First we had the pay freeze, then came the pension cuts and re-banding of jobs. All the while we have also seen the privatisation aka ‘outsourcing’ of healthcare services and this continues abound. Now we have proposals for regional pay and changes to terms and conditions. Here in the South West, 20 NHS trusts have banded together to form a consortium designed to stitch us up further. Critics of the plans have described this consortium as a cartel. Their sinisterly named Project Initiation Document (PID) outlines the plans cooked up by senior health bureaucrats. 

It would be a mistake to think that the Consortium’s proposals are out of step with pressure on existing national pay agreements. Under the Agenda for Change (AfC) national agreement that currently governs pay and conditions for NHS staff, proposals have already been mooted by employers in the following areas:

• “Paying sickness absence at the base rate for the Band regardless of when the absence occurred”. At present, if you are sick for example on a Sunday or night shift then you are paid at the enhanced rate for that shift.
• “Increasing employer flexibility by removing or revising the requirement to offer enhanced payments for night, weekend and Bank Holiday working”. This does not need explaining. Every day is like Monday…..
• “Linking pay more closely to outputs by reducing the number of incremental points within existing pay Bands”. This is performance related pay rewarding brown-noses and scabs.
• “Reducing annual leave entitlement”

Alarmingly, the Consortium claims that some of the healthcare unions have “indicated that there is scope for further discussion” around these issues but not on the proposal to reduce annual leave entitlement.

The South West Consortium has stated that unless there is swift agreement i.e. union surrender on these proposals then they will have no option but to move towards a regional system of pay and terms & conditions. This would signal the end of national collective bargaining in the health service. The Consortium’s PID goes beyond the national proposals indicating that attacks will also be launched against the length of the working week and pay levels.

The aim of these proposals is to reduce the wage bill from an average of 68% to 60% of total expenditure. This has been calculated by the health unions as being equivalent to a 10-15% cut in pay. For a hospital porter this would drive down wages from just under £15000 to under £13000. A newly qualified nurse would see their wage fall to around £18000.

At present, the main strategy of the health unions appears to be one of raising awareness amongst their membership. Some of the emerging anger amongst health workers is predictably being channelled towards signing petitions, contacting politicians and ‘building for’ a national autumn demonstration.

It is clear that the proposals are an ideological assault on collective bargaining and unionised labour. After successive easy victories, the Government is coming back for more and they will return again should this dispute be lost.
Again we see the skeleton organisation of the health unions rattling and creaking at the first sign of pressure. The lack of organisation and reps on the ground, the result of years of social partnership under New Labour, reveals a gaping chasm between the union machinery and the (often isolated) workforce.

The reaction of health workers that we have spoken to is one of anger and outrage. This is obviously a normal response and anything else would be disturbing. Nevertheless it would be daft to deny that there is a prevailing sense of demoralisation, cynicism and individualism amongst this as well as other sections of the workforce. This is in part a result of the social democratic unions rolling over and accepting many of the attacks that have come before. It is also of course a sign of the age and the successes of the political establishment and the media in manufacturing and grooming a mentality of egocentricity. 

From our view, we would like to see the anger of health workers in the South West articulated rather than diverted into well-trodden cul-de-sacs. Workplace meetings and campaigns could be organised by those affected by these proposals rather than by distant paid officials. We think discontent would be better directed towards confrontation (such as pickets and demonstrations for example) with the Trust boards and those responsible for dreaming up and implementing these cuts that will damage our health service and all of us that rely on it for good quality healthcare and, in many cases, survival. By organising ourselves on the ground and making links with service user groups we can start to form the structures upon which to build a future socialised health service. A service based on need directly controlled by those that provide and use health services.