Why NHS workers promise a summer of discontent

Pay/ strike threat

THE Government faces a summer of discontent in the NHS, with nearly a million health workers prepared to take industrial action over pay. Unhappiness about working conditions has come to a head in the Government's attempt to impose local pay bargaining, with a proposed national award for health workers of only 1 per cent, and a further 2 per cent to be negotiated with individual hospital trusts and health authorities.

In the space of a few months the Government has managed what seemed the impossible - to antagonise traditionally peaceable unions such as the Royal College of Nursing and the Royal College of Midwives, which for decades have rejected industrial action even in the 1978 "winter of discontent".

In March this year, the midwives ended a 115-year-old tradition by voting in favour of industrial action. Two months later, three other health unions followed suit, with 99 per cent of the nurses voting in favour and 90 per cent of Unison members. The Health Visitors' Association voted unanimously for action short of striking.

The resentment and depth of feeling throughout the service has come to a head over the latest pay offer, although it is seen as "the straw that broke the camel's back". Many health workers oppose local pay bargaining and fear that trusts may not pay the full 2 per cent or will add strings. Bob Abberley, head of health at Unison, said: "They [the workers] feel that the Government no longer supports them nor values them."

The Health minister, Gerald Malone, countered by saying: "Any sort of action would mean patients feel the pain. Simply put, if nurses do not fill in forms, trusts would not be able to treat patients and waiting times will grow."

Disruption is unlikely before August. Unison and the RCM will not ballot for at least another month in order to enter talks, while the RCN's result will be returned on 29 June. HVA voting is not likely to begin until the end of June.

The four health workers interviewed here are employees or former employees of the University College London Hospitals Trust (which comprises the Middlesex Hospital, University College Hospital Obstetrics Unit, Elizabeth Garrett Anderson Hospital and the Hospital of Tropical Diseases).

The depth of their disaffection is plain.

The staff nurse

David Carr, 32, is a staff nurse in a burns and plastic unit. The rate for his grade is pounds 13,850 (with London weighting it comes up to pounds 15,000).

"I started out as a porter in 1983 and took what seemed a great opportunity to move into nursing. But all I've seen is cut after cut after cut. Everything in the health service now is all about being competitive enough and what we're able to afford. We have to decide whether we admit someone for a liver biopsy or someone with breast cancer. What kind of choice is that?

"We have to think in terms of competing for custom and revenue. When you compete you have to cut costs. You can't appreciate how damaging it is to work on the basis of market economies for the past three or four years. And while we're trying to keep the service going, caring for people, other people are raking it in - the gas chairman Cedric Brown and others like him. It makes me so angry.

"There's a huge feeling of uncertainty among nurses. The 1 per cent is an insult. And leaving the rest up to the trusts means that they can add whatever strings they like. I know at one place, where the trust have given 1 per cent without strings and then said the last 1 per cent will be related to performance.

"Lots of people have this feeling that the Government is not interested in the health service. The public are really upset at what's happening. I think we'd have great support from them if we called a march.

"There are those of us who have looked to the Labour Party to stop the decay but the Labour Party has become more conservative with a small c.

"I think we should go for strike action. When people talk about working to rule, not doing paperwork, I think that has a worse effect. When I'm doing a job, I do it. If the phone's ringing, I'll pick it up. If someone needs an X-ray or a scan, I'll do it. It's easier for me to go on strike. I'd be happy to go on strike next week. I want to be on the picket line to show what's happening to the service.

"We wouldn't harm patients' health. If we went on strike there would be emergency cover - in fact we would probably calculate the management figures plus one extra. And if there was a major emergency every single nurse would come in off the picket lines. If the Government tried to blame us for something going wrong, they should remember that things go wrong in hospitals every single day.

"I may sound disillusioned but I still get a great deal of job satisfaction out of my contact with patients.We'll take in a person who's severely burned or injured, completely dependent on nursing staff. And then you see them walk out and shake you by the hand and that's what makes me realise it's worthwhile."

The student midwife

Hannah Freedland, 26, is completing her training as a midwife in the City and Hackney Trust after being employed by UCL as a general nurse since 1988. Pay: about pounds 16,000.

"I had no dreams of being the next Florence Nightingale but I wanted to be able to care for people and be able to improve their quality of life in what can be difficult circumstances. People are attracted to midwifery because you're able to work in your own right rather than only being part of a team.

"Midwives aren't the sort of people who get angry easily but they are more angry than I've ever seen before. The 1 per cent the Government offered is such an incredible insult when you think we have the responsibility of delivering the next generation.

"The morale of midwives is so low and it reflects on those who use our service. If we're not happy when we work and don't work in the right conditions it's the general public it affects.

"Midwives realise that local pay bargaining means we're developing a two-tier system in the NHS. If it goes on, the rich trusts will be able to afford to advertise and employ high-quality staff by offering incentives.

"Although I think there are midwives who are willing to strike, they're probably not at the point where they're organised enough to do so. It's not something people in our profession do lightly.

"It's tremendously positive that the Royal College of Nursing have dropped their no-strike clause, too. It shows the extent of our feeling.

"I don't think the public will lose sympathy for us. In my experience when I went on strike at UCH [in protest against its being closed down] they realised it was their service we were fighting for. They know if you put yourself through industrial action what the Government is doing must be very wrong."

The porter

Karl Winder joined the health service in 1990 as a hospital porter, seeing it as an escape from the building sites on which he had previously been employed. Now he is not so sure.

"On an average day as a porter, you're on the wards by 6.30 in the morning taking all the rubbish off them, then running to the kitchens to take the meals up.

"Then next minute there'll be a call, a nurse phoning up to tell you there's a body to be taken away or there's a bed to be moved or whatever. You do a complete cross-section of things. And the basic wage you get for a 39-hour week is pounds 130.

"The kind of conditions we're working in are disgraceful. We're behind the nurses 100 per cent. Because there's not enough staff there's an awful backlog of jobs building up and then we have to explain to the wards why we're 20 minutes behind.

"The whole atmosphere is bad and health workers are taking it out on each other even though it's no one's fault.

"If the nurses went on strike then the management would have to take over and then they'd see what it was like. All chaos would be let loose. They'd find out porters are only human and have ruined backs by the age of 35.

"When ancillary workers here had a strike recently over multi-skilling, it was hysterical watching personnel managers tottering around on high heels pushing trolleys. No one's treated well here any more. Nobody's smiling now except when they leave work.

"They certainly don't smile when they get their wage packet. Porters used to think that even though it wasn't a good job, at least it was a job for life. If I had to leave, where would I go? I suppose like everyone else, it would be McDonald's."

The senior nurse

Janet Maiden went into nursing for the job satisfaction. Twelve years on, a senior nurse, she feels bitter at the way health workers have been treated. Pay: pounds 17,600 (with London weighting).

"I quickly realised I had been very idealistic going into nursing. The amount of responsibility I had from day to day compared to the money I was getting was ludicrous.

"I work on a haematology ward with leukaemia patients, where as well as sorting out X-rays and scans and general care, psychological support is very important - and it's something I don't have time to give.

"People had the illusion that the Labour Party would make the health service better. But support is not coming from any corner and nurses are realising they have to do it themselves. The 1 per cent offer was the straw that broke the camel's back. It's an insult to people working so hard.

"I think to bring in local pay bargaining is the first step to deconstructing the whole health service.

"I want to know that if I go to another London hospital tomorrow I can be paid the same wage.

"The NHS is a huge employer and people want to feel secure Local pay bargaining is the first step to running hospitals like little businesses.

"I think nurses would be willing to strike. People got their first big pay awards after the action in 1988 [over re-grading] and they realise that's what's got to be done.

"We've always been taken for granted. Life has been getting harder and I think everyone should be pleased to see us getting more angry.

"The average age of a nurse on my ward must be about 26. People get burnt out or leave to find well-paid jobs. But I want to stand and fight. I was apolitical before I took up nursing but I'm certainly not now."

Photographs by David Rose