Tracey never expected the work she does to be easy, but she did expect to be adequately remunerated for it.
A healthcare assistant at Arrowe Park Hospital in the Wirral, Tracey does permanent nights on the ward, supporting vulnerable patients suffering severe mental health problems, dementia, Alzheimer’s and alcohol and drug withdrawal symptoms. She’s a band two healthcare worker, required only to undertake personal care responsibilities, such as supporting patients with toileting, bathing and feeding, but for the past ten years, she’s been regularly and routinely doing clinical duties such as taking and monitoring blood; carrying out ECG tests; venipuncture, complex dressings; and recording patient observations. In fact, a recent Unison survey of more than 430 healthcare assistants at the Wirral NHS Trust found most healthcare assistants are doing duties above their pay grade.
Over the years, as roles have evolved and expanded, healthcare assistants have taken on more clinical responsibilities but without the pay and recognition to match. Healthcare assistants like Tracey are some of the lowest-paid workers in the NHS. At the top of the band two pay scale, she earns just £10.90 an hour. Other colleagues fare far worse. ‘I know a girl who’s worked at the trust for 20-odd years as bank staff [employed on temporary contracts]. She joined our ward as permanent staff about 12 months ago. Even though she’s worked here for two decades, she’s come in at the bottom of band two, which is disgusting. She’s on minimum wage.’
Tracey’s disgust is made worse by the horrible conditions on the ward—conditions so bad that her safety is at risk on every single shift she works. ‘I love my job, but sometimes I hate working in there. I absolutely hate it,’ she exclaims with an air of resignation. ‘I’ve had black eyes, bruised jaws, and cut hands after being attacked by patients. The majority of them have dementia, and they are scared. I get that. But we have people with alcohol and drug withdrawal who swear at you and abuse you. I was threatened to be put through a window a couple of weeks ago,’ she tells Tribune. ‘Honestly, it’s awful. I wouldn’t recommend anyone to go and work there. I really wouldn’t.’
Many patients require attentive care and one-to-one support, but this has become virtually impossible as healthcare assistants are now responsible for ten patients each. ‘We are dealing with more and more patients, and they are getting neglected. That’s what really winds me up. They don’t get the care they should be getting. It’s dangerous. 90% of our patients are fall risks. We can’t be in five or six places at the same time.’
On her night shifts, Tracey is not just responsible for looking after patients but cleaning, decontaminating and sterilising the entire ward. These abundant tasks are listed and ticked off a board, with a sister coming in the morning to check. ‘It’s just downright disheartening. You might have had the night from hell, been short-staffed, had confused patients and security on the ward, and you’re never asked in the morning, “How was your night?” or “How are the patients?”, it’s a case of was the cleaning done, was this done, was that done?’
Nikki has worked as a healthcare assistant for over 28 years. Every morning, she goes into a surgical theatre at Clatterbridge Hospital, setting it up to be ready in time for surgery to take place. ‘I have to get all the equipment ready, every single thing, before the surgeon comes in for a huddle with the team, which can be very stressful,’ she tells Tribune. ‘We are expected to look after the patient in the anaesthetic room with an anaesthetist even though we’re not trained. We’re expected to handle all of these specimens without guidance, and then we’re we are expected to train staff members when they join the trust. We’re not recognised in any way, shape or form for that.’
Breaks are hard to come by even though healthcare assistants are entitled to them. ‘We don’t always get our lunch. Sometimes it’s a quick fifteen minutes in the tea room, if you’re quick, while the surgeon goes to see the next patient.’
‘It’s tiring and it’s hard,’ says Nikki. ‘It’s hard on your body. It’s hard on your mental health. It’s hard on everything. But you don’t get a break from that. You’re just expected to get on with your job.’
According to national NHS job profiles, all these duties should be paid at least band three—meaning healthcare assistants have been underpaid by thousands of pounds over the years. It’s why workers like Tracey and Nikki are campaigning to be re-banded, rewarded and respected for the work they’ve put in for patients.
Above and Beyond
Last month, over 400 healthcare assistants at the Wirral University Teaching Hospital Trust signed a collective grievance. A group of over eighty presented the grievance in person to trust Chief Executive Janelle Holmes and a group of senior executives before the trust’s Board meeting. And 150 healthcare assistants individually wrote to the chief nurse calling for a clear commitment to back-pay and raising concerns about the impact on patient care if they are not rewarded for undertaking clinical duties.
Instead of changing banding to reflect the level of work being done, healthcare assistants were told not to undertake the additional tasks they’d been doing for several years. This approach has only created greater tension on the ward as burnt-out nurses struggling with understaffing have even less support.
‘Because we’ve downed tools, there’s an atmosphere. Nurses aren’t happy that we won’t do these additional tasks,’ explains Tracey. ‘We’re going to have more nurses leaving. They’re already struggling as it is.’
The NHS relies on the goodwill of staff who often work above their contracted hours and expected responsibilities in the interest of public safety. Often, when workers work to rule as a form of industrial action, they’re told that they’re recklessly endangering lives. But this is precisely what senior management is advocating instead of paying them for the additional work.
‘We are putting patients at risk. A lot of things don’t get done because nobody else is doing them,’ explains Nikki. ‘We’re always understaffed and we’re always expected to pick up the slack. But when they don’t pay the people who go above and beyond for them properly, they leave.’
Morale on Tracey’s ward is at an all-time low, with regular chat about giving up and looking for work in a less stressful job for more pay. ‘A lot of my colleagues are gone. I don’t blame them.’ Tracey would leave tomorrow if she could. It’s only the flexibility in shift patterns that allow her to look after her grandchildren that keeps her there.
At present, healthcare assistants are underpaid by nearly £2000 a year—a substantial sum of money for a profession with a typical salary of £21,000.
‘I know healthcare assistants that are using food banks because they just can’t cope. We’re expected to do the same job for the same amount of money when there are chief execs on over £200,000 a year, sitting in their nice office, not taking any notice of our struggles on the ward, expecting to get a free ride from us,’ says Nikki. ‘It’s not just about the money. It’s about the recognition for the work that we’re doing. And the responsibility that is forced upon us.’
Acutely aware that the current way of doing things is unsustainable in the long run for everyone at the trust, healthcare assistants, alongside supportive colleagues from across the trust, presented a petition last week signed by over 1300 members of trust staff, including doctors, nurses, consultants, and surgeons. The petition called on the employer to award back pay to band two staff working above their band dating back to April 2018, in line with commitments made by other North West trusts who have settled this issue.
Demanding Their Worth
On Wednesday 7 June, a group of sixty clinical support workers working for Wirral University Teaching Hospitals NHS Trust marched on their trust’s board meeting to demand back pay for years of carrying out duties above their pay band. After the chief executive of the trust refused to meet the staff, the workers entered the Arrowe Park Trust HQ building and entered the boardroom, only to find it empty despite a scheduled meeting.
Healthcare assistants are furious they’ve been continually ignored. ‘The board refusing to meet with their staff was so upsetting. Without us doing these duties above our pay grade, the trust simply wouldn’t function. The board should recognise this and value our work. They just don’t care,’ exclaims Tracey. ‘The chief exec proved that by not even turning up to listen to us last week. It’s so disrespectful. She’s fuelled the fire.’
At six other health trusts across the North West, band two staff have been moved onto the higher rate and back-paid to April 2018. But at the Wirral trust, their pleas have fallen on deaf ears. ‘They’re hugely behind the times,’ says Nikki. ‘They are refusing to meet us. How can you negotiate if someone won’t even give you a chance to talk?’
Sick and tired of being ignored, Unison gave the trust seven days to respond to their collective grievance before threatening potential strike action. That threat was ignored and now these workers are gearing up for precisely that—the first time ever healthcare assistants have taken strike action over banding issues.
‘We will all be out on strike. We didn’t want it to come to this, but enough is enough. We’ll be on that picket line and we’ll do whatever we have to do to get the recognition we deserve,’ says Nikki. ‘We stood with the nurses when they went on strike, taking them teas and coffees and joining them on our breaks. The trust probably thinks that because we’re the lowest paid, we can’t afford to strike. The truth is we can’t afford not to. They’ve got a big shock coming. A huge shock.’
Often under-seen and undervalued, healthcare assistants form the very backbone of the NHS. They are the eyes and ears of their colleagues, ensuring symptoms are picked up, and patients are cared for properly. For far too long, their goodwill has been taken for granted. Without these vital workers, hospitals would fall apart. It’s time they were treated with the respect and dignity they deserve.