Why Jeremy Hunt wants to cut our pay further (and what we should do about it)

Read this great analysis from Grumbling Appendix alongside this post for a full overview of what lies behind Jeremy Hunt's decision.

Jeremy Hunt, the Minister for Health, has spoken out against the 1% pay rise proposed by the NHS Pay Review Body for NHS staff, and has proposed that NHS staff should not receive any increase, and instead the money "saved" should be spent on "modernisation" of the existing pay structure.

The withdrawl of the pay rise is getting the most coverage, but the main issue is actually the "modernisation" which the government wants to implement.

We do not receive automatic pay rises

At present NHS employees, like many in the public sector, receive what are called increments. This is an incremental pay increase for every year of service, roughly 3.5% per year which moves you from the bottom of your pay band to the top, over a period of about 10 years. After 10 years service, you've reached the top of your pay band, and further pay increases only come with promotion to a higher band or when the government grants them to the whole NHS. Which they haven't for two years, and don't want to do now.

The different pay bands, and the incremental points within them are shown in this table . The starting salary for a Staff Nurse (Band 5, point 16) is £21,388. After 10 years of service the nurse would have moved up to point 23 and be receiving £27,901. They will receive no further incremental pay rises after this point.

Now the government and the media have been calling increments an automatic pay rise. They are not. Instead they the way NHS has institutionalised new staff earning only 75% of the actual salary their job is worth. The reality is NHS staff are only paid their full salary after 10 years service.

As well, with over half the nursing workforce being over 50, and having been on the job 10 to 20 years, the majority of nurses are at the top of their pay band and no longer receive increments. This is similar across the NHS where the nature of the work and long term permanent employment means most NHS staff have been on the job longer than 10 years.

Don't let anyone tell you we receive an automatic pay rise; its a pay system set up so we're paid less than we should be for the first 10 years on the job. It needs to be “modernised” by raising everyone's pay to the top of their pay band, and instituting an automatic yearly pay rise pegged to inflation. A modern pay system would protect the pay of workers doing the important job of saving lives and keeping people healthy, not seek to underpay them and create iniquitous and divisive pay systems to reduce the cost to the employers.

This is about privatisation and cost cutting

The governments plans are aimed at reducing staff pay, transforming pay rises from a contractual right, to being linked to performance, and reducing the overall wage bill in order to make NHS services cheaper to privatise.

This sort of system would be completely subjective and open to abuse by managers, leading to inequalities developing between staff. Managers, the gatekeepers for any performance related pay system, would be stuck with extra work trying to individually assess our performance. As well it creates opportunities to abuse the system, to reward their favourites, and punish anyone who causes trouble or is outspoken about poor care or privatisation.

Lower staff wages allow private companies to make greater profits off our labour, which is the final goal of the Tories; the transformation of healthcare back into commodity which you have to pay for, and which private companies can make money from.

The money is there for good pay

The government and the media protest that the money is not there for any pay rise. This is at best disingenuous, and really, is a lie. The NHS has been creating underspends of billions of pounds per year due to the government's enforced “efficiency savings” (read: cuts) and the Treasury has been taking these billions and not returning them, despite the government pleding that they were a) not cutting the NHS budget and b) any savings would be reinvested in the NHS.

The NHS also has large cash reserves, recently projected to be almost £4 billion. I'm not advocating NHS reserves be spent on raising staff pay, any pay rises should come from the treasury returning the billions it has stolen from the NHS, or from increasing taxes on the super-wealthy. These figures just show how shallow and false are statements that we don't have the money for good pay.

And its a fact that good pay for staff is necessary to provide good patient care. NHS staff cannot provide good quality care or run a service well if they are worrying how they will pay their rent or mortage, or having to decide whether they will be able to heat their home this winter or feed their kids.

The money is there to do this but those in power are choosing not to spend it, or choosing to spend it on other things, like reducing the deficit. And the reason we have a huge deficit is because the government bailed out the banks to the tune of £850 billion back in 2009. And how have the bankers repaid us for this? Given themselves massive bonuses. And what has the treasury done about this? Gone to court to get the EU to lift its cap on bankers bonuses!

A clearer example of which side the government is on would be harder to find.

Time to organise

The only way we're going to secure better pay is if we organise to fight for it. The government will give us nothing, and is treating the continual inaction of the unions as a greenlight for further and further attacks. Given the unions inability and unwilingness to build a movement to defend the NHS from privatisation, there is an avenue here for reaching out to those who are ambivalent or ignorant of the realities of privatisation, and draw them into a campaign over an issue which clearly affects them. The government has picked a fight with the entire NHS workforce. We should show them we're willing to stand up to them, or they will just come back for more. With 1.3 million of us we have numbers firmly on our side.

And this is directly linked to privatisation. They're trying to cut our pay so they can sell us cheaply to the private sector. Any movement which maintains our terms and conditions creates another obstacle to privatisation of the NHS.

Any campaign needs grass roots organising, the details of which I'll comment on later, but I want to make a couple of points about what we should say.

We need to make a positive demand. Any campaign takes peoples time and energy, and if we strike over this, which will be necessary if we're to get anywhere, it will cost people money too, at a time when everyone is finding it tough. Demanding a 1% rise isn't enough. We've been losing 3-4% of our pay each year to inflation. This needs to be addressed. I'm in favour of asking for an 11% pay rise across the NHS. This is what parliament awarded themselves, if its good enough for them, its good enough for NHS staff.

We need to be clear about where the money should come from. The austerity drive is hitting everyone, and the government is playing divide and rule, playing off private sector against public sector, employed against unemployed, those born here against migrant workers. We can't let ourselves get sucked into these divisive politics.

The money should come through returning the billions the treasury has withdrawn from the NHS budget, or from increasing taxation on the super-rich. They don't need to touch another budget or cut services elsewhere, or victimise any more benefit claimants or migrants, they just need to return the money they stole, or take some more from the super-rich whose wealth has increased by billions in the last several years.

We can take action

Talking about taking action, or a strike will be unsettling for some, who understandably think it puts patients at risk, or who believe their duty to their profession and their patients means they shouldn't strike.

There are many things we can and should do first before striking; actually protesting will help rally public support for us and the NHS. Having a public demonstration on a Saturday puts no patients at risk. The sight of NHS workers marching in the streets will raise the issue and bring pressure to bear which the government won't like.

Having a day for lunch time rallies at hospitals across the country for staff and supporters to attend would help build momentum behind the campaign, and if successful could be repeated weekly to keep up the pressure and make sure the issue isn't lost or sidelined.

There are lots of action we can take in the workplace short of a strike, and would actually make our jobs easier. Refusing to do non-essential paperwork and not comply with management audits will free up our time for patient care, and ruin the targets system which is responsible for so much needless work and stress.

An overtime ban is an option. If they won't pay us anymore, why should we continue doing the unpaid labour which comes out of our own lives? The reality of an overtime ban might focus managements mind on what are the essential and necessary tasks for us to do, rather than continually dumping more work on us and simply telling us to cope.

Ultimately strikes are our most powerful weapon. A strike forces the government to deal with the issue by making it a problem for them in a real material way. At the moment the pay freeze is our problem, we need to make it their problem so they do something about it.

This may sound extreme, but strikes don't endanger patients, anymore than the reduced staffing at weekends or at night shifts. NHS workers stop work in non-essential services, and maintain a weekend or night shift level of service in all others. Non-essential surgery is cancelled, but surgery and other services still run for emergencies. In well run strikes in the health service, health workers have tended to take charge of staffing and which services to run, to ensure they guarantee a safe but minimal service. How safe a strike is, depends on how organised we can become over the weeks and months leading up to the strike.

The other point that needs to be made, is we know appalling conditions exist in the NHS at the moment, and management and the government are not doing anything about them, or are actively the culprit due to implementing the governments cuts, and these situations have nothing to do with strikes.

When hundreds of patients died at Mid Staffordshire hospital, it wasn't because of any strike action. Rather it was because no one took action against the budget cuts imposed by hospital management. 

Its not that there is no risk in strikes in the NHS, but the risk shouldn't be any greater than the risk that exists on a weekend or during a night shift. And if that is tolerable then, it should be tolerable during a strike.

Its because the government fears the prospect of a strike that it attempts to emotionally blackmail health workers into not taking this most effective form of action.