The NHS is almost universally hailed as Britain’s greatest asset, but recently it’s been making headlines for the wrong reasons.
Unprecedented levels of strike action during October saw the spotlight fall on many trusts and employers’ groups. The main focus of the unions’ anger is health secretary Jeremy Hunt’s decision to ignore recommendations the Pay Review Body made in February of a 1% annual pay increase for all NHS staff.
It’s largely that decision that sets the dispute in the NHS apart from the wider disquiet among public sector workers, around 1 million of whom initially voted to strike between 13 and 15 October. And while two public sector unions, representing civil servants and teachers, called off the strike as a deal was reached, all seven bodies in the NHS went ahead.
The NHS is also a huge topic in Westminster. On 22 October there were six questions about the organisation in Prime Minister’s question time. And Labour leader Ed Miliband has vowed to take the NHS “to the ballot box” in the build-up to the May 2015 election.
So how can we sort the truths from the myths around the current state of the NHS? And where do the main players stand?
Getting the message
Reportedly 400,000 NHS workers took part in the 13 October strike, a figure reached by combining the membership of every union involved. But NHS Employers director of employment relations Gill Bellord disputes this figure.
“It was actually around 40,000 staff,” she says. “And of the unions that did ballot for strike action, only around 5% of their members voted for it.”
Bellord puts the apparently inflated figure down to “the lure of the headline” and admits it can be difficult to get NHS employers’ message across in the current climate. She is also insistent that the number of employees whose pay was completely frozen has been exaggerated.
“More than half of staff got an annual increment worth on average 3%,” she says. “Those who didn’t get that were eligible for a 1% pay increase. So a pay increase was open to everybody, subject to performance. Therefore, I think the staff knew what they were likely to receive or not.”
One of the most noteworthy aspects of the strike action was the involvement of the Royal College of Midwives (RCM). While NHS strikes by the likes of Unite and Unison are still relatively rare (this was the first strike over NHS pay for more than 30 years), this is the first time RCM members have ever voted to strike in its 133-year history.
RCM director of employment relations Jon Skewes puts the historic action down to a feeling among members that the secretary of state and employers have “broken faith” with them. He calls Jeremy Hunt’s decision to overrule the Pay Body Review’s proposals “unprecedented”.
“This had never happened before,” he explains. “A secretary of state had never set aside a Pay Review Body award and then imposed something that was effectively much worse – and over two years rather than one.”
Skewes cites the lack of a guarantee of further pay increases even beyond those two years as “the final straw” for his organisation’s members. He warns that there is likely to be more activity into 2015. He adds that the action from all unions could “potentially go on for some time”.
He is keen to stress talks are ongoing with both MPs and NHS employers. But communication with Hunt himself is proving difficult for all unions.
“All the unions have said we want to talk to the health secretary with no pre-conditions,” says Skewes. “But he’s refusing to talk unless we accept his two-year ‘pay envelope’, which would mean we would only be able to shift the chairs around the Titanic in terms of pay. It’s unacceptable.”
The wellbeing angle
It’s inevitable that pay is dominating conversations about the NHS at the moment. It is the primary reason for the strike and an area around which there is genuine anger. But what of staff wellbeing?
Cary Cooper, distinguished professor of organisational psychology and health at Lancaster University Management School, doesn’t believe the two should be looked at exclusively. He says that pay issues feed into a sense of worth, which in itself affects wellbeing. But he also thinks there is more at play.
“The NHS has fewer people doing more work. They’re under financial strain and job security isn’t like it used to be,” he says. “So how do we create a workplace where people feel valued, trusted and motivated?”
Cooper sees the answer in a focus on management. Employees should be managed by “praise and reward, not fault-finding”. As such, he is critical of recent remarks by Jeremy Hunt that suggested mistakes by NHS staff cost up to £2.5 billion every year.
“He should never have said that because it effectively says ‘you make mistakes’. What’s the communication message? He should be thinking about how you create a culture where people don’t make mistakes.”
Just as there was anger at that statement, the frustrations of staff are often directed at decisions made at national level rather than locally, according to director of HR & OD at Wrightington, Wigan & Leigh NHS Foundation Trust Jon Lenney.
“From speaking to other HRDs anecdotally I get the feeling people in the strikes were reacting to political issues rather than against their employers,” he says. “Engagement is generally high. That’s not to say there aren’t things to work on though. Our priority remains to maintain the wellbeing or both our staff and our patients.”
There are “reasons to be hopeful” according to Skewes. He points to talks with backbench MPs who realise that a major dispute of this nature is “the last thing they need” in the run-up to the election.
And Bellord sees signs even in the strikes themselves that relations between HR directors and staff continue to be strong.
“We did a great deal of preparation ahead of the day,” she says. “I don’t need to tell the HR directors that their relationships with staff and trade union leads going forward are very important. They know they need to get through the difficult times, but ultimately everyone needs to get back to work and start thinking about patients.”
It’s clear from speaking to Bellord and Lenney that there is a real desire within HR and employment groups in the NHS to keep relations with all parties strong in the current climate. The unions’ anger appears to be directed over their heads, which is something largely out of their control.
The NHS faces more difficult days ahead. But if employers can keep channels of communication with all stakeholders open and honest they face the best chance of getting through them with the fewest scars possible.