Many will have been shocked to read that some nurses and ambulance staff are contemplating strike action in support over their pay and working conditions. Before considering the dilemma that such action might pose for NHS staff today, it is worth looking back at the origins of strike action and of the word itself.
My Shorter Oxford English Dictionary
devotes eight columns of small print to the 55 different meanings of the noun or verb, strike. Amongst these is the one at issue, to withhold one's labour as part of collective action. Although the word came across with the Vikings, this specialised usage is usually attributed to the action of seamen in the late 18th century on merchant ships, striking the sails to prevent them carrying their cargo until the seamen's demands were satisfied.
Withdrawal of labour became a common but risky means of achieving better working conditions with the growth of factories and the Chartist movement in the early Industrial Revolution, when workers had neither rights nor representation in parliament. At that time, withdrawal of labour risked suppression by the militia, imprisonment, deportation or starvation – not something to embark upon lightly. One early group to suffer in this way was the Glasgow handloom weavers in 1787, six of whom were shot dead by the militia while their leader was publicly whipped and banished from Scotland.
Even after working men had gained the vote and up to the 1930s, to go on strike meant the risk of starvation. The contrast between the haggard faces in newsreel of the Jarrow marchers and the figures to be seen on some picket lines points to changing times and expectations.
Since Chartism, strikes have often had a political aim alongside the local aim of improving conditions for isolated groups. Many will remember the two coal disputes, one of which in 1974 probably brought down the Heath Government and the other in 1984 which was intended to have a similar effect on Mrs Thatcher's Government but ended in the defeat of the National Union of Mineworkers, accelerating the necessary decline of the whole industry.
An interesting contrast between the two was pointed out to me prior to the second one by Joe Gormley, leader of the miners in the earlier one; that a union should never prioritise the larger political over the personal aims of individual workers, as it is the wholehearted support of the workers that is necessary to withstand the hardships of loss of income. The second strike proved divisive.
Since the 1940s in the UK, we have seen the growth of large collectives of workers employed by the government, the so-called public sector, of which I was a member for my entire career save for two years in USA when I was part of its public sector. We have had several advantages over workers in the private sector: relative security of employment, reasonable pensions to look forward to, awareness of being part of a community contributing to the well-being of our fellows, and relative protection from the whims of employers in a competitive market.
On the downside, we could never have expected to become very rich and our salaries have been subject to restrictions that do not apply to those in the private sector, such as pay freezes. Some doctors can have the best of both worlds and work part-time in each sector – you can see their and their patients' Bentleys and Porsches parked in Harley Street. This is hardly the case with nurses and ambulance staff.
The immediate instinct of someone of my generation is horror that anyone in the NHS could consider striking, withdrawing one's labour from an organisation which is already short-staffed and under huge pressure to care for sick and worried people. But my generation benefited from free education and did not graduate with huge debt, so we could live on the absurdly low salaries we started on, knowing that they would increase gradually as we worked our way up the ladder. And in those days, banks had managers who were happy to allow an overdraft, also in the knowledge that our professions offered the security of increasing salary. It was also possible to get a mortgage and houses were much more affordable than they now are. These changes in wider society mean that many more people even in professional jobs may be on the verge of poverty and even homelessness. This is exacerbated by the obvious wealth and over-consumption of people in the class from which the entire UK Cabinet is drawn.
One thing that has barely changed is that nurses in the NHS are 90% female and 40% are employed part-time. One that has changed dramatically is that women have many more opportunities of entering the professions and rising in them than they did. Increasing opportunities lead to recruitment problems for previously female-dominated professions such as nursing and primary school teaching. However, like medicine and teaching, nursing is a vocation which nobody should consider merely a career; the satisfaction arising from it is the understanding of one's contribution to the welfare of others. Financial rewards are necessary but secondary to this. This means that, in being urged to strike, a nurse or paramedic is presented with a dreadful dilemma and many would refuse absolutely to do so when it comes to the crunch. Even partial withdrawal of labour would harm the NHS's ability to look after its patients.
What is driving these universally-admired professionals in this direction? I do not believe it is only money, though this is clearly vitally important at the lowest pay levels. Most likely it is frustration at the working conditions in understaffed services, forcing many into unpaid overtime, and the relentless load of work as more colleagues leave under the strain or for easier conditions in the private sector. People can endure such tribulations for a while, but only if they can see a way out; regrettably, current political conditions do not hold out much promise, and experience suggests that the pressures will continue increasing as they have over the past two decades.
Looking back, and I have been doing a lot of this recently, the present time strongly resembles the 1978/79 Winter of Discontent when many workers, including notably local authority garbage collectors and gravediggers, went on strike and a divided Labour Government under Jim Callaghan fell to Margaret Thatcher. There seems to be an irony in that her drive to make the public sector more efficient over the next 14 years led directly to the current most severe problem in the NHS, the problem of waiting times.
It will not have escaped anyone's notice that nurses and paramedics are not alone in contemplating or actually participating in strike action. The rise in costs of living, food, energy and accommodation following years of complacent government in both UK and Scotland, together with an obsession in agreeing pay increases on a percentage basis factoring in inflation has inevitably increased the gap between the rich and the poor. The effect of inflation is mostly on the poor and those in the early stages of buying their homes. People on middle and higher incomes can cut down on expenditure without serious consequences, but increasing numbers at the bottom, unemployed or on low pay are driven to foodbanks or go cold and fall ill.
If a pay rise is linked to inflation, a 10% rise for the poorest paid will make little difference while a 10% rise for the better off – well, if you are on £125,000, you will get a rise of £12,500 which will pay for another cruise, but if you are on £10,000, the extra £1,000 will go towards your fuel bill and leave nothing to cover the food. The pay gap increases by £11,500, and it requires appropriate taxation to adjust this towards equity. The argument for a pay increase in line with change in inflation in hard times is only justifiable among those on lower rates of income – inflation-matching increases in public sector pay across the board risk wasting public money on the better off and necessarily increase inequality.
It seems to me that the Scottish Government's offer of a single sum rise in salaries across the board for NHS staff is an enlightened method of addressing this problem. In times of financial hardship for an organisation under stress such as the NHS, everyone must realise that there has to be a limit on what a government can extract in taxes to pay for its staff. Just as nobody in a well-run organisation is indispensable, so everyone should be essential.
While hierarchies exist and greater expertise and experience attract higher rewards, it is difficult to see why the differences between the top and bottom should be greater than a factor of five. Single sum increases across the board can engineer a reduction in the pay gap, enabling 'levelling up' and reducing a cause of grievance within an organisation.
This leaves aside the issues of external comparisons and work-related stress. Nurses can and do find employment in the private sector, where life is less stressful but perhaps less satisfying. Pay in the NHS needs to be at least as good as elsewhere in the public sector, and this includes other similarly essential professions such as teaching and social care. Work-related stress is inevitable in all these professions and it is a matter for good management to control its intensity.
Addressing the fundamental problem of staffing levels and workload is essential and I shall discuss this in the context of a changing NHS in my next article. In the meantime, I hope (as a patient and direct descendent of a Glasgow hand weaver) that the UK governments will treat fairly and sensibly those on whom we rely, and work to improve their currently worsening conditions, so that the need to withdraw their labour gradually disappears.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own