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1% Is Not Enough – It’s Time for NHS Pay Justice

After clapping for NHS staff and calling them heroes, the government is proposing to give nurses a pay increase of just £3.50 per week – it's time for a real reward that would end hardship in our health service.

On 17 March 2020, Prime Minister Boris Johnson stood in front of the nation and declared: ‘We must act like any wartime government.’ It was the latest in a trend of wartime rhetoric that presented Covid-19 as the invisible enemy, and health and care settings as the frontline.

The comparison came with historical connotations, in particular it suggested the need to respond to Covid-19 with welfare and social security. The First World War had ‘homes fit for heroes.’ The Second World War had ‘from cradle from grave.’ If Covid-19 is an event of this genre – and its human cost and social disruption justify the comparison – then it demands similar ambition.

Nearly a year later, however, there are indications that this ambition will not be forthcoming. Alarmingly, a 4 March document issued by the Department of Health and Social Care announced: ‘In settling the… budget, the government assumed a headline pay aware of one percent for NHS staff. Anything higher would require reprioritisation.’ We’re not even out of the pandemic, and the government is proposing a pay rise worth just £3.50 per week for an experienced nurse.

A recommendation is not policy. But if that ‘assumed headline pay award’ is made official in a few weeks’ time – when a final decision is made, as now seems very likely – it will represent a major abdication of their duty to those who did so much for us this last year. More than that, it would be a move that risks the health of the nation and has little economic merit.

A Poor Reward

The best reason for a substantial pay rise for health and care staff is simple social justice. There is a duty to recognise not just what they went through during the last twelve months, but also during the austerity decade.

During Covid-19, health and care workers have braved considerable risk to their health and safety. According to the most recent official statistics, nurses, nursing auxiliaries and nursing assistants all had significantly higher rates of death involving Covid-19 compared to the general population.

The extra risk is partly down to the nature of their work, but also big problems with the government’s response. Overwhelmingly, healthcare professionals felt the government failed to keep them safe during the pandemic. One study in April 2020, covering the first Covid-19 peak, showed that three in four healthcare workers felt the government had not done enough to protect and test healthcare workers.

The impacts were not just limited to physical health, either. After just the first wave of Covid, most healthcare workers were experiencing much worse mental health outcomes. Half felt it was impossible to protect their family and friends. One in four felt their finances or financial security had got worse. Many were struggling with childcare and accommodation. And it has now been two waves and a year of severe pressure.

This all came on the back of a decade of hostile government policy. Most notably, between 2012 and 2017, was the government public sector pay freeze. The result of this decision was a large real term pay cut.

Even now, once accounting for inflation, pay remains around 10 percent below 2010 levels, a statistic that has real consequences. According to recent research, two in three nurses are working overtime to pay bills; 30 percent rely on borrowed money to pay for essentials; four in ten have skipped meals to feed their families; and reports of nurses using food banks are anything but uncommon.

To pay homage to the bravery and sacrifice of the health and care frontline, the best many could do during lockdown was ‘clap for carers’ at 8 o’clock on a Thursday. But applause does not pay the bills.

Through this scheduled NHS pay negotiation process, the government has the power to make sure the lights stay on, food is on the table and financial security is assured for all health and care workers. But a one percent pay rise would not even get close.

A Path to Poor Health

If the government does not commit to a substantial pay award, then there will be a health price to pay. Covid-19 has created a huge backlog – electives, delayed cancer care, worse cases of heart disease and dementia. We can only get through that with a strong workforce.

Sadly, a decade of austerity has left us with anything but. There are significant vacancies in almost every profession – tens of thousands of nurses, thousands of doctors, and thousands of midwives. The remaining workers are subject to overwork as a consequence, leading to burnout. In 2019, the number of NHS workers who reporting feeling ill due to stress broke the half a million mark.

The burn-out means more workers leave, putting more pressure of those who remain. It’s the very definition of a vicious cycle.

The experience of Covid-19 has pushed them further. Estimates suggest around one in five could leave the NHS after the pandemic – the equivalent of 300,000 people. Who could blame them?

But if they do leave, it will be a huge problem when it comes to recovering from Covid-19 – let alone, delivering on government rhetoric around ‘build back better’. Better reward and recognition is a key way to drive recruitment and retention of a sustainable workforce.

Poor Economic Sense

The justification for a low pay award would be the state of public finances. As per the trajectory set by the budget, the government are looking at how they can reign in public spending and levels of debt.

Even with these objectives, then there is still little sense in freezing public pay. There is every indication that the government would recover the vast majority of money spent delivering a decent pay rise.

According to the London Economics consultancy, if the government were to deliver a 5 percent or a 10 percent pay rise, they would recoup 81 percent of the total costs.

This would flow back to the Chancellor in a number of ways. Most immediately, there would be income tax receipts. There would be less government write-offs of student loans. There would be increased retention of staff, itself a cost saving.

Most importantly, given the bleak economic weather, there would be more tax receipts from consumption as healthcare staff spend their hard-earned money.

On paper, a 10 percent pay rise would cost £3.4 billion. In reality, these wider benefits take the bill down to just £660 million. That’s a big discount on investment in people, that would in turn benefit the places and economies they live in.

Do Right by Our NHS Workers

Covid-19 is a virus that reminds us that we are reliant upon and responsible for one another. It has reminded us of the importance of society – people following the rules, volunteering, setting up mutual aid and looking after neighbours.

This idea of mutual reliance is one that should define the government’s decision on pay. We are reliant on health and care workers.

They are our safety net – whether during a pandemic, or not; whether we are sick with Covid-19, or something out. But they cannot do right by us, unless we do right by them. That means giving them the pay and financial security to do their job and to keep us safe.

After World War One, there was homes fit for heroes. Now we need care fit for carers, built on a foundation of a fair pay settlement.