. These people effectively mask the effects of job losses, and even of strikes; the fear that voluntary labour may be used for strikebreaking has often inhibited workers from taking industrial action in the past. This is not to deny the useful work performed by voluntary workers, particularly in geriatric and psychiatric care, and care of the mentally handicapped. But the extent to which voluntary labour has replaced paid labour in hospitals of all kinds puts in doubt both the future standard of care in these hospitals and the good-will extended to voluntary workers by employees whose livelihoods they threaten.
