Strikes in the Health Service
Contrary to press reports at the time, the strike by night nurses at North Manchester General Hospital in January was not the first in the British medical service. In 1922 asylum workers at Radcliffe Mental Hospital, near Nottingham, resisted attempts to cut wages and increase working hours but the strike collapsed and the branch secretary was forbidden to enter the hospital again. There was a greater degree of trade union militancy in mental hospitals during the 1920s and 30s because the decline in manufacturing industries between the wars led to recruitment of male nurses, who tended to be older than their female counterparts and experienced trade unionists. It was not until May 1962 that a further show of militancy among nurses led to widespread demonstrations against low pay and a further ten years elapsed before hospital ancillary workers took the lead with strike action.
Over the years health service staff (with the exception of senior medical and administrative personnel) seem to have been remarkably tolerant of low pay, difficult and stressful working conditions — often in outdated hospitals or redundant workhouse accommodation — and undemocratic, hierarchical structures in the different occupational groups. They have, on the whole, failed to combat their exploitation effectively despite the fact that trained nurses attained professional status and legal protection of their skills with the 1919 Nurses Registration Act.
The reasons for this prior to the formation of the National Health Service were the depressed economic conditions prevailing in the inter-war years; the failure of nurses to organise themselves into an effective trade union; the perception of nursing as a “vocation” in which high pay was seen as likely to attract undesirable people, motivated by financial consideration; and the domination of nursing by single women who, by living in subsidised hospital accommodation, were comparatively well off in spite of low pay.
The post-war period brought different problems in the struggle to improve pay and conditions. The technological advances which made nursing more labour intensive in the acute hospitals, and the severe shortage of labour in the 1950s, should have strengthened the position of nurses in the labour market; in fact this did not happen. Enoch Powell, Minister of Health in the 1951 Conservative Government, recruited nurses from the West Indies and this ready source of labour was tapped up to the time of the 1968 Immigration Act. The less popular branches of nursing such as geriatrics, mental illness and mental handicap would undoubtedly have collapsed without black immigrant labour, and the policy had the added advantage of suppressing pay levels.
The industrial expansion of the 1950s and early 60s led to an increase in trade union membership, with the Royal College of Nursing accepting male nurses and state enrolled nurses as members in 1960. The next two decades were marked by bitter rivalry between the trade unions and the RCN and as recently as 1981 the latter voted heavily against affiliation to the TUC and the use of strike action. To retain its appeal as a “professional” organisation it has concentrated on developing specialist interest groups to provide educational information in high technology areas of nursing, a successful strategy but one which caused a rift between ward nurses and managers. But probably the most divisive policies of the RCN have been a refusal to accept nursing auxiliaries as members; the jealous guarding of professional skills; and the attempt to exclude nursing auxiliaries from pay negotiations.
The management changes within nursing and economic pressures on the National Health Service brought about a certain unity among nurses. Privatisation of ancillary work in some hospitals also gave rise to the fear that nursing would be the next service to be exploited by entrepreneurs, and this served to foster a degree of trade union solidarity with ancillary workers, at least among lower grades of nurses. But nurses remain essentially divided among themselves: professionalism. exemplified by the RCN, and trade unionism, represented by COHSE, NUPE and NALGO still contest control of the labour market.
By the 1980s mass unemployment had altered capitalism’s priorities for health care and further cuts in patients’ services followed. For nurses, this meant a greatly increased turnover of patients: pressure to be more “efficient” led to earlier hospital discharges. often with earlier readmissions as a consequence. High technology nursing, which is particularly labour intensive, has led to the admission of patients who would have been considered untreatable in the past. And the increased mortality rate among middle-aged. unskilled male workers over the last 40 years, together with the rising numbers of old people in the population, have put intense pressure on dwindling resources.
The final straw which led to the Manchester nurses’ strike was the government’s intention to reduce shift pay, even though it is the worst of any British industry working a continuous three-shift system and one-fifth of all qualified nurses do one or more jobs to supplement their income. The strike achieved its aim: the government backed down, although the Prime Minister tried to save face by declaring that the Pay Review Board’s recommendations would only be considered if no further industrial action took place. The Sunday Express portrayed the dispute as a lightning strike engineered by left wing extremists, even though the decision to strike was taken three months in advance and emergency cover for the wards was arranged.
On 21 April the government announced that nurses would receive a pay award averaging 15.3 per cent and that the recommendations of the Pay Review Board would be funded in full. Thatcher’s claim that the award had been granted because of the RCN’s no-strike rule conveniently ignores the fact that the government tried to reduce nurses’ shift pay before the Manchester strike.
A closer look at the pay award shows that it is not quite as generous as the newspaper headlines suggested: a considerable number of nurses will receive just over four per cent. The largest rises will go to London, where the government’s recent policy of selling off hospital accommodation for nurses has caused an acute nursing shortage. The other big awards will go to those working in specialised units, the outcry at the deaths at Birmingham’s Children’s Hospital having forced the government’s hand.
Hospital ancillary workers remain badly paid in spite of having taken strike action in the past because the low market value of their work gives them little bargaining power, particularly when there is a surplus of unemployed labour. Trade unions are defensive organisations. They work within the wages system trying to improve pay and conditions and therefore have a vested interest in the prosperity of the organisations in which their members are employed. At a time of economic expansion they are able to take advantage of the need for labour and the profitability of the industries in which they are employed to gain concessions from their employers. During a slump, however, they are limited to trying to protect their conditions of employment, and the difficulty of doing so is confirmed by the Low Pay Unit. Of the employers they checked only 7.9 per cent were paying below the legal minimum in 1970 but the figure increased to 13.4 per cent in 1974; 31.5 percent in 1981 and 35.0 per cent in 1982.
What then, can be said about the potentialities and limitations of trade union action, in the health service and industry generally? Something Marx wrote is as true now as it was a hundred years ago. and particularly apposite in the nurses’ case:
The working class ought not to exaggerate to themselves the ultimate working of these everyday struggles. They ought not to forget that they are fighting with effects . . that they are applying palliatives, not curing the malady.