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Unfinished Business

June 10, 2014

Hands up if you remember the 1988 nursing strike! I certainly do. I was working at Nether Edge Hospital in Sheffield, a small but militant former workhouse, much of which has now been buried beneath a housing development. Weather-wise it wasn’t the best day, but we had cloaks to keep us warm, the union stood us breakfast and it was South Yorkshire in the 1980s –  everyone loved a striker. Tooting their support, lots of passing motorists kept up our morale.


The strike was over pay. Trawling the web for articles about it, I came across a BBC ‘on this day’ piece featuring 3rd February 1988. It reported that ‘Department of Health plans to offer nurses a 3% pay rise and end national wage increases in favour of regional variations were leaked yesterday…The general secretary of [the National Union of Public Employees] – which is leading the current protest – Rodney Bickerstaffe, described the 3% as “a pathetic and bitter blow to other health workers already totally demoralised and dejected.”‘. If he thought there was a good case for strike action then, I wonder what he thinks about the situation now.


Because methods of calculating inflation have varied over the years, it’s difficult to be sure what the actual UK rate was in 1988. Estimates put it at 2.6% in February, rising to 3% in March. So even though it climbed quite sharply later in the year, Health Minister Tony Newton was not far off the mark when he remarked that “Wage rises of just under 3% would compensate the average earner for price rises over the last 12 months”. What he was conveniently forgetting, of course, were the many earlier years over which nurses’ wages had been allowed to fall behind.


In contrast, the comparable inflation rate today is lower – 1.8% for April 2014 – but the government’s pay offer to nurses – 1% for those not receiving performance-related annual increments – is below even that; in effect, it’s a pay cut. As in 1988 though, this offer comes on top of several previous years of pay-containment. No wonder that rumbles about strike ballots are once again being heard at union conferences. But would a strike achieve what it set out to?


The problem with striking is that without an exceptionally clear game-plan, the results it delivers can be unpredictable. This was very apparent in the outcome of the 1988 action. Included with the BBC article is an ‘in context’ sidebar giving some ‘what happened next’ type information. It cheerfully states that ‘a new clinical grading structure came into force and average pay increases of 15% – more for specialists – were recommended by the pay review body when it reported in April. The government accepted the recommendations’. I remember it well, and for those of us who were fairly graded, it did seem like an enormous rise, particularly when the backdated element of it arrived all together in a single massive pay packet. But it wasn’t like that for everyone.


The government cash-limited the re-grading exercise, meaning that there were insufficient funds to place all nurses on the pay point they deserved. The result was that a year after the award had been granted, thousands of nurses were still mired in disputes about what their grade should be. In his address to the COHSE conference of 1989, Colin Robinson, union president, told delegates that health unions had been involved in an ‘epic struggle’ with the government to ensure all members received their proper financial rewards. The same year, the government published its Working for Patients white paper which introduced the concept of the ‘NHS internal market’. It’s likely they hoped it would also serve as the catalyst for their new era of locally-agreed NHS pay structures.


What is really surprising, when we return to this subject now, is just how little things have moved on. Unsocial hours premia remain intact. The old grading structure has been replaced by new pay bands, but each one still contains within  it the same annual increment points. Moves make progression along these dependent on performance – rather than automatic, as they were before – have met with only partial success. Meanwhile, local pay deals never materialised; pay is still negotiated nationally and paid at the same basic rates throughout the NHS. The government must get reform in order to push ahead with the changes mapped out by the Health and Social Care Act. Nurses badly want a pay rise worthy of the name. Who holds the trump card?


At first glance, it might seem to be nurses. We certainly have right on our side: after years of pay-restraint and real-terms cuts, our pay has fallen way behind. And unlike in 1988, when RCN members still had to abide by their organisation’s ‘no-strike’ policy, there is now the potential for greater unity amongst nurses. Against that, the government may have calculated that following recent NHS scandals and the avalanche of negative media coverage, nurses no longer command the high levels of public sympathy they once did. The potential on-the-day effects are also unclear: bank and agency services are more widespread and organised today than they were in 1988*, and astute Trusts could make use of them to plug gaps – although obviously, this is an option that comes with a price-tag.


Ultimately, the success or failure of striking depends on the negotiating positions of the two sides – and how much each of them is prepared to concede in order to achieve the goal it really wants. The government’s negotiating position is dictated by larger ideology. In order to make NHS contracts attractive to private sector, it needs as a minimum to jettison both incremental pay (while maintaining an element of performance-related pay), and unsocial hours enhancements.


The unions’ position appears to be to play for time: keep up the pressure – including the threat of strikes – until next year, in the hope that a change of government will bring a change of attitude. But in the light of recent local and European election results – not to mention the aftermath of the Scottish referendum, which could ultimately deprive the Westminster parliament of whole swathes of Labour votes on English matters – this looks like a decidedly risky plan. And it does nothing to assuage the pain nurses will be feeling in the eleven months still remaining until the election.


For the Tories, nurses’ pay is unfinished business. The decision to reject the recommendations of the NHS Pay Review Body for 2014-15 was just the latest and most outrageous chapter in a long-term game-plan of demoralisation that practically amounts to ‘starving nurses into submission’. It’s a strategy for which the financial crisis merely provided a convenient cover. Recent activity on staffing could be seen in the same context: the staff side’s ability to improve their PR standing in an upcoming dispute by including demands on – for example – minimum staffing levels, has been effectively cut off.


So against this background, the argument for or against industrial action boils down to this: can an across-the-board pay rise that is larger than the one originally on offer be achieved by striking? I think the answer is no. And here’s why: there is a chronic shortage of nurses, which is likely to persist for a years to come. Once the government has secured the concessions it wants, and paved the way for local pay deals, it will tell nurses that the market will decide their worth. And further more (it will add) if the laws of supply and demand operate as they are supposed to in a free market economy, wages will be driven up. Whether nurses will indeed benefit from this remains to be be seen – but it’s not really the point. So by all means go on strike. Show you’re not going to take it lying down. But the battle here is for the triumph of market ideology in health care; tales of individual hardship are merely collateral damage.

*It is currently unlawful for agencies to knowingly supply staff to cover workers who are on strike. I think the operative word there is ‘knowingly’.


For the BBC ‘On this day’ piece, see:

For a recent Nursing Times article about the government’s position on nurses’ pay, see:

For a more in-depth analysis of why the government is desperate for reform of nurses’ pay, see my earlier article:

The Radical Nurses Archive also contains some interesting reaction from the late 1980s, especially

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