Nursing the sick - and grudges

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The survey revealing senior NHS managers had pay rises of 7.6 per cent has provoked a predictable response, the most vocal from the Royal College of Nursing (RCN), whose members, on average, enjoyed a 3 per cent increase in the same period.

The RCN would persuade us that nurses care about patients and managers do not. The RCN tell us their members are poorly paid, and ignore the fact that nurses, compared to any other work group, have enjoyed the largest percentage increase in earnings since 1971, at more than 120 per cent in real terms. The RCN demanded, and got, an independent pay review body, and now they don't like the results.

Thanks to the former Tory leadship hopeful, John Redwood, managers are characterised as men in grey suits, ignoring the fact that it is their Technicolor vision that keeps the NHS in the black. Thanks to party conference rhetoric and a cheap round of applause, the Health Secretary, Stephen Dorrell, has made NHS managers a soft target for cost-cutting, ignoring the fact that in most towns the biggest employer and the most complex business will be the local hospital.

The hospital boss will have responsibility for 3,000 staff, a budget of around pounds 90m and the progress and treatment of hundreds of thousands of patients. He, or she, will work 11 hours a day with evening and week- end meetings thrown in for good measure. Were this work done in the private sector, the salary would be more like pounds 120,000; in the NHS it is merely pounds 65,000.

Managers' contracts of employment, calling for performance, productivity, hours of work "commensurate with requirements", are short term and subject to termination on the flimsiest of grounds. Managers have never gone on strike, threatened to strike or organised themselves into a trades union.

Nurses are the opposite. The RCN has ditched its "no-strike policy" and last year threatened to withdraw co- operation, plunging the NHS into industrial-relations chaos, terrorising vulnerable patients. Nurses' contracts of employment are enshrined in binding national agreements that give cradle- to-grave protection. The RCN has seen to it that performance and productivity are words no nurse ever need worry about. It threatened a strike last year if any hospital trust had the temerity to try to attach performance strings to nurses' pay settlement.

Who are the angels? Is it the nurses who manipulate public opinion and weak politicians with threats, rhetoric and intimidation, or is the real spirit of public service in the hearts and minds of managers who make a creaking nationalised industry work for lower wages than they are worth and more grief than they deserve.

The writer is an associate at the Centre for Health Services Management, University of Nottingham.