MediCave

There was further NHS strike action this week. You may or may not have noticed. This is because health workers set out to make a point, withdraw their labour but not to cause harm to patients.

I think most of us would agree that we would rather see our health workers working and not picketing the front of our local hospital. The thing is, is that most of them would rather be doing their jobs than stood out front in the cold. Some of them have had to take difficult decisions to forgo a day's wage to support the strike action. Can we assume, therefore, that they have done it for a good reason?

The global financial cliché has put ever increasing pressure on our publicly funded services. This has translated into a pay freeze for many NHS workers over the past four years, though the government deny it.

Most jobs within the NHS follow the Agenda For Change payscale. A given job will have a payband and within that there will be several incremental pay points. For example, a newly qualified nurse might be a band 5. If they meet their targets at appraisal, after a year they will move up to the next pay point within that band. If they are promoted to a deputy ward manager role, they will move up to the next band, where they will start again at the first pay point within that band.

The government has accepted a 1% pay rise, but only for those who are not entitled to an incremental rise (moving up to the next pay point after a year).

So a nurse/physiotherapist/occupational therapist/radiographer etc may have to work for several years and move up to the top of their pay scale before they are entitled to this 1% rise. Yes, they would get their annual increment, but because of inflation, each pay point is worth less and less every year.

This means that as a group, healthcare workers are earning less than their predecessors did 5 years ago.

I think that pay needs to at least match inflation and that is before incremental increases that recognise the value of another year's experience and training.

If pay falls in real terms (as it has) then morale follows it.

You cannot separate health from wealth and many of our lower paid colleagues are really struggling to cope. There are some who feel they cannot support strike action because they cannot afford to lose 1 day's pay. Making a less-wealthy group of society even less wealthy will cause more social and health problems in the future. It will also affect recruitment.

How many radiographers, physios and OTs will be advising their kids to follow them into their professions when it's clear that the government doesn't value them?

In places where there is a reasonable amount of private sector activity, you will lose valuable staff to other companies. In places where there is not, such as many northern towns and cities, then people rely heavily on public sector employment as their only chance of a decent career. I also think it's naïve to blame managers for everything (as the UKIP representative did on Question Time when I asked about this) as healthcare is incredibly complex and someone needs to steer the ship.

Pay is not the only thing getting worse. Look at page 5 of this document for a comparison of pension schemes and you will see that it is moving towards career average (rather than final salary), with later retirement ages and reduced lump-sum benefits. Many workers, such as doctors, will have to make higher pension contributions. This led to the BMA taking strike action in 2012 for the first time since 1975.

Financially speaking, people don't have much sympathy with doctors and I can understand this. We are a relatively well remunerated profession. Junior doctors, however, end up worse-off year on year. Doctors' pay is calculated on a different pay scale. The pay has been frozen in a similar way to that of other healthcare workers. The only 'pay rise' they have received is when they move up from one year to the next having gained extra skills and taking on extra responsibility. If you want to see how the Daily Mail reported this please read here. Please also read the comments below to see some angry doctors' responses. The pay increases are, in effect, for a promotion from one grade to the next. When you get there, you get paid the same as what you would have received 4 years ago. With inflation, this amounts to a pay cut.

This is not the only financial hit junior doctors have taken in recent years. Tuition fee increases mean student debt for the 5 or 6 years of medical school has exploded. Up to 2007, hospitals had a duty to provide accommodation for first-year doctors. Now they don't. The loss of this benefit-in-kind amounts to a pay cut. The European Working Time Directive has reduced hours, but also reduced pay-banding for junior doctors. The NHS pension scheme is worse with each iteration, as discussed above.

Hunt will say that if we pay staff, we will have to cut jobs. This is a fallacy. The fact is, is that the NHS needs more money putting in. I think this needs to come from HMRC getting all the tax it's owed from the wealthy and from big businesses. I also think we need a more progressive tax system, with a tax on wealth, so that those who have the most, contribute more to our society and the country from which they benefit.

We spend less on healthcare than most comparable countries. We have an increasing inequality within our society. Pay cuts to healthcare workers affect many of the poorest in our society and will create problems for the future. I think we have to find the money to pay staff what they deserve.

MediCave

Friday 28 November 2014

Podcast Episode 5 - NHS staff strikes, ebola, space, infected chickens.

Strike.

Thursday 6 November 2014

Dog News

Tuesday 4 November 2014

Podcast Episode 4 - Drugs, boozy calories, BBC Question Time