This will not be the most popular of HSJ editorials. There is no doubt that most NHS staff deserve an inflation matching, even busting, pay raise – but there are also good reasons why they should not receive one.
In an ideal world, the 1 per cent pay cap for NHS staff would be lifted and they would be rewarded for their work and loyalty during the seven years of austerity. The recent increase in inflation makes the cap even harder to defend and a rise would go a little way toward shoring up crumbling morale and tackling rocky recruitment and retention.
If money is spent on pay, it will reduce expenditure elsewhere in the public sector
But Brexit Britain is not an ideal world. There is massive economic uncertainty and public funding will continue to be constrained for many years to come.
The election’s shock result was meant to mark “the end of austerity”, but in truth even Labour’s public spending proposals were relatively modest.
If money is spent on improving pay, it will reduce expenditure elsewhere in the public sector.
This might happen directly, depending on whether the extra cost is fully covered by increased funding, but the greater danger is indirect.
A pay rise costing billions would create the impression in the public mind that public sector austerity had finished – without one extra nurse (or teacher) being hired or one more ward (or school) being opened – and without a finger having been lifted to ease the crisis in social care.
It would give those in politics and the media who wish to see a smaller state more ammunition to argue that once again the NHS has swallowed a large sum without any real change to its ability to cope with rising demand or any reversal in rationing.
If the NHS – or one supposedly more deserving sector of its staff such as nurses – was given special treatment on pay it would strengthen the Treasury’s case that the NHS has had more than its fair share of scarce public resources and that higher revenue funding to shore up the brutally tight funding settlements for 2018-19 and 2019-20 or mark the service’s 70th birthday is an ask too far.
Pay rises can improve morale, though that is usually short lived
Finally, there is considerable doubt that rises will achieve what its proponents claim. Will an additional take home increase of, say £6 a week, really prevent a nurse working on an understaffed ward at full occupancy from jacking in their job? As the “service in crisis” headlines continue to spew forth, will the attractiveness of a job in the NHS actually be transformed by a marginal increase in pay?
Pay rises can improve morale, though that is usually short lived. What makes an authentic difference to job satisfaction is giving people the ability to work effectively in well resourced teams, organisations and systems. If the government presents the service with an effective choice between more nurses or better paid nurses, the former must be the priority.
Above inflation pay rises have a part to play in this stage of the NHS’s journey. But they need to be tightly targeted at the roles and regions where shortages are creating the greatest problems and, in some cases, adding to the service’s cost burden through the reliance on agency staff.
A change in public sector pay policy now seems to have been written into the narrative of a Conservative Party desperate to be seen as paying attention to the domestic political agenda and the various pay review bodies are likely to be given new marching orders soon.
It would also be unreasonable to gainsay the moral strength of the argument that many relatively poorly paid NHS staff who have seen their salaries fall significantly in real terms should get a healthy boost to their pay packets.
But even if that case wins the day, nobody should be under any impression that it will resolve the substantive and pressing dilemmas besetting the NHS.