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This country is for hard-working people. But not hard-working nurses?
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?
The paradox of thrift and bankers' bonuses
Over the last decade, pay at the top of the UK’s largest listed companies ballooned up to £4.2 on average on average for FTSE 100 chief executives from £1 m between 1998 and 2010, while salaries for workers barely kept place with inflation. Jeremy Bentham (1748-1832) had a huge impact on the world of philosophy, proposing utilitarian value as, ‘the greatest happiness for the greatest number of people works well as a way of doing justice’. This encapsulates why so many members of the general public appear to have a fundamental problem with excessive bonuses for bankers. Whilst people on the left politics-wise do not necessary deny the contribution of bankers to ‘wealth creation’ of the UK economy, many such citizens resent that they appear, along with Premier League footballers, to have levels of pay which represent an excessive contribution to the social value of society. The utilitarian could in fact stress that growth, wealth and GDP contribute much to the happiness of all. These depend upon a functioning banking system. Likewise, banks, in turn, need investment bankers to turn a profit. If those bankers are best incentivised by the promise of large bonuses, then so be it. Indirectly, that makes everyone happier.
Earlier this year, Downing Street appeared to concede defeat in its battle to stop banks paying huge bonuses to their staff; dictating the size of individual bankers’ payments or overall bonus pools was not possible. Instead bank bosses and ministers tried to thrash out a deal that would publicise details of payouts that could reach £7billion this year. The climbdown on bonuses has been a huge embarrassment for Government ministers who had threatened much tougher measures. The impression conveyed in the UK media that bankers have not been adversely affected by #gfc, and indeed some feel that the bankers have profited. This has been against a whirlpool of accusations and counter-accusations that the taxation policy has been indeed been ‘regressive’. Whilst politicians and economists have latterly been at each other’s necks, both are aware that there is enormous voting capital in ‘getting this right’. Equally in the USA the Obama administration have immersed themselves in a populist attack on wealthy US citizens including corporations.
Rumbling along in the background is a subplot ignited by John Maynard Keynes, an outstanding Cambridge academic, and a Liberal. There has been much discussion about whether Vince Cable, a Cambridge graduate, and a Liberal Democrat, follows in the tradition of Keynes, to some extent fuelled by Cable himelf. Robert Skidelsky, Keynes’ official biographer, has made his concerns patently clear. Cable has extensively studied Keynes for his Doctoral studies. Perhaps playing to the Keynesians last week at the Liberal Democrats’ 2011 Summer Conference, Cable opined that, “Keynes talked about a ‘paradox of thrift’; everyone and every country being individually wise but collectively foolish – leading to a downward spiral”.
The paradox of thrift is a very famous paradox of economics, popularized by John Maynard Keynes, though it had been stated as early as 1714 in The Fable of the Bees, and similar sentiments date to antiquity. The paradox states that if everyone tries to save more money during times of recession, then aggregate demand will fall and will in turn lower total “savings” in the population because of the decrease in consumption and economic growth. However, there have many inward attacks of Keynes’ well-known paradox, not least because of the unwitting conflation of the terms “capital” and “savings”. It is mooted that the classical theory of growth in macroeconomic did not presume that every saver was the ultimate investor of goods, especially in relation to the earlier work of another great economist, Ricardo. Economists have recently been quick to point out that Keynes uses the term “savings” to embrace a ‘hoarding behaviour’, which leads Keynes to his direct proposition of a ‘paradox of poverty in the midst of plenty’. Again, there is a problem with definition, as bankers bonuses might constitute ‘plenty’, but not the growth in the UK economy called ‘pitiful’ by Prof. David Blanchflower, himself a pupil of Keynes.
Should the alleged ‘excessive profits of bankers’ be clawed back by the State for its benefit? David Ricardo is credited with the first clear and comprehensive analysis of differential land rent and the associated economic relationships (Law of Rent). In schools of economic thought including neoclassical economics, land is recognized as an inelastic factor of production. Rent is the distribution paid to freeholders for “allowing” production on the land they control. Of course, corn and money, and farmers and bankers, are not necessarily synonymous.
“As soon as the land of any country has all become private property, the landlords, like all other men, love to reap where they never sowed, and demand a rent even for its natural produce. The wood of the forest, the grass of the field, and all the natural fruits of the earth, which, when land was in common, cost the labourer only the trouble of gathering them, come, even to him, to have an additional price fixed upon them. He must then pay for the licence to gather them; and must give up to the landlord a portion of what his labour either collects or produces. This portion, or, what comes to the same thing, the price of this portion, constitutes the rent of land ..”
There has been a wider issue about whether the ‘differential theory of rent’ is due to strong emotions concerning ‘private property’, but prominent liberals such as JS Mill have proven words and deeds on the issue, through for example the Land Tenure Act. Adopting a populist stance has always been easy for Vince Cable, and most Liberal Democrats heavily tout that St Vince The Cable was apparently one of the first to predict the banking crisis (as indeed objectively evidenced in Hansard). Whilst a synthesis of the economics is undoubtedly interesting to economist, both new and old, people will want to know what Cable can do about it. The answer is ‘not much’, as the FSA’s code on renumeration is considered ‘good practice’ (but relatively ‘toothless’). Cable wishes also to address the ‘disconnect’ between the excessive pay of top Directors and the performance of these companies, where Cable feels that a schism has developed. Many believe that many senior bankers seem virtually unsackable, which makes an analysis of what level of pay is appropriate for bankers from the “wage curve”. Blanchflower and Oswald (1994) how the existence of a wage curve for a dozen countries, defining the wage curve thus: “A worker who is employed In an area of high unemployment earns le than an identical individual who works in a region of low joblessness”. It would be interesting to know what the views of 31-year old trader, Kweku Adoboli, are towards that. Or indeed, what Oswald Grübel thinks: according to the Wall Street Journal this morning, “Oswald Grübel resigned as chief executive of embattled Swiss bank UBS AG in the wake of a trading loss that cost the bank more than $2 billion and now has cut short the career of a giant of Switzerland’s business community.”
