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Wages for angels
Published 02 August 2007
Disgruntlement in the NHS is greater than ever
The great weakness of meritocracy, as many sociologists accept, is that it leaves large sections of the population with low self-esteem.
To believe you are at the bottom of the social ple because God placed you there is one thing. To be told it's down to your own lack of effort, initiative and intelligence - a deficiency of personal merit, in other words - is much harder to bear. Even more galling is to see people you regarded as your peers forging ahead into bigger houses and flashier cars.
I suspect something of this sort explains, at least partly, the failure of the NHS's Agenda for Change. Affecting one million nurses and other NHS staff, this pay system was introduced to create more equitable rewards ("equal pay for work of equal value"), put career progression on a more rational basis, improve recruitment and retention, and deliver a better deal for patients. It was underpinned by a job evaluation scheme, awarding points for such things as "analytical and judgement skills", "emotional effort" and "working conditions".
The results are set out in a new report from the King's Fund (Realising the Benefits? by James Buchan and David Evans). Most health service staff got pay rises of more than 10 per cent.
Nurses received around 15 per cent and did better than office staff (as, I am sure, we would all wish). The costs far exceeded estimates and, with the new contracts for GPs and hospital consultants, contributed half the NHS's £900m deficit for 2006-2007.
Yet disgruntlement in the NHS is greater than ever. The proportion of staff who feel that their work is valued by their employer is down from 43 per cent to 26 per cent; those who believe that promotion is fairly determined are down from 60 per cent to 51 per cent; and those who think patients get good care are down from 58 per cent to 42 per cent.
What went wrong? The old pay system, as the King's Fund says, was a mess. Dating back to 1948, it was based on national bargaining units involving multiple unions and staff associations. It was too inflexible to absorb new roles in the rapidly changing health care professions and was open to repeated challenges under equal-pay laws. From any rational viewpoint, it had to go.
But I suspect many workers aren't all that rational about their wages.
Under the old system, most staff would have developed a fatalistic attitude. Their pay was determined by a remote, inscrutable fate and, if they didn't get much, it was no reflection on them. They might grumble, but their anger was not directed against their immediate employer, still less against their closest colleagues. Besides, their rewards were not supposed to be in material things, but in the satisfaction derived from being angels of mercy.
Now, under the new job evaluations, there were precise and all too visible reasons for their wage levels. Some evaluations were carried out locally and others involved matching local roles to national job profiles. Local, identifiable managers were at least partly responsible. The wages were nearly always higher, to be sure, but many staff felt they had been judged and found wanting, sometimes in relation to people working alongside them.
This echoes a difficulty in much of the public sector, which ministers and their advisers have never quite grasped. It is not easy to deal with unruly children, sick patients or dysfunctional families unless your own self-esteem is reasonably high. Many public sector workers, not being celebrities or highly rewarded derivatives traders, may derive such self-esteem as they have from the belief that they are caring and altruistic, even if that is often untrue. Attempts to define and quantify what they do, in their view, somehow miss the essence not only of their jobs but of themselves as human beings.
A few more pounds in the wage packet are always welcome, but can nevertheless be demeaning and devaluing and lead to tensions between colleagues. Bad enough, you may think, for meritocracy to expose your deficiencies in determination and intelligence. If you work for the NHS, you may find it still more painful to have your job or yourself graded low for "emotional effort".
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