In January 1988 a national survey carried out by the Association of Community Health Councils showed that half of the hospitals in England and Wales were closing beds, wards or specialised units. Their conclusion that parts of the NHS were on the brink of collapse and the impending bankruptcy of the Manchester Royal Infirmary forced the government to release extra funds to prevent serious financial problems among the other health authorities.
Also during January 1988 the government declared its intention to reduce nurses’ enhanced rates for unsocial hours, weekends, public holidays and night shifts despite the fact that they were already inferior to any other British industry. The nurses were not prepared to accept a trade off of their shift payments for vague promises that a new regrading structure would restore their pay, and a strike by 38 night staff at North Manchester General Hospital on 7 January 1988 forced the government to back down.
With this background to the nurses' regrading structure it was obvious that the government's announcement on 21 April awarding nurses a pay rise averaging 15.3 per cent had to have a catch in it. Most nurses had to wait until late October or early November to find out what their new grades were and, as expected, the vast majority received pay increases of considerably less than the figure announced.
The new grades, besides cheating nurses by paying most of them much smaller rises than the much-publicised “average" awards, also attempted to "play off” nurses against each other by awarding fairly big rises to a small minority of them. The majority of nursing auxiliaries in general hospitals and nursing assistants in psychiatric hospitals have been allocated the lowest possible grade even though they often have to work without supervision. Probably the most discontent has resulted from the regrading of staff nurses and ward sisters. Nurses working on the same wards have been graded in an arbitrary manner, with some being graded differently for doing the same work.
For nurses on the lowest grades, nursing auxiliaries and staff nurses have been awarded just over six per cent and ward sisters 4.2. In keeping with the governments attempt to reduce shift payments, thwarted by the 1988 Manchester nurses' strike, the vast majority of night nurses have been given the lowest grades possible which, with shift payments having been pegged at the 1984 rates of pay, gives rises of under five per cent in the pay packets of these workers.
Enrolled nurses have tended to fare better but a number of general hospitals have stopped employing them, in anticipation of single certification for all trained nurses proposed in changes in nurse training for the future. Many enrolled nurses have, as a result of this policy, been forced to work as bank nurses on a casual basis to cover periods of staff shortages. These nurses receive neither sick pay nor holiday pay and have been graded lower than enrolled nurses in regular employment, cheapening their labour power still further. Student nurses have received around a seven per cent increase but have not been regraded because they are in training and their status is, therefore, temporary.
But even with trainee nurses excluded from regrading, most health authorities are faced with having to handle over a thousand appeals each. Clearly, the fact that a substantial majority of nurses up and down the country have appealed against their grades contradicts statements by the government and regional health authorities that nurses have had good rises. In addition, many experienced nurses feel that they have been downgraded and this has led to as much discontent as the paucity of the pay rise.
Another problem with the nurses' regrading is that it varies from hospital to hospital and this could lead to movement of staff in the future and artificial shortages in some areas. And the fact that there are now effectively two grades each for staff nurses and ward sisters could lead to a shortage of suitable applicants for nurse tutor training in three or four years time, because of the need to have had experience as a ward sister before applying for training.
The government has gambled that its strategy of dividing the nurses will succeed, for it must be aware that a 50 day strike by the Royal Australian Nursing Federation in the Southern State of Victoria affected over 40 hospitals and led to the regrading being abandoned. However, the British government knows that there are four unions involved — NUPE. COHSE. RCN and. to a lesser extent, Nalgo — and that the largest union, the Royal College of Nursing, is opposed to strike action.
But it is just possible that the RCN's stance on industrial action could change in the future because some of its members are being lost to more militant unions since it advised its members not to take part even in the limited industrial action of "working to grade". In the past the RCN has tended to gain members when industrial action has occurred and this reversal of the usual trend demonstrates how angry nurses are and could lead to a reconsideration of industrial strategy.
Nurses' strikes have occurred at some hospitals and "working to grade" at others, but the industrial action has been patchy with individuals torn between anger and disappointment at the way they have been treated and their sense of “vocation". Nurses are beginning to realise, however, that they are not going to get a “fair deal" from the government, although they have so far failed to understand that the health service is most useful to capitalism during periods of economic expansion, when a healthy workforce is needed. In any event, all centrally funded welfare services represent costs against production and the state will, therefore, try to reduce costs as much as possible.
But it is not just nurses’ pay which looks likely to be a problem in the future: ancillary staff, whose already low pay and poor working conditions had been adversely affected by increasing casualisation and privatisation of domestic and laundry services in a number of hospitals, are likely to rebel against conditions. A further problem is that the wages of skilled paramedical staff are now “embarrassingly low" according to the National Association of Health Authorities, and managers are "having to introduce illegal' grades and fabricated job descriptions in order to retain staff” (The Independent, 2 December). Medical secretaries, accountants, operating theatre technicians and computer staff are receiving well below industrial rates and “Experienced hospital pharmacists can be paid £5,000 to £7,000 a year less than newly-qualified entrants to High Street pharmacies. "(Ibid).
Without these workers the National Health Service would struggle to maintain essential services and either a strike or defections to industry could cause severe difficulties. The government could even become a victim of its own propaganda, for if people believe that the nurses have had good pay rises then ancillary staff are going to be more dissatisfied over their own poor pay rates.
It remains to be seen whether the government has gambled correctly in trying to divide nurses and, by deceiving the public, deprive them of support. It also remains to be seen whether the increasing militancy among nurses during the last twelve months will gather momentum or, as the health authorities hope, the long drawn out appeals procedures over the gradings will blunt industrial action. But the nurses need to keep up the pressure on their health authorities and the government if they are to avoid being cheated yet again.
Carl Pinel
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