Our NHS Heroes Need a New Deal

We all remember the scenes – a Prime Minister and Chancellor standing side-by-side outside Downing Street each week, honouring front-line NHS staff who risked their lives each day serving the public, while many of us were instructed to stay home. Did this nationwide celebration of the NHS inspire renewed respect for our front-line healthcare staff? Well, fast forward a few years and nurses, ambulance workers, junior doctors and Consultants all took to the picket lines over pay – citing that real pay had fallen to their 2008 levels. The cheerleading from our leaders became a distant memory as Rishi Sunak insisted that strikes were the “number one reason” for record NHS waiting times. In an era where we face significant challenges with an ageing population, evolving health needs and a huge backlog, we have gone from clapping carers to demonising doctors in a race to the bottom on NHS wages that is crippling our healthcare system.   

Workers’ wages across the board have been devastated since 2010. The Resolution Foundation report Ending Stagnation showed that from 1970 to 2007 real wages grew 33% each decade, before falling to zero in the 2010s. 15 years of lost wage growth has cost the average worker £10,700 each year. For NHS staff, a 2022 study by Nuffield Trust found that since 2010 Consultant pay had dropped 11%, junior doctors pay by 8% and midwives pay by 9%. The impact on the NHS as an attractive workplace is staggeringly clear – there are 112,500 vacancies. How can an organisation charged with the care of our most vulnerable in society – our elderly grandparents, our sick children – be effective or safe when it is missing this many front-line staff? This woeful workforce strategy is rescued by bank and agency staff which are expensive. Between 2018/19 and 2021/22, bank staff costs have risen by 51% (from £3.45 billion to £5.2 billion) and agency staff costs have risen by 23% (from £2.4 billion to £2.96 billion). 

We can see the impact. The UK has fewer doctors and nurses per head than most of its peer nations and it is expected waiting lists will hit 8 million by Summer 2024. This lack of capacity to deal with patient demand is the direct consequence of political decisions dating back to austerity in 2010. From 1997 to 2009 as a percentage of GDP healthcare spending rose consistently from 6.8% to 9.8%. However, from 2010 this flatlined until the COVID-response in 2020. By 2019 the UK was below average compared to peer countries on health spend relative to GDP, putting us below America, Germany, France, Australia and Netherlands. The public is feeling the pinch – overall satisfaction with the NHS fell to 29%, representing the lowest level of satisfaction on record, with 51% of people dissatisfied with the NHS. We are now numb to the annual ‘winter crisis’.  

A report by the TUC shows that 31% of health staff have taken steps to leave their profession or are actively considering it, with 50% of staff saying the government approach to pay is a driving factor. Let’s consider carers who have a starting salary of £14,000 a year, which goes £25,000 on experience (roughly £12 per hour). These people look after our most vulnerable, feeding, bathing, dispensing medicine and taking clients to the toilet. They work unsociable hours and take on health, safety, and legal responsibilities for those in their care. But many are looking elsewhere – some are seeing working in a supermarket as more attractive, a true indictment the erosion of the value of care in this country. Then take our doctors. Many choose this career at around 16, and the journey requires excellent academic results, completion of a gruelling 5-year degree which loads them with student debt as high as £100,000, before undertaking a strenuous and competitive training program. Within highly pressurised environments these young people are thrown into the coalface, quickly facing life-or-death scenarios requiring snap-judgements within under-resourced environments. Our doctors look after sick children and patients with cancer; they deal with death daily and do so while supporting bereaved, emotional and angry family members. They are accountable and responsible for prescribing medication to alter our physiology, and they perform surgery – literally cutting up our bodies to investigate our problems, adding devices to help us and removing tumours that will kill us. It is widely known and sadly accepted that high levels of workplace stress is commonplace and they deliver care within organisations known to be “toxic and corrosive”, facing internal bullying and harassment as a part of the job. Junior doctors start on £32,397 and can – assuming there are no career breaks – make it to Consultant within 6-8 years which earns them between £93,666 and £126,281. This is frequently compared by some sections of the media to the average salary – but this shallow comparison misses the point. Their skills and qualities of intelligence, judgement, resilience, and compassion are exactly what we should be harnessing for our future NHS workforce. But numbers do not lie – UK doctors are increasingly looking abroad and bright, highly ambitious students will consider what they could earn if they chose a different path, such as plying their talents in the City. 

We must be clear with the public – this race to the bottom on wages will drain the NHS of its most important resource, undercut its ability to perform its core function, and make it more prone to mistakes. These consequences are felt by us all, especially those who need help the most. 

A new government must set out a new vision for public healthcare in this country – raising standards, expectations, respect, and the value of our front-line healthcare workers. 

We can do this by: – 

  • Reforming the NHS Pay Review Body (NHSPRB) – today this body merely recommends pay changes that a government can ignore or hide behind. These decisions should be made by those who know their organisation the best, knowing what is needed to attract and retain talent for the long-term. 
  • Significantly expanding the scope and means of the Key Worker scheme to ensure every public sector health workers benefits from preferential mortgage and rental support. 
  • Introducing meaningful worker representation in the boardroom – modelled on Germany’s policy of co-determination – including NHS Trusts. 
  • Nurturing a culture of ‘citizenship’ by getting young people engaged in front-line public service. This can be done by transforming the National Citizen Service and UK Year of Service Programs into a school-leaver program, encouraging young people to complete a domestic ‘gap year’ for 1-2 years putting their energy into a range of public, voluntary and charity bodies. In exchange, those completing the program would receive financial support for University fees, Further Education or work-based training. They would gain valuable hands-on work experience in front-line and business placements, building a network across the country with other young people and employers. Such a program, done well with a reputation for high-quality training and results, could build an ethos of citizenship, transform the profile of public service and deliver a strong message that public service is rewarded. 


To read more from Adam, see Repositioning Childcare – A silver bullet for prosperity.