How do you sensitively exploit a pandemic to secure better working conditions? That’s the question facing healthcare trade unions in the next six months as they confront a government too busy to listen and the likelihood of a deep economic recession. Some even worry that the higher moral standard to which their frontline workers are now held could hinder their chances of a meaningful settlement.
On 27 April, the official coronavirus death toll of NHS workers in England stood at 82. Sixteen care workers have also died, although BBC News analysis suggests the figure is higher. All the healthcare trade union contacts the New Statesman spoke to insisted that their sole aim now was to secure personal protective equipment (PPE) and safer conditions for their members to prevent the number of deaths rising further.
But unions are also starting to draw up a long list of structural and financial improvements badly needed within the sector. Unison, the UK’s largest trade union, with half a million healthcare members, will call for a new tripartite system between the government, employers and unions in the social care sector.
According to Kate Bell, head of rights at the TUC, the organisation will also renew its push for an end to the outsourcing of certain roles such as cleaners and hospital porters in the NHS, as well as the removal of zero-hours contracts. That’s in addition to TUC general secretary Frances O’Grady’s recent proposal of a National Council of Reconstruction and Recovery. The council would give healthcare workers a voice in a dialogue between government, business leaders and unions to rebuild the ravaged economy.
The government has announced that the families of frontline NHS and social care staff who died from Covid-19 England will receive a £60,000 compensation payment, which has been welcomed by the unions. But they have also started to consider standard pay demands and are assessing the types of claims they could make across their bargaining sectors. This could include a claim on the value of public sector workers more generally, according to Christina McAnea, assistant general secretary of Unison.
They may also push the government to reward lower-paid staff who have gone above and beyond during the crisis, though this could be complicated by ambiguous definitions of frontline and essential workers. “It’s indefensible to think some of these frontline workers have been doing these jobs and getting paid £8.72 an hour [minimum wage] for it,” says McAnea.
What’s the best that low-paid workers can expect based on current projections? Much depends on the government’s post-coronavirus fiscal policy, which is so far unknown. Economic consensus appears to be shifting away from austerity as the appropriate response to higher debt, and Rishi Sunak’s March budget unleashed the largest rise in government borrowing for 30 years. But ghosts remain: former chancellor George Osborne has suggested that further public spending cuts will be needed after the crisis, and Sunak’s recent concerns over government debt suggest his next budget could be an austere one.
Either way, the UK’s budget deficit is now expected to surge to the highest levels since the Second World War, surpassing the damage caused by the 2008 financial crisis. As public spending rises to fund emergency support measures and the economy enters recession, the Office for Budget Responsibility (established by Osborne in 2010) has said the budget deficit could reach £273 billion this year, with GDP dropping 6.5 per cent in 2020 as a whole.
Our chart below paints a bleak figure. It shows, unsurprisingly, that public sector wage growth has tracked the budget deficit in the past 20 years. But using the OBR’s coronavirus reference scenario it indicates that, if the government once more pursues austerity when the UK emerges from the coronavirus crisis, public sector pay will decline by as much as 2 per cent when adjusted for inflation.
While healthcare workers’ stock is at record high, their representative bodies’ numbers are still suffering from a long-term slump. The decline in trade union membership and influence has been well documented. The chart below shows a steady 40-year decline in membership, with the trend continuing the same trajectory from John Major’s 1990-97 premiership through to 2019.
More recently, however, public sector membership has experienced a coronavirus bump. Figures released last week by Unison showed an increase in its membership of 16,000 since the beginning of 2020. Roger McKenzie, who is responsible for recruitment at Unison, believes that the number will rise further across the year. “People are scared in their workplace, so they join the union. Whether they then stay is another issue.”
While the general decline in membership is attributed to anti-trade union laws and a failure to recruit younger members (less than 10 per cent of workers under 24 are union members), healthcare organising has its own problems. The British Medical Association (BMA), which represents 160,000 doctors in the UK, has been slower than its smaller counterparts to confront the government over PPE.
“If they had done more earlier around securing protective equipment, things may have been very different,” says Selma*, a Manchester-based GP and BMA member. The BMA responded by saying that it has been sharing information with the government from over 100 suppliers and manufacturers of PPE. “It is illogical that the blame for the current situation should be shouldered by the BMA and other organisations. This is squarely a failure of government.”
A new breed of activist groups has emerged in recent years to respond to this perceived sluggishness. Some, such as EveryDoctor, have done so in reaction to the BMA and Unison. Others, such as United Voices of Workers, have supported the more precarious jobs of zero-hours contract workers such as delivery drivers and cleaners.
But if frontline healthcare workers are to secure any meaningful coronavirus settlement, it’s the largest unions that will need to repair relations with the government after years in which they have fractured. The junior doctors strike and the removal of student nurses’ bursaries in 2016 left long-lasting damage, although the Conservatives put higher NHS spending at the centre of their 2019 manifesto, promising to reinstate the bursary as well as build 40 new hospitals.
The Government has been talking a good game too. Responding to criticism over PPE supplies, the Health Secretary Matt Hancock has stressed that “listening to the voices on the front line is a very, very important part of how we improve”. And there were hopeful signs of cooperation in the early days of the virus’s spread: The Department of Health and Social Care created two sub-groups: social care and PPE in social care, with Unison represented on both groups.
But according to McAnea, who sits on the groups, their importance appears to have been recently downgraded by the government. The groups were established with senior civil servants attending. They have now been replaced by junior colleagues who are often short on answers and cannot make decisions. “My worry is that the government is already forgetting about this newfound cooperation,” says McAnea.
Other union figures have said that, despite their aim of constructive engagement with the government, their position has hardened in recent weeks as PPE has failed to materialise and health guidance has shifted to match the supply of the equipment, rather than the science. This more critical approach could be a risk in relation to public opinion over longer-term settlements, though. There is high support for the government’s approach in the North of England, and hostility towards any attempt by Labour or its affiliates to politicise the crisis.
Higher unemployment once the virus passes could sway the public, too. According to the OBR, more than 2 million people may lose their jobs by June. But the NHS has maintained around 100,000 vacancies throughout 2020 and the health sector accounted for 20 percent of new job adverts in the first two weeks of April, up from 10 per cent last year. “As health workers we’re at no risk of unemployment, unlike most other people now,” says James*, who works at a central London teaching hospital. “The virus is making life difficult for everyone in healthcare, but that’s not something that gets solved by petitioning for better pay and conditions.”
A larger question persists within the sector, however: why should the grim sacrifices made over the past month be necessary to prove a job’s value? “We’ve long valued work in this country in a weird way,” says Kate Bell of the TUC. “That’s been exposed by this crisis.”
Even the weekly round of applause for health workers, each Thursday at 8pm, has started to wear thin within the profession. Some believe it has become an unthinking dogma or worse, a gesture co-opted by a government on the backfoot from shortages of PPE, poor planning in the early stages of the virus and a rising death toll of NHS workers. (For some hospital workers contacted though, the applause is nothing more than a show of appreciation. “I feel appreciated – nothing more complex than that,” says Jenny*, a nurse in Queen Alexandra hospital in Hampshire.)
Unions have been reluctant to criticise the applause, with most outwardly supporting it. But there is a growing anxiety among the organisations that the gesture is replacing action, and could even undermine any future settlement. “You can’t eat applause,” says Roger McKenzie. “Applause won’t pay the rent; you need money for that. These are things that we’ve been talking about for some time.”
Some believe the deification of frontline health workers could be inhibiting them from speaking out. “This martyr complex assigned to NHS workers of angels as nurses and doctors as superheroes is completely hollow,” says Dr Julia Patterson, who founded EveryDoctor. “They have not been pushing for basic rights because they’re deemed to be a different class of human. But they didn’t sign up to become war heroes; they signed up to become healthcare workers.”
The fear of being held to a higher moral standard is echoed by McAnea, who says that many of Unison’s members would be reluctant to push for a financial settlement because “it could be perceived as mercenary”. For now, the focus remains on securing PPE and emerging through the first peak rather than seeking longer-term improvements to pay.
“We’d like to open up conversations with government,” says Patterson “But the reality is that our colleagues are still dying. And I can only think about that right now.”
*These names have been changed on request of anonymity
Tom Young is New Statesman’s head of digital
Michael Goodier is a data journalist at New Statesman media group