If we refuse to pay nurses properly, how can the NHS function?

If you won’t give people decent, liveable salaries and you drive them like pack mules, they will start to look for alternative employment

The holy god of the market is still worshipped with an almost religious fervour on the Tory benches. It’s luminaries still preach the virtues of free market capitalism. Rishi Sunak, a committed Thatcherite, is a true believer despite the quite absurd attempts of his opponents to paint him as a “socialist”.

Why, then, do they fail to understand the way the labour market is working in an NHS they still claim a devotion to – despite all evidence to the contrary?

You won’t be at all surprised to learn that I’m going to talk about the vexed subject of pay. This week, thousands of nurses have walked out in the biggest strike in NHS history. This industrial action has come as part of strikes across public sector jobs, encouraging talk of a second “winter of discontent” – this time presided over by a Conservative government.

A question that has been raised when they hit is whether those of us who use the service, who are in many cases reliant upon it for their lives, will notice any difference.

This is not a criticism of the strikers. Far from it. It’s just that no one disputes that waiting times at A&Es have exploded. If you have a long-term medical condition requiring regular checks, you will be doing well if you manage to get a cursory appointment after two or three cancellations. In some cases, you’ll be doing well to get an appointment at all. I speak from personal experience here.

These problems obviously built up during the pandemic when hospitals were full to bursting and in-person check-ups weren’t deemed safe. The question of why this is happening, however, is rarely addressed. Partly because the answer is almost as uncomfortable for Labour, which would really rather not talk about the strikes because they raise questions about what it would do, as it is for the Tories.

It is happening because the NHS, and by extension the government, will not pay enough for the staff it needs or treat them well enough to get them to stay.

Unison, the service’s biggest union, points out that there are 133,000 vacancies in NHS England alone, nearly 10 per cent of the workforce. Some hospitals will be relatively better off, but that means some will also be much worse off. Imagine trying to clear a backlog with, say, 85 per cent the people you need.

Money is not the primary motivation for most people working in the NHS. The same is true of those who earn their crust in other vial public services. Education would be one. For them, it is a vocation. The trouble is, this is something governments of all colours have shamefully exploited over the years.

The strikes are a reflection of the tipping point we have reached. Public sector workers have had enough. They need salaries sufficient to pay their bills and enjoy some sort of life when they have recovered from the brutal schedules their work often imposes. Married to a former teacher, I’ve seen this in action. Some are willing to fight for that. They have every right to do so.

What we should be equally concerned about is that others are protesting with their feet. If you won’t pay people enough and you drive them like pack mules, they will start to look for alternative employment.

Maybe that involves working at a Tesco, a Sainsbury’s or somewhere else. Maybe they consider moving to the private sector. Maybe they move abroad. The skills they have are very portable, and other countries, with better rates of pay and improved conditions, look favourably upon them. That’s the reality of market forces for you, Mr Sunak.

Workers in the private sector have not been immune from the cost of living crisis – far from it. According to the Office for National Statistics, they saw their average pay rising by 6.9 per cent between August and October. That compares to wage growth of just 2.7 per cent in the public sector. The TUC notes that in real terms, incomes in the public sector are underwater by 5.3 in real, inflation-adjusted terms since March 2020, the start of the first lockdown. That compares with 1.2 per cent for the private sector.

This is having an impact. Hospitals have even taken to setting up food banks for their lowest paid staff. This is unconscionable, and the problem is eventually going to have to be addressed. The cracks as a result of poor pay in the public sector widen by the day. They add to the sense that Britain is simply not working. So why not now?

Ministers have claimed that the country “can’t afford” proper pay rises. They have warned darkly of an “inflationary spiral” if they were to find money, what with price rises in double figures. The latter is a tired old argument and it isn’t hard to find economists who disagree with it, including some of those working at the Institute for Fiscal Studies, no less.

As for the former, given the state of the public services, I would ask whether we can afford not to deliver the pay rises these workers need – and deserve.