Paying healthcare workers more should end strikes – but it’s just a sticking plaster. Now the real battle for NHS begins
WELL, thank goodness for that: The nursing and ambulance strikes are over.
Now the NHS can recover a bit from months of walkouts after ministers and trade unions agreed a new pay deal.
If the doctors sign up to something similar, then we can all breathe a sigh of relief, right?
Wrong. The pay agreement struck on Thursday evening is already unravelling.
The unions representing nurses, ambulance workers and other healthcare staff came out of their talks with Health Secretary Steve Barclay believing the package of pay rises and one-off “NHS backlog bonus” payments would be funded by new money from the Treasury.
The Treasury thought otherwise, pointing out that there hadn’t been any more funds in the Budget only the day before.
I understand the money is expected to come from NHS efficiencies and — a phrase I’ve never heard before — “Department of Health underspend”.
Neither of these are very plausible.
Perpetually disorganised
Why does it matter where the money is coming from?
The only people who should care about this are the bean counters in Whitehall, while the rest of us get on with our lives, surely.
The problem is that if it’s not new cash, then it’s coming from an existing pot of money, and the NHS budget itself isn’t immune.
The “NHS efficiencies” line is beguiling.
While there are obviously areas where fat can be trimmed — such as its spend on management consultants and the way it is so perpetually disorganised that it blows billions on agency staff — the health service is much leaner than the popular caricature suggests.
It spends 2p in every £1 of its funding on administration, compared with 5p in Germany and 6p in France.
It has already agreed to making savings worth £12billion — and these don’t take the new £2.5billion pay deal into account.
It is cutting its administration at its core by 30 per cent and has asked integrated care systems, which is in charge of hospitals, GPs and so on in different local areas, to make similar cuts too.
Its bosses were content to sign up to these kinds of cuts — but only on the understanding that to shave off any more would be impossible.
Not all the money will be available immediately, either, as it will be swallowed up by redundancy payments for the staff who are leaving.
The Government might go from one fight with the unions to one with the health service itself.
In the autumn, NHS chief financial officer Julian Kelly warned that making any more savings would hit “investment in cancer, mental health, primary care, diagnostic capacity”.
That sounds dangerously like the “frontline services” that Rishi Sunak this week insisted would be protected despite this expensive deal.
If the Prime Minister doesn’t want to cut frontline services and if the magical “departmental underspend” doesn’t materialise, then chances are the Department of Health and Social Care will have to go back to the Treasury, cap in hand, and ask for some new cash.
Sources tell me that negotiations “to resolve any new funding needs” are still a possibility — and that means Jeremy Hunt’s Budget is being torn up just days after he delivered it.
The unions weren’t just protesting about low pay for their members.
They were very good at making the strikes about the wider state of the NHS, with understaffed wards and operations cancelled because there aren’t enough doctors and nurses to perform them.
Healthcare workers deserved a pay rise purely on the basis they’ve had to put up with this ropey situation for too long.
They definitely deserved a plan to fill the vacancies.
The health service itself had been led to believe that plan was coming in the Budget.
But on the day, nothing.
Instead, the Chancellor complained that £3billion a year was being spent on locum doctors and agency nurses.
He fixed the pensions problem that was prompting many senior doctors to retire early but didn’t publish the plan to recruiting and retaining staff across the service — even though he used to campaign for this himself when a backbencher.
I’m told Hunt is still very committed to a workforce plan and wants to publish it with the NHS “shortly”.
If he takes too long, the unions will wonder if he heard any of their pleas about the conditions their members are working in.
It is also difficult to see how a health service can become more “efficient” when it is starved of capital funding for repairing its crumbling buildings, let alone buying up-to-date computers and IT systems.
The NHS has a much smaller capital budget than health systems in other European countries — it’s currently only around six per cent of its overall spend — and it shows.
So, no, the NHS pay crisis is very much not over.
The nurses might not be on picket lines again this year, but now the really difficult stand-off begins, over who is going to stump up the cash — and who is going to lose out even more than they already have.