In Harrogate on Tuesday morning, the congress of the Royal College of Nursing will vote to amend its constitution to allow nurses to take industrial action against NHS hospital trusts. Next month, the proposition will be put to a postal ballot. It is the latest manoeuvre in a sequence of engagements fought between post-1979 governments and public sector employees over control of costs, each side claiming that it represents the public interest.
This year, for the first time since the NHS was founded, the 900,000 NHS workers have been told that their comprehensive national pay award is to be replaced by a two-stage procedure, 1 per cent to be negotiated centrally and 2 per cent in deals with individual trusts. To resist this change, the Royal College, though it will continue to eschew the right to strike, may decide to arm itself with a powerful weapon: the freedom to withdraw co-operation with managers. Given the amount of paper in the modern NHS, the effect could be devastating.
Two features of the battle will make it unusually absorbing to watch. The first is that we all have more intimate feelings for nurses than for other occupational groups. They usher us into the world, and in most cases they will usher us out of it, with the same brisk, tough-minded compassion. The second is that it constitutes an adroitly chosen test case. If the Government wins, this will probably weaken the resistance of other public sector employees to local pay bargaining - a significant victory. A lot hangs on the leadership of Christine Hancock, the RCN's general secretary.
She is a large-framed woman of 52 with wide-lensed spectacles, dark hair cut in a schoolgirl's bob and captivating high spirits. She dresses conservatively, lightened by a dash of bright colour. She and her partner, Tony, live in a terrace house on the fringes of Regent's Park, London. Its rooms are hung with watercolours of the Languedoc, where they spend walking holidays. With 300,000 members, she is the highest-paid trade union leader in Britain: £74,418 a year plus £l5,803 in benefits.
The daughter of a bank manager, Ms Hancock grew up in a comfortably- off, Conservative-voting suburban family in the South-east. The last of the three grammar schools she attended, Orpington Girls', was an academic hothouse. Ignoring advice from her headmistress, who told her she would be "throwing away her life" by becoming a nurse, she joined King's College Hospital as a £9-a-month trainee. She then spent three years as a ward sister at the National Heart Hospital, working with the transplant pioneer, Magdi Jacoub.
Nursing had begun to politicise her, a process that was accelerated by three years at LSE in her mid-twenties, attending lectures by Richard Titmuss, Brian Abel-Smith and other influential social theorists. With a 2:1 in economics, she returned to the NHS on the management ladder: first as matron at Whipps Cross, the Whittington and the Royal Northern, all hospitals serving hard-pressed inner London neighbourhoods, then as a nursing officer in Camden & Islington and Bloomsbury health authorities. The NHS leviathan, then as now, was in permanent revolution. A capable manager working in London had the career advantage of becoming known in the Health Department. In the mid-1980s she started applying for vacancies as a district general manager. There were 192 districts in the NHS, only half a dozen of whose chiefs were women. She applied and was turned down for six posts in succession - in one case being first accepted by the Health Department and then rejected after opposition from the district's senior doctors. The phrase "petticoat power" was uttered. Eventually she bagged the job at Waltham Forest in east London.
Margaret Thatcher had hired the late Roy Griffiths of Sainsbury's to advise her on how to introduce industrial management techniques into the NHS. By l988 Ms Hancock had made a reputation as an energetic promoter of reform, with a good chance of making it to the top of the NHS executive with which she is now embattled. When emphysema forced Trevor Clay to retire early as general secretary of the Royal College, he encouraged her to apply for the job. One of the fruits of the Edwardian suffragette movement, it had been founded in 1916 to establish standards of training and qualification for the profession. It became a registered trade union in 1977. She took over in 1989.
Her relations with the Secretary of State for Health, Virginia Bottomley, are correct but cool. Ms Hancock speaks more warmly of Mrs Bottomley's two predecessors: Kenneth Clarke who, she thinks, has never received proper recognition for keeping some of Mrs Thatcher's barmier ideas off the statute book, and William Waldegrave, the Cabinet's sole intellectual.
The idea of introducing local pay bargaining into the NHS was first mooted officially in Clarke's 1989 White Paper, Working for Patients, which proposed that hospital trusts should be free to set their own pay rates. She lobbied successfully against the idea, and it was shelved. It popped up again in the Citizens' Charter after the last general election. The Royal College prudently began to train its regional officers and hospital representatives in negotiating skills, but still believed that there would be no dramatic change in the immediate future.
On 9 February the nurses' review body announced the new formula. Ms Hancock says it came as a shock. The Government has always claimed that pay review bodies are free from political influence, but she suspects that Mrs Bottomley leaned on the review body's chairman, Mike Betts (former deputy chairman of BT).
Some NHS veterans think that, as an erstwhile manager, Ms Hancock privately favours the use of pay as a management control and that she is opposing it only because she fears that she will otherwise lose members to the militant Unison, the rival health workers' union. She denies it. "I was extremely angry," she says. "I was vitriolic. I think it took Mrs Bottomley and her officials by surprise. Anger isn't something I feel very often. I didn't believe that the Government could be so stupid and not think through the consequences. I've been warning ministers for three years that local bargaining would politicise the nurses. That's what happened in New Zealand."
A flurry of recrimination ensued. Then Ms Hancock demanded to see the Prime Minister face to face. He refused. There was to be no compromise. For the nurses it would be win or lose.
Ministers argue that nurses' incomes are secure (they have increased by 78 per cent in the past six years, compared with 49 per cent for the economy as a whole) and that more than half the hospital trusts in England have now offered the full 3 per cent, but that trust managers need to use pay bargaining to induce changes in working practices. Example: sickness rates in the NHS are running at 5-7 per cent, admittedly lower than railwaymen and policemen (11 per cent), but higher than Nissan car workers (2 per cent).
Ms Hancock replies that the multiplicity of negotiations will waste money; that differential pay will encourage nurses to move frequently from hospital to hospital, making life more not less difficult for managers; that nurses' productivity (so far as the concept is applicable to hospitals) is already high: they are treating 121 patients for every 100 they treated before the latest NHS reforms; and that many conditions that trust managers want to impose on nurses are ridiculous. Example: linking their pay to the trusts' attainment of financial targets, when there is little more that nurses can do to affect those targets without damaging patient care. She worries that "New Labour", anxious to offend nobody, has been silent.
She commands the loyalty of her cautious but determined membership. Recognising this, Alan Langlands, the NHS's chief executive, has been briefing journalists with honeyed words about her. Her allies at Unison fear that there may be a split in the two unions' united front in the coming months. "Christine has done a very good job at the RCN," says a friend there. "She's an excellent manager, but temperamentally she finds being involved in a dispute with the Government difficult to handle."
Ms Hancock says she was shaken by the strength of her members' hostility to the new dispensation, but that the outcome of the postal ballot is still uncertain. She is presumably not going to advance until she is sure that her troops will follow. The miners were destroyed by an error of judgement of Charge of the Light Brigade proportions on the part of their leader, Arthur Scargill. This weekend Christine Hancock's generalship looks altogether steadier.Reuse content