When your script is written by a hard-nosed hedgie or private equity fund owner, it can be easy to lose sight of the basic fact that it’d be impossible to run the NHS without nurses.
“Aspiration” has been a powerful slogan for all main political parties in the UK, with a history of its own. Historically, Labour has drifted away over decades from ‘working class people’ to ‘middle class people’, so much so people have asked what Labour really can offer those at the lowest end of the pay scale.
“Hard-working” is not necessarily synonymous with “being very well-paid”. There are hundreds of thousands of healthcare professionals, staff grades or experienced specialist nurses, who are extremely hard-working. Many of them are not well-paid. Professional footballers and employees in the City tend to be well paid. Nurses tend to have their job as their source of income. Some people have various sources of income, naming no names.
Unsurprisingly, the Unions have criticised Government moves to halt a 1% pay rise for all NHS staff in England. The Department of Health said the increase was “unaffordable” alongside the current system which sees many staff automatically receive incremental annual rises. This is, of course, a totally bizarre argument when you consider that around £3 bn was returned into the Treasury only last year.
It was decided that these savings should not be pumped back into frontline care, staggering when you consider the close link between patient safety and safe staffing. Health trusts are currently under pressure to make savings and the NHS wage bill accounts for around 40% of its budget.
The Conservative party conference was plastered with the phrase “hard-working” – “For Hardworking People” beaming from the platform – and a host of frontbench speakers milked the term for every last iota of rhetorical impact. It’s hard to know exactly where this odd meme came from, but it might be something to do with George Osborne decided to tweet #hardworking in his popular tweets.
Of course, “hard-working” – whether it is a predicate of “families” or “people” – is potentially ‘low-hanging fruit’ in political communications. It has various layers of meaning, however.
‘Hard-working’ also relates to the issue of how hard nurses actually work. Whilst nurses work shifts, there is no sense that any professional nurse should wish to leave punctually at the end of the shift, if there is a patient with unmet needs (and who hasn’t been safely ‘handed over’ to nurse colleagues). In previous discussions about rewarding nurses, it has been mooted, for example, that ward managers should be incentivised to stay at the bedside rather than being forced to choose administrative roles if they want to progress their careers. However, it is generally the case that individuals do not enter the nursing profession to make ‘loadsamoney'; there are other income-generating routes which are far easier. That is why people who have had an easier life, through politics, aren’t fooling anyone by dressing up in a nurse’s outfit for a day and for some cameras.
Take for example the issue of ‘hard-working’ in the context of compassion delivered by nurses. It is hard to know what the link between ‘hard-working’ and ‘compassion’ might be, except nurses who are looking after busy wards with not enough time even to go to the toilet report genuine frustrations in having time to deliver ‘compassionate’ care.
The word “hard-working” generally connotes something else: the virtue of the dedicated employee, who is ever available, an asset to company and country, never shirking, never clock-watching. This is particularly case in relation to the work ethic of nurses. Nurses work in teams, and has a strong ethic of collaborative working. If however a nurse agrees on professional grounds that the working environment is unsafe, and needs to ‘speak out safely’ against this, this can be professionally difficult.
There is nonetheless a slight twang from the Right that “hard-working” is linked to the neoliberal conception of the entrepreneurial self. This self never stops working; writing blogs, professional networking, setting up innovative businesses. However, this belief falls down with the fundamental finding that many ‘hard-working’ nurses on the left-of-centre in politics also voluntarily do such activities. A related issue there is that the Right do not have a monopoly on entrepreneurialism or innovation.
The word “collaboration” implies working together for the greater good but actually encompasses far more. Several pre-conditions must be in place for collaboration to be successful. Collaboration must have shared objectives. The value system among the participants must be similar. Communication must be honest, respectful, and purposeful. Nurses are especially good at this aspect of their working hard.
Indeed, most people in the general public acknowledge that nurses are caring and hard working in the face of challenging conditions, research has shown. A poll by YouGov revealed that 76% of those asked think nurses do their best and care about their patients. However, 82% of the 1,968 people surveyed also said nurses should be given the chance to speak more freely, with only 14% believing that this is already the case.This finding implies that nurses have a strong sense of professional ethic for their patients, and not just ‘doing time’ to receive the salary.
Another desirable quality of ‘hard-working’ is the notion of thrift. This boils down to an old notion of second world war pluck. Given the perceived necessity for tightening our belts and knuckling down and applying the old elbow grease in order to dig. It will be ‘hard-working’ people who, in a ‘war-like’ spirit get ‘Blighty’ out of this mess. For this, the alleged ‘profiligate spending of Labour’, which turns out to be £860 billion recapitalising the banks and sufficient public spending to ensure the highest satisfaction ratings of the NHS ever, is the enemy. Austerity is the cause under which we can all unite together?
The NHS is now expected to deliver 65% of its planned efficiency savings by year end, officials have told MPs. However, hard-working nurses, working at demands which far outweigh safe resourcing levels, will be a recipe for a disaster, as Mid-Staffs showed. The Care Quality Commission has issued the hospitals with warning after carrying out inspections, and the Keogh mortality report (and the Francis reports) have given plenty of examples of how even hard-working, well-meaning nurses, can’t cope. Of course it can be demoralising for ‘hard-working nurses’ to come home after their shift to listen to a diatribe of abuse about hospital standardised mortality statistics once they come home from work.
Notably, the term “hard-working” brings with it a status in front of your bosses. You might believe yourself to be “hard-working”, but to really know for sure you’d have to be told it by a rich person. Wealthy health service managers will now be able to pocket salary increases of 4%, which could boost annual pay packets by over £6000. By contrast, it was revealed this week that a 1% rise for NHS staff in England had been scrapped. A manager on £100,000 could be in line for a £4000 salary boost, while an NHS director could get up to over £6000.
In one sense, it evokes a “dignity of labour”, related to a productivist ideology of a historical layer of skilled workers; “Protestant work ethic” or the “Presbyterian work ethic”. Osborne’s decision to visit factories and skilled manual workers in particular may suggest he was aiming to evoke this sense. The problem with this approach, putting enormous emphasis on ‘productivity’, is that it conceptualises healthcare in the same terms as the efficiency of making an iPad. Heavily based in the Frederick Winslow Taylor management school of efficiency and productivity, it tends to ignore the professional ethic of nurses, or the value that they bring in their professional work which is hard to measure.
The “hard-working” theme is thus a populist-right appeal which encodes a series of policies designed to profoundly transform British society. However, it turns out to be a sham when you consider how it gives the appearance of not including ‘hard-working nurses’.
The general secretary and chief executive of the Royal College of Nursing, Dr Peter Carter, said that Chancellor George Osborne said it was “affordable” to give NHS staff a 1% pay rise in this year’s spending review. Dr Carter added that the Government was “emotionally blackmailing hard-working staff”.
All a bit of a shambles. But quid novi?
