A relative suffered a stroke before Christmas and is soon to be discharged from hospital. Three cheers for her, and three cheers for the NHS. But the sequel leaves a rather bitter taste. The plan is that she will be discharged on a Monday so that she receives a full five consecutive days of assistance – before her designated carers knock off for the weekend. This is a health authority and a council with a reasonable reputation. But even here, it seems, on Saturdays and Sundays patients newly readjusting to their home surroundings are left to the vagaries of fate.
Now maybe the calculation is that relatives and friends will be freer to help at the weekends than at other times, so the arrangement makes sense. Perhaps. But I remain to be convinced. It smacks rather of a culture of working hours that for some reason remains entrenched in the very places it should never have been allowed to take hold. The emergency and caringservices are, it increasingly emerges, not only almost the last haven of 9-5, Monday to Friday operations, but sectors where anyone required to work outside these hours is handsomelyrewarded.
The Prison Service furnishes one of the most egregious recent examples. It turned out that at Ford Open Prison there were only four members of staff on duty on New Year's Eve, in charge of 500 prisoners. That any one of these four ventured to mount an illicit alcohol check beggars belief, given the paucity of back-up, but this seems to be what happened, and the riot we heard about the next morning was the result. From what has emerged since, it appears that such "out of hours" staffing levels were not exceptional – though whether this was a matter of money, or hours, or both, was not apparent. Whatever, it reflects a patent failure of management.
As do the terms and conditions for hospital consultants that have recently seen the light of day. Last week it was disclosed that some – well, quite a few – consultants were earning tens of thousands for "overtime" on top of their £100k-plus salary. This is no comment on the worth of senior doctors. You and I can dispute till the cows come home the ethics of a system that rewards the average Goldman Sachs employee so much more than the average hospital consultant. But for the time being, that is how things are. The particular scandal here is that NHS administrators, or successive governments, or both, have acquiesced in such an opaque system for so long – a system which is, after all, funded by taxpayers.
It used to be assumed that the professions were above such considerations as overtime. Such payments were for those required to clock in and out. But you don't have to be an economic or ergonomic genius to suspect that some consultants might have organised their commitments so as to maximise their overtime. One of the more illuminating, and at once obvious, comments made after these revelations was from someone who said that such payments fell sharply when consultants were required to post their commitments on a large calendar wall-chart. You bet they did. Shining a light into dark places generally has a salutary effect.
What the NHS has somehow managed to do with its hospital doctors and GPs – and let's not forget the occasional nurse who calls in sick to take a higher-paid agency shift elsewhere – is to shell out for overtime and bonuses, while still contriving to leave staffing at nights, weekends and holidays shockingly bare.
Which may be why another survey has shown – not surprisingly – that death rates for emergency hospital admissions rise significantly at these times. I dare say standards also fall in maternity wards, as midwives clock off for their evenings and weekends, and in care homes, where more senior staff leave the prosaic business of actual caring to agency workers on little more than the minimum wage. A recent hullabaloo from hospital managers and junior hospital doctors blamed the EU Working Time directive for staff shortages after hours. Yet many more, and more experienced, doctors would be available, if seniority did not buy exemption from what used to be called unsocial hours.
From here it is but a short leap to London's fire brigade, whose union was just canny enough to realise that a Bonfire Night strike might be counter-productive, but which has only just settled a dispute over shift patterns; and from there to the city's Tube drivers, who did strike on Boxing Day because they wanted – if I am not mistaken – triple time and a free day in lieu, on top of their seven weeks' annual holiday. And I haven't even started on the millions in bonuses and overtime paid to the police.
As with the NHS, all these services illustrate how, even now, basic pay and actual pay are still quite different things, defying all modern demands for openness. They also show how jealously these closet emoluments are guarded. With the firefighters it was an open secret that their curious shift patterns permitted both overtime and a wide range of second jobs. No wonder the union never published a typical week's diary of an overworked and underpaid firefighter. The Tube drivers' dispute was just as much of an anomaly in these austere times. They had signed up to an agreement more than 10 years ago that recognised Boxing Day as a normal working day – as it has become in much of the private services sector – but they felt aggrieved because more of them were now actually being required to work!
That agreement, in fact, should have been the shape of things to come. There are jobs where working weekends, bank holidays and "unsocial" hours should long ago have been made a basic requirement for everyone and built into the pay structure: no overtime, no allowances, just a range of days and shifts, fairly allocated. Most of the private sector adjusted to this fact of life long ago. Add up all these concealed extra payments, distribute half to increase pay in the lower echelons of the emergency and other services, and there should be more than enough left to pay for the respite that Riven Vincent and very many other unpaid, round-the-clock carers really need.