An NHS nurse speaks out on pay, privatisation and demoralisation

The conditions that have led to a haemorrhaging of trained staff from the health service have not come about by accident and will take a serious fight to reverse.

Lalkar writers

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Overwhelmingly, both NHS staff and patients want to see our health service back in purely public hands. But in order to achieve a truly universal, high-quality and free service, a serious campaign needs to be organised – one whose leaders are prepared to harness the collective power of the working class and who won’t be intimidated by the pressure, blackmail and lies of the privateers and their servants in the political and media establishments.

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The following article was written by a long-serving NHS nurse and party member.


A myth was perpetrated in the late 19th century that continues to this day. A new political party, the Labour party, had been born to represent the interests and needs of the urban working class – but, looking back, when has the Labour party ever truly fulfilled that role?

Reaching power in 1945, at the end of the second world war, it was Clement Attlee’s government that brought the National Health Service (NHS) into being, along with the welfare state.

But what was the real motive?

How did we get the NHS in the first place?

The NHS was designed to appease the working classes and crush any ideas of socialist rebellion at a time when the socialist USSR was standing tall following its victory over fascism.

The same government, under the direction of Ernest Bevin, assisted in the formation of the North Atlantic Treaty Organisation (Nato), which was created to fight against communism in Europe. It encouraged the British workforce to ignore the nefarious acts committed by the same ‘party of the people’ against the working classes, their comrades, outside of Great Britain. This goes some way to explain, but not excuse, unacceptable behaviours of some sections of the working class who blame ‘the other’ for their ills rather than laying blame on the true culprits: the ruling classes and their acolytes.

This year marks the 75th anniversary of the founding of the NHS, but there is not much left to celebrate. Privatisation of this vital organisation continues apace, ensuring that pay is now far lower than it was a decade ago. Staff shortages and low staff morale have steadily become accepted as the norm, impacting hugely on patient safety and staff wellbeing.

Too many British workers, both staff and patients alike, seem unaware that the NHS has been and continues to be privatised by stealth.

Systemic racism against many we rely on for our care

This year also marks both the 75th anniversary of the Windrush generation as well as, unfortunately, the 10th anniversary of the Francis report (an inquiry into the high level of avoidable deaths at the Mid-Staffordshire hospital trust). The passengers aboard SS Empire Windrush and other such ships made a valuable contribution to rebuilding Britain after World War 2. Many of them were to become the mainstay of our NHS’s workforce.

In addition to their practical help, they brought a wealth of cultural enrichment to our society, whilst experiencing appalling racism and discrimination. Their descendants have been subject to further cruelty and prejudice by the British government in recent times, as we have written about previously.

Additionally, the latest and brutal Illegal Immigration Bill will prevent refugees seeking asylum here and enhancing our culture and workforce.

Conversely, the NHS has actively recruited overseas nurses, mainly from India. Many of these excellent recruits struggle to integrate within the existing workforce owing to both unconscious bias as well as episodes of discrimination; despite all hospital trusts waving Bame (black, Asian and minority ethnic) friendly banners alongside rainbow ones.

In recent trade union ballots, many of these immigrant workers have declined to vote owing to fears of losing their visas. Some were bewildered by the ballot process and were not sure if they were eligible to vote; possibly due to an undercurrent of feeling ‘less than’. The government is keen to employ overseas nurses as they have been ‘grown’ and paid for elsewhere.

Bullying and harrassment still rife

Despite the publication of the Francis report ten years ago, it appears that lessons supposedly ‘learned’ during that inquiry have long been forgotten. Bullying, cliques and harassment were endemic within the Mid-Staffordshire hospital and this was a factor which led to its serious failings.

There is still a culture of cliques and bullying (including racism and the undermining of those with invisible disabilities)in mnay NHS workplaces, and plenty of anecdotal evidence of nepotism too. Many trusts have installed full-time ‘freedom to speak up’ champions, but it is unclear whether these measures have afforded any respite to victims of bullying.

In one trust, a respected obstetrician and gynaecologist was sacked after voicing his concerns regarding ‘normal birth’ ideology. He indicated that other staff on lower pay grades would be unlikely to speak out as a result of the treatment he received merely for speaking up.

Bed shortages create needless pressures

As reported previously, the number of beds in the health service has decreased over the decades to such an extent that this shortage now leads to a host of artificial pressures in the NHS. The cuts to social care budgets, meanwhile, result in medically fit patients remaining in hospital whilst interim beds or carers are frantically sought, adding yet another unnecessary pressure to the service.

All this stops the flow of patients from A&E to the wards most appropriate for their care.

It was recently reported that there are no beds available to mental health patients on a regular basis. This, in addition to a lack of care in the community, leads to increased numbers of meantal health patients getting stuck in A&E and repeating the downward cycle. Across the country, A&E patients are now routinely given treatments in waiting rooms and other non-clinical areas.

The Royal College of Nursing (RCN) has stated that it does not endorse nursing care provided in non-designated clinical areas such as corridors, as a result of frozen patient flow. This statement is to be applauded, of course. However, the RCN has not as yet proffered a single solution to this degrading and unsafe practice.

Stressful conditions no accident

The ruling-class approach of divide and rule is fully evident within the NHS. All these added pressures, combined with low pay and bullying, result in chronic stress and sickness, and a haemorrhaging of trained staff. There is no doubt that this is not accidental, but is a system designed to aid the complete privatisation of the NHS by keeping morale and the wage bill low.

The government of Margaret Thatcher got the ball rolling in earnest on this project, and subsequent Labour governments maintained its momentum, despite rousing speeches promising the opposite. The Labour party under Tony Blair continued John Major’s Private Funded Initiatives (PFIs) and created ‘foundation’ hospital trusts that left the health service with overwhelming debt and bills, meaning these extortionately expensive buildings cannot be maintained to acceptable levels.

While ‘Partygate’ stories dominated the mainstream media news cycle, most have forgotten the horrors endured by all NHS workers, their patients and their families during the peak of the Covid-19 pandemic.

Many colleagues died horribly from the virus or from complications caused by it. Those remaining were expected to carry on working with drastically insufficient personal protective equipmet (PPE). As a result, many lived in fear and had to take personal responsibility for decontaminating themselves after long shifts before greeting their children and families.

The government has recently offered a below-inflation pay award to NHS workers that includes a one-off ‘Covid bonus’ payment – a Covid bribe for workers. The offer is seen as attractive by many, especially those being paid less than workers in private companies, but the ‘Covid bonus’ in no way compensates for the trauma experienced by many of us.

Despite this, recent (extremely niggardly) pay rises that have been awarded to NHS workers were made by raiding existing NHS budgets, thereby impoverishing other sections of the health service. Health workers are considered ‘greedy’ for simply asking for a restorative, above-inflation pay rise, which has been made all the more urgent during the present cost of living crisis. Headlines scream that pay rises cause inflation, but it has become clear to most of us that this is a lie, and that inflation is not caused by pay rises at all.

Problems within the NHS are manifold, and there is a culture of fear that is deliberately perpetuated so as to prevent workers in the industry from speaking out about these issues. Meanwhile, student nurses are being used inappropriately as cheap labour in an attempt to plug staff shortages.

Workers on zero-hours contracts (bank shift workers) pick up additional shifts, often on top of their already onerous jobs, just to earn enough to survive. Despite them proving to be a crucial part of the workforce, they will not receive the one-off ‘Covid’ payment – another blow that will likely cause many to seek employment elsewhere.

What are our union leaders doing?

The RCN’s strike ballot closed on 23 June 2023. It was an aggregate ballot of all members in England working in the NHS and included on the ‘agenda for change’ pay scale. The rank-and-file support for the strike was strong.

Despite this support amongst their members, the union’s leadership capitulated and recommended ‘no’ to strike action. This created a furore amongst members, however, resulting in the RCN’s leaders performing an abrupt about-face and running a polished ‘Vote to strike’ campaign instead. As this article was being written (before the results were announced), there were already rumours in the media that the result would be a disappointing ‘No’ to strike action. No doubt these rumours aimed to demoralise those who were eligible to vote in the ballot.

Many healthcare workers are not members of unions; some because they are unsure what a trade union does, but most because they do not believe the unions can offer them anything worthwhile and that therefore the union subs do not reflect good value. This attitude, although disappointing from a class-conscious perspective, is not hard to understand considering the performance of British trade unions over the last 35 years, particularly when every penny counts toward many workers’ survival.

Each union has a unique selling point aimed at attracting the subs necessary to run slick campaigns that appear to support their membership. Nevertheless, meaningful work such as fighting in solidarity for the genuine restoration of pay that improves patient safety, while retaining existing and attracting new staff, is not forthcoming. As a result, workers simply do what they feel is necessary for their survival.

Many nurses have left their principal roles to join private agencies, which then contract their services back to the NHS at extortionate fees (another example of stealth privatisation). They thus return to their former workplaces with improved salaries, increasing the wage bill by far more than if they had simply been given the pay rise they need and deserve. Meanwhile, much of the increased cost to the NHS is syphoned off to create profits for private shareholders, profiteering from the slow break-up of our health service.

Given all the above, it is hardly surprising that healthcare support workers feel undermined, overworked and underpaid. Or that so many are actively seeking employment outside the NHS – away from their vocations and the jobs they love and have been trained to perform with excellence.

Meaningful debate censored

At the RCN congress that took place from 14-18 May in Brighton, guess whose question wasn’t read out by Pat Cullen! It was fun listening to her stumble for a few seconds as she realised its content before quickly moving on to a different one about what to do if members have not received their ballots.

The question I asked can be read here: Model motion: Defy the anti-trade union laws.