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Bankers need incentives, but so do nurses

Monday 8 March 2021

Boris Johnson must grasp that showering health care professionals with praise is no longer enough. In this, as in other respects, the Conservatives must ditch pre-pandemic thinking


An unusual way to start a column, but here goes: before you read on, take a look at Jonathan Williamson’s Tortoise photo essay from last July, in which, in a series of harrowing pictures taken with a Nikon Z6, the anaesthetist at an unnamed London district general hospital charts the ordeal of his colleague, Nurse Raquel, from her first days bed-ridden by coronavirus, via weeks in intensive care, to the early stages of her recovery.

The portfolio is remarkable for two reasons. First, Williamson’s images are a rare and unsparing insight into a crisis that, because of Covid’s ferocious transmissibility, has mostly unfolded behind closed doors in infernal, sweat-drenched wards.

Second, the pictures are a humbling reminder of the risks to which health care workers have daily exposed themselves in the past year, the sickness which so many have suffered and the tragically high number that have paid with their lives.

It is generally agreed that the figures collated so far by the Office for National Statistics underestimate the full extent of NHS staff mortality from Covid, not least because recording of these figures was patchy in the first phase of the pandemic. But they are the most accurate numbers that we have to date. 

According to the ONS, 414 Covid-related deaths among health care workers were registered in England and Wales between 9 March and 28 December 2020. To put that figure in perspective: it is a little shy of the 456 British troops killed in action in Afghanistan – though that conflict lasted 13 years (2001-14), as opposed to the nine-and-a-half months captured by the ONS data. 

By the end of December, more than twice as many NHS workers had died of Covid than British troops died in the Iraq War between 2003 and 2009 (the number of fallen in that conflict being 179). It may be objected that there is no meaningful comparison between a war with bullets in the Gulf and a struggle with a microscopic pathogen in hospital wards back home. To which many nurses would reply that at least the British soldiers had helmets and kevlar vests to protect them from the enemy rather than – during the early PPE crisis – marigold gloves and bin liners.

It is almost 11 months since the prime minister paid his own heartfelt tribute to the nurses who had helped save his life in St Thomas’ Hospital in Westminster. On 12 April, in a video post, he thanked those “whose care has been so astonishing… I want to thank Po Ling, and Shannon, and Emily, and Angel, and Connie, and Becky, and Rachael, and Nicky and Ann. And I hope they won’t mind if I mention, in particular, two nurses who stood by my bedside for 48 hours when things could have gone either way. They are Jenny from New Zealand – Invercargill on the South Island, to be exact – and Luis from Portugal – near Porto. And the reason, in the end, my body did start to get enough oxygen was because, for every second of the night, they were watching, and they were thinking, and they were caring, and making the interventions I needed.”

Compare and contrast, then, the disclosure last week that Rishi Sunak’s second Budget proposes only a 1 per cent pay rise for nurses – almost certainly a real-terms cut. As it happens, this offer directly contravenes the undertaking enshrined in the NHS Funding Act 2020 that the health service pay increase for 2021/22 would be 2.1 per cent. 

So – in principle at least – the Royal College of Nursing will have the law on its side when the matter is put before the independent pay review bodies. The RCN’s self-evidently unrealistic demand for 12.5 per cent does its case no favours. But who needs favours when your opponent is Nadine Dorries, the health minister?

Interviewed on BBC Breakfast, Dorries – who is to empathy what gravel is to the perfect tiramisu – declared herself “pleasantly surprised” by the news of the proposed 1 per cent. This is nice for her, no doubt, but pretty irrelevant to those nurses who have calculated that their extra take home pay will be only £3.50 per week.

In the past three days, the government has mounted three principal defences of its offer. The first is that it has done its best but simply has no more money. “One of the challenges we’ve faced as a country is in terms of the financial consequences of the pandemic,” Matt Hancock, the health secretary said on Friday. “We’ve proposed what we think is affordable to make sure in the NHS people do get a pay rise.” 

Yesterday, the prime minister said much the same: “What we have done is try to give them as much as we can at the present time.” In the days of relentless Conservative austerity, such a claim might have been bitterly resented – but would, at least, have had the armour plating of consistency.

Not so in the new era of Blue Keynesianism: the government is on course to borrow about £355 billion for the fiscal year April 2020 to April 2021. It has (quite rightly) spent almost £50 billion on the furlough scheme, to stop viable jobs from being lost because of restrictions forced upon the economy by Covid, and expects to spend a further £60 billion on pandemic support in the next financial year. It has allocated more money (£22 billion) to the initially-disastrous Test and Trace scheme than was spent on the Channel Tunnel.

Against this fiscal backdrop, it sounds frankly silly to tell nurses – those at the very frontline of the struggle with the virus – that there is no money. There is, of course, plenty of money. How it will be paid back is another matter. But the chancellor who said a year ago that the NHS would get “whatever it needs” and last week that he would do “whatever it takes” cannot now seek refuge in the old left-my-wallet-at-home trick.

The second argument in favour of the 1 per cent offer is that the private sector employees have had it much worse, with considerably less job and pension security; and that it is unfair to expect the intermittently-employed barman to pay in taxes for the pay rise of the working nurse. 

To which the working nurse might reply, after a 20-hour shift: “tell you what, I’ll swap your furlough sofa for my fetid ward of death and we’ll see which you think is fair then.” Conservatives love claiming that public service workers have a cushy time compared to buccaneering private sector employees, boldly facing the blizzard of market forces. But – in a year in which more nurses have died around the world than perished in the entire First World War – this is probably a good moment to shelve that particular fixation for a bit.

Third, and related to this, ministers have resorted to the most insulting claim of all: namely, that nursing is a quasi-religious calling, rather than a regular profession. “I believe nurses are about more than superficial soundbites,” said Dorries, before delivering two of her own. “I think nurses love their job. They do their job because they love their job.”

I do not doubt that nurses believe profoundly in the work they do, the care they give, the unique ethos of the NHS. But it is the shabbiest sort of logic to argue that such commitment is a form of remuneration in itself. (Indeed, one might point out that the PM himself has reportedly been finding it pretty hard to make ends meet on a public sector employee’s pay.) 

Again, if the Conservatives are serious about meeting the challenges of the 21st Century and about what they call “levelling up”, they are going to have to learn that bankers, tech entrepreneurs and life scientists are not the only people who need “incentives”. 

One in ten nursing posts in this country is still vacant. Retention rates are terrible (28 per cent of nurses and health workers leave the NHS within the first three years of their service). According to one survey in December, 30 per cent said they were planning to leave the profession in the next twelve months, and 39 per cent said they had missed meals to feed their families, often making use of food banks.

The government cannot have it both ways on the NHS in general, and nurses in particular. The eight o’clock Thursday night doorstep applause, the celebration of health service “heroes”, Johnson’s claim that the NHS is the “beating heart of this country”.

All this is fine, but makes no sense – morally or politically – if followed up by a bloodless lesson in the harsh realities of fiscal conservatism. It is like singing the first verse of Jerusalem, and then reading out the terms and conditions of a life insurance policy. 

Never forget that Johnson’s journey to Number Ten, literally and figuratively, started in a bus that promised £350 million extra a week if we left the European Union. Which is to say: he started this. If there are elevated hopes within the NHS of a Brexit dividend – well, what did he expect? Did he think nobody would remember? That’s the trouble with populism: it tends to come back and bite you when things get real.

One wants to say: come on, Boris, read the room. Emotional intelligence is the PPE of modern politics. If you don’t wear it, you risk catching the disease of failure. An Opinium survey for yesterday’s Observer found that 72 per cent of the public – and 58 per cent of Conservative voters – support a more generous pay increase. 

True, the nurses’ unions would be ill-advised to go too far down the road of threatening strikes: a sure way to lose the moral high ground. But they also know that – as long as they do not actually walk out of their wards – the PM will catch much, possibly most, of the flak if such a dispute looks even possible. And this he will want to avoid. 

It was noticeable yesterday that he left the door ever so slightly but clearly ajar to compromise. “The independent pay review body will obviously look at what we’ve proposed and come back,” he said. The government’s recommendations were “part of a process and that is what will be looked at.” This is the language of a man who knows that, sooner or later, he will have to give ground. He’s right, and he should opt for sooner.

The greater question is whether he understands that the furore over nurses’ pay is only one instructive example of the many, greater structural questions that will face him in the autumn and beyond. The way in which we remunerate and retain health professionals in the age of deadly pathogens is just a single piece in the huge mosaic of challenges about to open up before him (and us). The vaccine roll-out will mark not the end of the pandemic but – one hopes – the end of its first, lethal phase, in which, at times, more than a thousand people a day died from the virus.

The next phase will involve a root-and-branch review and reset of how we prepare for future emergencies, how we organise our public services (education as much as health), how we marry economic realism with the growing scale of the 21st century state. 

“War is the locomotive of history,” as Trotsky famously said – a dictum Nye Bevan was supposedly fond of citing as he explained why postwar Britain was finally ready for the NHS. 

This pandemic will be such a locomotive, too. Those who expect a return to business-as-usual after its worst effects subside will find themselves left on the platform. What we shall learn in the next few months is whether Johnson has what it takes to assume control of the train.