Episode 1: The nursing role & the NHS pay deal

Welcome to the Feminist Nursing Pod!

In this episode we discuss public perceptions of nursing and the NHS pay deals past and present.

All views discussed in the episode are our own and do not represent the opinions of our employers, trade unions, or professional bodies.

Music is by friend of the show Chris Catalyst, and you can find us on social media @femnursepod

Links to media discussed:

2009 Guardian article

Owen Jones Tory Party Conference video

Transcript

L: Do you want to hear the incredibly insulting but hilarious thing that my colleague said to me when I told them I was doing a podcast? So I was like “oh, guess what I’m doing? Isn’t this exciting?” And then one of them went “isn’t doing a podcast just the new sourdough starter?” [laughter] And they’re not wrong.

[intro music]

All: Welcome to the Feminist Nursing Pod, tackling the bullshit affecting our practice. We are Holly, Lindsay, and Ruby: three badass feminists here to ruin your day.

R: All views discussed in this episode are our own and do not represent those of our employers, trade unions, or professional bodies.

So welcome to our first episode, our maiden voyage into the podcasting world. We thought we’d start with a few little introductions into who we are, how we got here, because, you know, it’s been a long road I think to getting us to record.

So I’m Ruby. I’m one of the co-founders of the Feminist Nursing Network, who are an intersectional nursing platform that tackle feminist issues, amplify the voices of people doing some amazing work around anti-sexism, anti-racism, and work in the UK and internationally. So I started that with Lindsay, and we go back – what is it, twelve years? [Lindsay: It is.] That we’ve known each other. Heck! We trained together originally, and met in a moshpit!

L: Yes we did – Biffy Clyro!

R: Yes! Oh god!

L: Our maiden voyage into friendship.

R: It was so long ago! I know. Yeah, we were in the same seminar group. And then, we went to the same gig, didn’t know each other were going, and the moshpit split, and we saw each other, and from across the- we were like “it’s you!” And we’ve kind of been inseparable ever since, and a kind of fearsome duo I think.

L: I would agree.

R: Yeah. And Holly, who I fangrrrled, I think, about so long-

L: I’ll agree with that Holly, because they haven’t stopped talking about you. Ever.

R: Oh don’t! You’ll make me sound like a creep.

L: It’s not wrong.

R: Not wrong.

H: So yeah, I’m Holly, and obviously we’re at opposite ends of the country, but connected, essentially, in the crazy social media world where we all spent so much of our lives in the last eighteen months. I kicked off NHS Workers Say NO, which is a campaign for pay justice for NHS workers. Obviously working in a predominantly female workforce, I spent a lot of time thinking about how – especially being a female pay activist – how we were treated in the media, how we were treated amongst our colleagues, by being essentially really vocal, really loud, and agitating and organising and mobilising and essentially saw what Feminist Nursing Network was saying on social media too and thought “yeah, these are pretty awesome”, and kind of linked up that way, and got talking and then we were like “how can we get this message out?”, and thinking back to how female nurses are treated in the media, and how we can talk about this important stuff, really, and that’s how we came up with a podcast! And here we are: on our maiden voyage.

R: Yeah. Lindsay, do you want to come in?

L: Yeah I suppose I should say that I’m Lindsay – the other person of the FNN that’s on this podcast. I’d say that I was brought in because Ruby can’t use Instagram, so that’s essentially what I do. But then I also can’t take any credit for any of the Twitter stuff, because I won’t darken those doors.

R: That’s – you know, preserve your mental health, is all I can say.

L: Exactly. But Instagram is really good when I actually do update it, you know. I’ve been a nurse for lots of years – worked in Crit Care most of it, and essentially just get incredibly cross every day about how, once again, nurses are tret in our everyday lives, because we’re a predominantly female workforce, from essentially every single person in the NHS and the government, which has led me to become very angry.

R: Mm. And I think as well, for those of you who maybe don’t know the FNN, or – we’re coming to do this podcast obviously for the first time; you don’t know any of us really – so I have a background in gender studies as well; it’s one of the things that I teach to nursing students to some extent. And I think that there is also this overlap of it, like it is a predominantly female workforce, but also the work that we do is incredibly gendered. Like, a lot of care work, a lot of mental and emotional labour that is really hard to make a product, to sell on. And it’s also kind of valuable to not acknowledge it as work, because it means that you can pay less for it; you can constantly undercut or devalue care work in society, just because you go “oh, well it’s women’s work and we can’t make a profit from this”. I think that there is a big calling in nursing activism at the moment and in discussions about the pay deal, around that. I don’t know how you fall about that, because that’s kind of my take on it.

L: Yeah, I think that is exactly what it is, and I think (and I’m sure we’ll get into this later on in the podcast), but it’s fully realised in how we’ve been praised as these “angels” and these “Covid heroes”, so they haven’t had to pay us. Like I’m a hero because I’ve essentially turned up to do my job. Which I’m very good at, but you can pay me for it! I have hobbies; I have things that I don’t need to- I wouldn’t work for free. And what they’ve done is to frame us as these people that have gone to war, and all this horrible kind of messaging that they’ve given, so that they can turn around and do this now. And it’s like banging my head against a brick wall, especially when you’re watching it happen.

H: Yeah. And it just completely devalues our profession, our training, our education, our skills. You know, as recently as the Labour conference a fortnight ago, Keir Starmer was giving his speech and speaking about the wonderful care that his mum received, and you know, that day it was his mum; another day it would be someone else’s mum. A really important message in that sense, and then he referred to it as our “calling”, and I just thought “ah, no!” We’ve got to stop that. We’ve got to stop that, because by feeding into that narrative that it’s our calling, it’s because we care, the stuff Lindsay said, the angels, the heroes, the going to war, you know. That in turn then makes people call us greedy when we say we want fair pay. When we’re campaigning for equal rights at work, when we’re campaigning for all of this stuff it’s like “well you know, but it’s your calling”. And that’s a really important thing that we have to be stamping out.

R: Yeah, I think as well, as somebody that did leave the NHS because they were so burnt out, even before Covid, to hear back that “well it’s their calling” – it kind of hit something quite deep in me of being like “well actually, I’m exhausted. I have nothing left to give”. If this is my calling – because a lot of people do feel called to come into care work, or you know, you’ve got a personality that suits doing that really intimate and emotional work with people – if you then don’t feel able to provide that anymore, well, what is my destiny? What should I be doing? Or should I just suck it up and keep going, despite knowing that it’s draining my mental health, or I’m not able to get out of bed, but don’t worry, it’s your calling. I don’t know, for me there’s just so many- oh it’s just gross!

L: I just hate it because it wasn’t my calling. Does that mean that I’m not a valid nurse? It was a free degree – which again, we could do a whole episode about the fact that it’s not a free degree anymore. I come from a tiny little town in the backwater of Cumbria: I wasn’t going to university if it wasn’t getting paid for! It’s awful – I love my job, but it’s not a calling: does that make me not a valid nurse? That’s why I just find it incredibly frustrating to hear it.

R&H: Yeah.

R: I guess then it doesn’t acknowledge, like you say, it doesn’t acknowledge that class overlap with nursing, which is historic and current. The leader of the Labour party saying that? Fuck off.

L: Well yeah, I think there will be plenty of people who say they like their job, but it’s not their calling, and that doesn’t mean it’s any less valid as a career choice. Why can’t nursing just be a career choice?

R: Why can’t it be both?

L: Why can’t it be both? It doesn’t have- well that’s the point. So every time I hear that you were called to do it, or “it’s all I ever wanted to do”, I just think “well no, it wasn’t”. I fell into it. As did my mum.

H: Yeah, and I think that ‘s the same for a lot of people. Me and my partner, we’re both nurses, and as you said, we could probably do a whole podcast around the fees and the bursary and how training has changed for nurses over the years: that’s a whole separate thing. But we’ve both said we probably wouldn’t have ever come into the career if we’d have had to pay, if we hadn’t got the bursary, and so yeah, you’re right: if it wasn’t your calling, that you were drawn to the NHS, does it make you less. And then back to what you were saying Ruby, about how you’d left the NHS to go into education. What does that mean to you? And I’ve spoken to people who have left nursing, who have said that there is real NHS guilt and this nursing guilt when you leave the profession, kind of how you’re left feeling afterwards, and it is all around that narrative I’m sure, so much of it.

R: So that’s a little introduction into who we are. Do we want to- so a lot of our first episode – I guess we could call it a series – is going to be looking at the pay dispute, historically, and where we’re at now, and our possible responses, possible activism, around the pay dispute in the NHS, and I think probably in the whole public sector at the moment. Do we want to talk a little bit about the history, like how did we end up here?

L: Yes, that sounds like an excellent idea. Only because that’s the bit that I’ve been doing my reading on! I will preface this by saying, just to keep in with the theory of the NHS is that I planned to do quite a lot of reading yesterday and then we were three doctors down and ten nurses down, so I didn’t do as much reading as I was planning, but if anything, it feels topical! I was going to kind of start just by acknowledging when the NHS was created in 1948, by our lovely Nye Bevan, and how it was met with wide outrage really, from the Tories. And also, interestingly enough, the BMA, the British Medical Association. Now I tried to look into this, and I couldn’t see anything really from nursing groups. I think, in 1948, nursing groups weren’t really a thing. Because, you know, we had the doctors [sighs]. I couldn’t see a response from them, but essentially the BMA were really against it: they thought that it was going to ruin the pay, make the lower classes be lazy and unfettered, I think is a word that I read, and that doctors would lose out really. To which Nye Bevans’ response was just to pay doctors an incredible amount of money. Which is insane, isn’t it, in the context of where we’re at now, to think that at one point we did value the NHS, or the government, I should say, did value the NHS, and realised that the way to keep people in it was to pay them properly. And I don’t know, maybe it’s just me, but I was just reading about it, and I think I’d forgotten, or I’d just never worked in an environment where the government wants to pay me properly for my labour. And so just to hear that that was how the NHS was created, is crazy for me. And Nye Bevan used the phrase “let them sleep in gold”. That is the phrase he used, that he gave the BMA, so that he got doctors on the side. I just thought it was very interesting to see where we’re at now, which is-

R: I love the idea- I know it was a misspeak, but the idea of Nye Bevan having doctors “on the side” [laughs].

L: Yeah! [laughs] I mean, maybe he did? I like to think that. So yeah, it was just a little start really. I think because the doctors’ union was threatening to boycott the NHS right up until kind of February, before the April it was created. They were really, really against it, and it was only because they paid doctors so well that the union really didn’t have- well, the association didn’t really have any members left to help them boycott! Which is just unimaginable now, when you think where we’re at. And obviously I appreciate the NMC isn’t a union, but as our body, there’s no-

R: Mm, yeah, because nurses were registered from, was it 1919 I think?

L: Something like that, yeah.

R: So, if we think about the way that doctors were treated then, and how they were brought on board: previously they would have had their own practice, and they could have charged people, and they could probably establish their own rates. [Lindsay: Yeah.] And then, to then go and be waged and work in a public institution would be potentially a massive pay cut and a massive change in their autonomy, practice wise.

L: Yeah, absolutely.

R: I can see that there would need to be an incentive to come in. Compare that to now – and I know this is a nursing podcast – but compare that to the pay that consultants have been receiving over the past decade: we have some of the worst paid consultants in Europe.

L: I think that you should just compare it to the fact that, if you think- just to put it in a very simple way to think about it, is that the government recognised this need for doctors for public health, and they went “well, I need to pay them; I need to incentivise them to stay”. Whereas now they’re like “we recognise the need for doctors and nurses to provide public health, but what we’re going to do is cut their pay, and accuse them of not paying patients when they are”. Which just- I just found the contrast incredibly stark.

H: Yeah, and now we’re left with the situation where we’ve got around a fifty thousand shortage of doctors, and we’ve got the lowest amount of doctors per capita across the whole of Europe. And then, as you say, people struggle to get appointments with their GPs, and struggle to get appointments with consultants when referrals are made, but you know, it’s no wonder that people are struggling to get appointments, and that’s the same across the whole of the NHS isn’t it, across all of our services.

R: And do you know, because it used to be that we had the fifty thousand nursing shortage as well, and I think those numbers have come down, but if that were-

L: I think we’re at thirty thousand at the moment. A very quick Google search is still quoting us up around at the fifty thousand nursing shortage.

H: Yeah, the rough figures released this says that we’ve got a shortage around- it fluctuates between about forty and fifty thousand. But they’re giving figures of around one in ten – that’s vacancies – one in ten in acute services, and one in five nursing posts are empty in mental health wards, which is dangerously low.

R: Wow, yeah.

L: It’s interesting as well, and I think- so I’m advanced practitioner, and they will have definitely counted me as a qualified nurse working in the NHS, but I’m not on a nursing rota; I’m on a doctors’ rota, so you can’t necessarily count me as someone who is providing nursing care in its traditional form, or its essential form.

R: Yeah, definitely. Especially when, like you say, the role of the nurse has expanded massively, and it’s changed differently as well, so you do still have that kind of classic, bedside nursing, but you also have advanced care practitioners like yourself, corporate nurses, nurse educators, modern matrons: people who aren’t necessarily going to be providing direct patient care, but are still essential to the running of services, or the work that they do might look different, so if anything, we probably need more nurses than we actually think we do.

L: Yeah exactly; I think it’s about highlighting where the shortages are. But it’s interesting isn’t it, because I think you have to acknowledge why nurses are moving away from the bedside as well – not that there’s anything wrong with moving away from the bedside; I certainly can’t judge anyone! But, are nurses being pushed to move away from the bedside, because actually their pay is probably going to improve, or their working conditions are going to be improved, when actually they would have stayed at the bedside. And I think that just brings us back to the pay dispute, doesn’t it?

R: Yeah, certainly for me one of the reasons that I wanted to move from a Band 5 to a Band 6 is that I would get paid the same amount that I was earning on a Band 5 wage, but I wouldn’t have to do any overtime. I could literally work my thirty-seven and a half hours each week, and take the same amount of pay home. [Lindsay: Yeah.] Which, you know, frees up a lot of my weekends – a lot of my life!

L: And then it comes full circle back to it, doesn’t it, “well, it’s a calling – why do you want your free time?” You should want to do overtime to help out, not because you get paid for working- horrendous hours as well, like I love my twelve-hour shifts; I love having days off during the week, but they’re really hard work!

H: And I think the twelve-hour shifts that came into force – I’m not sure exactly when, within the last five years, isn’t it, that they’ve come into force everywhere. I would argue that those shifts- they disproportionately affect women as well, especially women that have taken maternity leave and have a family. We know that women take on the majority of the childcare, and those sorts of shifts: they’re not flexible for women who have had children. I remember returning back to work after having my first son, and he was nine months old and I was straight onto a rota of working nights and then twelve-hour shifts, and I was like “this isn’t workable for me, whatsoever”. So we’re offered quite often little to no flexible working options.

I think things are improving, but it’s still not great, and I think that’s why we then often end up with a lack of women in senior roles within the NHS, because we then often have to step off the shifts; we have to step away from some of the commitments that come with the job, and then that kind of narrows room for promotion for a lot of women, and we know that there’s a real lack of women in senior positions within the NHS.

R: Yeah. Big shout out to FlexNHS for the work that they’re doing around making better working conditions and better rota conditions for people – not just people with childcare and stuff, but it’s to everybody, because it is so rigid.

H: Yeah.

L: That does actually bring me quite nicely into the next sort of thing that I did a big reading on. And I can’t believe that the two things I did reading on have been essentially doctor-based [laughter], so apologies to anyone that’s listening who thought this was all going to be nurses. But you know, we’re all one NHS, right? But I think that if we want to talk about things that have been relevant in, certainly my nursing career, which is coming up to ten years, the big one was the junior doctors’ pay strike. I think that you’ve done a bit more reading about things like Project 2000, Ruby,   but that really is before our time. It certainly affected us, but not something I was fully aware of.

But the junior doctors’ strike, I was in the midst of being a nurse and had solidarity with my colleagues. But that has disproportionately been shown to just affect women who are doctors, for those that don’t know about the doctors’ strike, it essentially happened in, I want to say 2016, and the government basically jumped on one headline that was in the Daily Mail, of course, that said that nothing happens at a weekend and more people die, which has been now proven to be absolute nonsense. And so the government jumped on it and said that they were going to change everyone’s contract, so there was going to be much more people around at the weekend, and everything was going to happen and you could get that outpatient podiatrist’s appointment on a Sunday evening at seven o’clock if you really wanted. And the biggest thing that affected everyone’s pay is that they changed the pay scales, so you got paid according to grade, a bit like nurses: Band 5, Band 6, instead of how long you’d been a doctor. So there were doctors who had children, so while their training post still had “time served”, for lack of a better phrase, and got paid well, whereas they suddenly took big pay cuts. And obviously that does disproportionately affect women.

And a strike happened and there was lots of solidarity, but it did unfortunately ultimately pass. And every doctor I speak to now, just- it’s awful. You know, they can do a lot less paid overtime; it’s just a bit rubbish.

R: Wasn’t that the Jeremy Hunt era as well?

L: Of course it was the Jeremy Hunt era!

R: Where the amount of NHS spin was appalling at that time. I’ve just tried to look it up and I can’t remember the name of the MP- I remember there being a really big newspaper article about how this MP went to a minor injuries unit! A minor injuries unit at the weekend, and complained that he didn’t see a doctor. And it’s like, you’re going to a minor injuries unit; it’s nurse-led; you’re not gonna, and you don’t need to. So instead of celebrating the work that the nurses had done, all the training, all of the skills that were put into giving this guy some crutches, it was the shock that, you know, doctors weren’t working at the weekend.

And I’m sure I’m not alone on this, but I remember looking after somebody that had come into hospital with a GI bleed, and said to me “well, my symptoms started at the weekend, but I didn’t want to bother anybody because there’d be no doctors here”. And I was just like, “if something had gone pop, if your symptoms had been worse, would you have still not come in? At what point would you have to have passed out and your husband called for an ambulance?”

Potentially that news article and that spin killed or potentially harmed so many people, and again, there was no discussion about the work that nurses do at the weekend, and the way in which so much of the NHS is led by nurses, and nurses in those kind of, often not banded senior roles, but who step up and take that leadership and provide that care, and are able to assess and escalate to doctors when they are needed at the weekends.

L: But yeah, I think that it once again just goes to show how much the government places on a name, versus any vague understanding of how the NHS works.

H: Yeah, and I think then falls back- we keep falling back to it, but that narrative of these sort of bedside nurses, who it’s their vocational role: mopping people’s brow and changing their sheets and hand-holding. And all of those things are really, really important parts of nursing, but nurses are also highly-skilled professionals as you were saying, Ruby. The role has changed greatly over the years, and the responsibility that nursing staff take on has increased hugely, and we’re multi-skilled professionals, and I think that the narrative that’s fed around us means that many people don’t understand what the role is at all.

R: No. When was the last time that you changed some bedsheets, Holly, for a patient?

H: Oh, like fifteen years, I would say.

R: Yeah, exactly.

H: Probably not since I was a student, if I’m completely honest. I don’t think I have since I was a student. I’m in community nursing now, but it’s not the job that a lot of people think it is.

R: Exactly. And I think if you have that image of what a nurse is, in your head, if you are then told “oh, I don’t change beds, I go and I do assessments, or I do that kind of real care management side of stuff” – people don’t understand that that’s part of nursing.

H: No.

L: Or I mean, I bet you get it as well Holly, but how many times, when you have to explain your job role to someone but it’s not what they’re traditionally seeing as a nurse, they’re like “oh so you’re one of those that’s too posh to wash!”?

H: Yeah, that bit does come up.

R: I just get told I’m not a nurse anymore. Like, well if you’re working in education and lecturing then you’re a lecturer; you’re not a nurse. And I’m like, “I’m both!”. Like this- [laughs]

H: Yeah. And you know, within our team, it would be, you know, if a prescription needs writing, ok, one of my nursing colleagues that’s a nurse prescriber can write that prescription for you. “Oh, ok, right!”

L: “Oh, so you write it and then the doctor will sign it?” No.

R: Oh dear.

H: Yeah, you can just do their job for them, and then leave them a little pretty pile of prescriptions for them to sign.

L: And also make sure they’ve got a fresh coffee every day, you know. [Holly laughs.]

R: Fucking hell! That is going back to- because you mentioned there Lindsay, about Project 2000, and that is where that nurse prescriber stuff started coming in, and admittedly we’re not all going to be nurse prescribers, but that is where our role started expanding or- the work that we were doing before Project 2000 actually became acknowledged and validated, and allowed us to move forward with a much more- I guess professional identity, that was more uniform in some ways, and a bit too homogeneous in other ways.

And I’m not saying that Project 2000 was a panacea, because it also was the start of when the NHS started to become more privatised. But it’s like all of those things- all of those changes have happened in nursing: we’ve had way more responsibility put on us, bigger roles; we are now taught in universities, in academia; we all should be working with degrees, or diplomas for our nursing associate colleagues, and the work that we do is in no way remunerated for that level of skill that we have and for that level of responsibility that we have in practice. Because people just don’t know what it is that we do! [laughs]

L: It is true, and there’s been no- the role of a nurse changes, like on a daily basis, I would argue, depending on how short-staffed the NHS is on everything else, but there’s been no reflection of that in any media that we watch, read, consume. There’s been no real reflection on that, and when nursing’s advertised to people: you still look at when the NHS did all their advertising, of kind of like “come and work for us”, and all the snapshots of the nurses were like them caring – it was really still very gendered, very- they were all women; they were all like my mum’s age, and they were all helping people get out of bed. All of which are fine, but there’s been no change of reflection of all the wide scopes of things that we can do.

R: And there are lots of female nurses that help people get out of bed, you know.

L: Not me. [Ruby laughs.]  Not me; I trip them up.

R: I mean honey, you’re not female, so it’s-

L: Oh yeah! [laughter] So it’s fine for me to trip them up. [Ruby laughs.]

H: Well I’m a learning disability nurse, and most people don’t even realise our branch of nursing even exists!

R: I mean how many universities even provide that level of training these days? I think it’s- you maybe have one for each region?

L: Really?

R: Yeah, LD as a field; the training is limited, so I think for Yorkshire, or certainly West Yorkshire, I think it’s only Huddersfield that provides learning disability training.

H: Yeah, it’s reduced massively. There’s only- I think it’s somewhere around seventeen thousand learning disability nurses on the register.

L: Gosh, I had no idea.

H: Yeah, there’s very few. There’s a massive shortage. And I think a lot of people think that there’s just three branches of nursing: adult, paediatrics, and mental health, and people think that people with learning disabilities just fall under mental health services rather than acknowledging that it’s a specialist role in itself.

L: It’s really interesting as well; I’m just reading- I’ve gone really back in time and just reading the Guardian article when it got said that nurses could only get- only had to get degrees. Just I think to encompass what we all have been discussing about, if you don’t mind me bringing a quote in, the Patients’ Association response was that “the basics of nursing care are dignity, compassion, and, above all, safety. Since the introduction of Project 2000..., which shifted training from the bedside to the classroom, nurses look to the personal prizes (such as) nurse specialisms and have been allowed to ignore the needs of their sick, vulnerable, and often elderly patients. These new proposals (the degree) risk making the situation worse”. [Ruby sighs.] “Making it degree-only sends out the wrong message”.

R: So they’re concerned about safety in practice, but yet they don’t want highly-skilled, evidence based nurses.

L: I mean, I say their concern – this article’s from 2009; they’ve probably disbanded at this point.

R: Well, they have or they’ve changed their tune.

L: Well yeah. “The academic must be secondary to the practical. Only then will patients get the nurses they want and trust – the ones with the right attitude”. So, none of us have the right attitude, which is true for me, but you two seem ok.

R: Oh, I feel like my brain just melted.

L: “It must never become more important to write about care than to give it. If our nurses do not have the basics of training,” your favourite phrase there Ruby, “the costs of care will soar because of infection rates and overblown bureaucracy”.

H: Then you just go back to a lot of what we’ve talked about before: why can’t it be both? You know, we can be degree-educated professionals and still have those skills and bedside manner and all of those caring attributes that bring people into nursing.

L: It just brings us completely full circle, doesn’t it, to- it’s a self-fulfilling prophecy: we’re all angels, therefore we don’t need degrees, but they do want us to be well-educated, but we still have to be angels, so they don’t pay us any more, and it’s a calling. And it’s just this huge self-fulfilling- until the view of our profession, and how nurses are presented to the wider world – it seems very difficult to see how this will get better. Not to bring the podcast down!

R: We did say we were going to ruin people’s day.

H: But it’s kind of why we’re here talking about this isn’t it, because it’s all of those things you explained, Lindsay, but then you mustn’t talk about it! You mustn’t be vocal; you mustn’t speak in the media; you mustn’t tell people what’s actually happening on those wards, what the reality is like.

L: You mustn’t tell your patients that there’s actually sixteen of them being looked after by one person. Who we don’t want to be degree-trained or have any other extra training, to make them at least just about able to manage that horrendous workload. But they also have to be happy about it because this is what they asked for; this is their calling.

R: And we’re not going to pay them any more for it – they’ve just got to accept their lot. Absolutely.

There’s kind of like the feminist critique in me-

L: Here we go!

R: I know right. Bringing it all back!

L: The fun’s here!

R: [laughs] Fuck you! I guess for me it’s thinking about- there are these real, on the face of it, binaries between: you’re either a hero and an angel, or you’re a gobshite, or you’re lazy, or you’re too demanding. I kind of feel a bit like it serves a purpose, certainly to the government at the moment, to keep peddling that idea, because the more that we just keep separating nurses out into these two categories, you don’t have to look at the problems; you don’t have to acknowledge our working conditions. We don’t have to be listened to either, because we’ve either got to be praising the government and saying “thank you for clapping us and giving us inadequate, terrible PPE! Oh, how can we ever thank you!”, or we’re going to be shut down because we’re protesting outside Downing Street, or we’re organising within our workplaces, or our unions are too gobby. It just never gets to the heart of the argument, and we don’t really get beyond it, to say like, “fuck you; pay me”.

L: I think, just on the back of what you said as well, that whole separating nurses into two groups: I think it’s interesting at the moment what’s happening as well with separating nurses into one big homogeneous group, versus the rest of the NHS, because once again it’s that kind of- well, and we’ll get on to talking about the pay deal we’re being offered at the moment, but it’s been offered to all NHS staff that are banded; it’s not just nurses, but it’s very much like “the nurses are complaining. The nurses, whose calling it is, who are angels, who are actually just gobshites, are complaining. And why can’t they be happy? No one’s getting paid enough; it’s been a hard year – look at all these other great NHS staff that aren’t saying anything”.

Well actually, if you talk to dieticians, physiotherapists, occupational therapists: people who came and worked on the front line of the pandemic, and I hate the phrase “the front line” – there wasn’t a war, but you know, came and helped me on Intensive Care, who had never done anything like that before in their lives, deserve to be paid more too, and they think that as well. But what they’re doing is separating it in the media, and the government’s making sure it seems very much like it’s the nurses that are moaning. Everyone else is happy, so we can ignore the nurses. And that is just simply not true.

R: It’s why I rolled my eyes at that “one NHS” phrase.

L: Oh, I hate it.

R: It doesn’t exist. You’re told, “oh, we all work as a team; we’re all one institution”, but we’re never tret like that.

L: I’d also say, have they never met an orthopaedic surgeon? [Holly laughs.] You can cut that out! But I’m not wrong! [laughter]

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R: So I guess then over to you, Holly, because this is the stuff that you really know about; this is your activism, probably with the majority of the work that you do outside of work.

H: Yeah. So as most people listening- well, I say most people listening will know; maybe not everyone will know. We were offered- well, we weren’t offered; we were given the pay award of three percent this year, so-

R: Did it start off at one percent – am I remembering that correctly?

L: Yeah.

H: Yeah, so the government were recommending one percent, and then the Pay Review Body came back with the recommendation of three percent, and then the government went with that. So the Pay Review Body are a supposedly-independent body who make the recommendation on what we’re paid, but they are a government-funded, run-by-government body. But the trade unions essentially submit evidence and make recommendations to the Pay Review Body, and they review all of that and come up with what they recommend our pay award should be. The government don’t have to do what the Pay Review Body say – they could have stuck with one percent. They went to three percent. So everyone’s going to have seen that in their pay pack by now, and received back pay. Have you had yours Lindsay?

R: So, because it pushed me- I’m lucky to be on a higher band, but because it has pushed me into the 12.3 percent pension, or 12.5 percent pension – I can’t remember which one – I got five hundred pounds of back pay, and six hundred pounds of pension arrears, so I was actually a hundred pounds worse off. Ruby was there as I opened my pay packet, and has heard this now many times – I’m so sorry!

H: Yeah, and I’m in a very similar position to you, when I received mine. And I think a lot of Band 3 staff have been affected in a similar way, because they were pushed up into the next bracket for pension contributions.

L: So shit.

H: So, yeah. But then we know with the rate of inflation, with the National Insurance increase, we know that it’s a real-terms pay cut.

R: As workers we shouldn’t be forced to choice between whether or not we opt into a pension or we can afford to eat – that’s ridiculous! And if that three-percent increase is going to affect our pay in such- a significant but equally, ultimately meaningless way, that’s not a pay increase in real terms at all.

L: Well that’s it, isn’t it? Doesn’t it work out about seven percent actually in real terms a pay cut? Isn’t that what we’ve had, over-

H: It’s even more than that. I think for some- obviously it varies per band, but it’s up to twenty percent in real terms. And I think the bit that frustrates me a lot – well, one part of it – the government talk about “we’re giving this three-percent pay award as recognition for efforts throughout the pandemic”, and I think we have to move away from that. Obviously the past eighteen months has been unprecedented and extraordinarily difficult for everybody working in the NHS – well, and other people across the country of course, but thinking in NHS terms. But this is about ten years of austerity; this is about ten years of cuts to our pay and to our services, and that’s why we need pay restoration. Obviously we need to consider the efforts throughout the pandemic, but this isn’t a reward for how we’ve worked.

L: And that’s absolutely how it’s being framed. And I don’t want a reward for working through a pandemic, because, not that I went into nursing thinking, “yeah, we’ve definitely got a pandemic coming”, but like, I work in medicine, and nursing, and the NHS, horrible big things will happen. I don’t need rewarding for that; I need paying properly for my work every day.

The Department of Health’s actual release statement about when they put it up to three percent was literally, “NHS staff from doctors and nurses to paramedics and porters are rightly receiving a 3% pay rise in recognition of their extraordinary efforts throughout this global pandemic”. No mention of just our general work – it’s only because we’ve seemingly performed better this time. It’s infuriating.

H: Yeah, and I think even calling it a pay rise offends me. The whole thing offends me and makes me quite angry, but when people have said, “how do you feel about a three-percent pay rise?” - it’s not a pay rise. Three percent is not a pay rise for any of us. This represents further cuts to our pay, and we’re rejecting it, and we’re opposing it.

L: Yeah.

R: Well, it’s like when the government brought in the – and I’m using air quotes here – “bursary”, after they took away the actual bursary: but it’s not real. It’s all just the labels that it’s given to try to hide the fact that actually it’s a real-terms cut.

L: I do think also that you can in one breath be like, “we’re giving you three percent; it’s more than everybody else, because you’ve worked so hard”, and then in the other breath be like, “well, actually, we’re going to put National Insurance up by two percent, and then we’re going to- then with inflation that’s another 3.8, so it’s 5.8 percent rise in your costs of daily living anyway”.

R: And your council tax.

L: And your council tax. Oh, and your Universal Credit is being taken down by twenty pounds, and, oh actually, if you’re a Band 3 and you got that pay rise, you probably don’t get Universal Credit anymore anyway. It’s just- it’s like a sinking hole. Of shit.

H: It is. And I know a friend who recently quit the NHS after nursing for ten years, and like her phrase she just said to me, “this ship’s sinking and I’m not going down with it”, she said. And I do feel like I’m being dragged down. And then to be offered that pay award is just – it’s a complete insult isn’t it? We’ve got, across the whole of the NHS – we’ve discussed vacancies, but across the whole service, we’ve got near on a hundred thousand vacancies. We’re topping five million on waiting lists: it’s unbelievable. Hospital admissions are rising, and for them to offer that at a time when we’re in a recruitment and retention crisis – it’s just unthinkable.

R: A lot of thought as well, isn’t it? Like you can’t tackle those waiting lists; we can’t talk about better-funded services – the work that we do as part of those services – you can’t just have more beds, more hospitals, more services open, without staff there. And if you’re not paying staff to actually do the work, and that pay doesn’t match the work and the labour that they’re doing, of course we’re going to leave; of course we’re going to go and choose other areas to work in where we are valued and paid better and we can live – we can survive within the current economic state of the country, at least- even if it’s not much better, at least it’s more comfortable. At least we don’t have the stress and the burnout that we do within the NHS. And so we can’t talk about waiting lists without talking about staff retention.

L: Well that’s it, isn’t it, and they’re very much presented as these very separate issues within the NHS. Waiting lists are very separate from the fact that we’ve not got enough beds. And the fact that we’ve not got enough beds is very separate from the fact that we’ve not got enough staff. And the fact that we’ve not got enough staff is very separate from the fact that we haven’t had a pay cut in ten years. When actually, they’re all one of the same thing, but they’re never presented that way. And you read any news article, and no one makes that link; no one makes that jump. It’s easy- you probably don’t get this- well you two don’t get this as much as we do, but I find that I forget how little people know about how a hospital runs, because I’ve been in a hospital for thirteen years.

R: Well, I would flip that round and say you don’t know how community runs [crosstalk] there’s just like, worlds that people just don’t know about.

L: Yeah, no, absolutely, what I’m saying is kind of against me really, in that I’ll talk to people who aren’t nursing about this, and they’ll be like, “well, no one got a pay rise”, and to me it blows my mind that they have no- that they don’t know how a hospital runs. But I think I’m just in a kind of bubble about it, because to me it seems very logical that you need more nurses, to make more beds, to bring down waiting lists.

R: Yeah, and I even had to explain this to my brother-in-law, through the pandemic, about this idea of, you can talk as much as you like about opening more beds, about having these “Nightingale” units, but without staff it’s completely meaningless-

L: Please don’t get me started on Nightingale.

R: Because what are you going to do: put patients in beds? And then, you know, “can you just hook up your own ventilator? Do you wanna just do your own therapy session? Do you wanna just auscultate your own chest? Tell me what’s going on”. You cannot have healthcare without workers – it just doesn’t work. You can put more equipment in, but without somebody there to actually use and interpret that equipment, it’s meaningless.

L: Yeah.

H: Yeah. And then we tip into thinking about privatisation as well, which we haven’t mentioned yet [Ruby laughs] – say the “P” word. But we haven’t talked about that, and how our pay is being a lever towards more privatisation. Pay underpins it all, doesn’t it? You’ve got services that are failing. Failing because you haven’t got enough staff, and then they’re pitched as that they’re not performing, and then private services come in, and take them over. I know of a local mental health ward where I work at the moment, and the CQC have actually closed it to admissions due to chronic understaffing. And it’s not that they’re not trying to get staff: they have adverts out – you’ll know this Lindsay – adverts stay out for months and months and months and people don’t apply. So then services are struggling, so then that hospital is closed to admissions, so, people don’t stop getting sick and needing hospital beds, but where do they go? They’ll go to the private hospitals within our county, and that’s how it happens, isn’t it?

R: Yeah, and we can see that in the hip-replacement numbers and figures that have come out recently, that there are more hip-replacements taking place in private hospitals than there are in the NHS. And if people are being forced to make those choices of waiting for care and treatment, or digging deep at a time of real economic insecurity, to receive that care – that’s a dire situation for people to be put in. It think it’s that difficult thing of, well, as you cut NHS services, as you stop a proper pay rise for NHS workers, you’re also opening this market up for private companies to come in and receive more business, and receive public funding because we have to outsource our ability to address those waiting lists, to the private sector, because the NHS itself cannot meet those needs.

H: So, rightly we’ve found ourselves at the position where our unions are balloting around whether we’re accepting or rejecting, and all the results have come back from the ballots of all the health unions, overwhelmingly reject. And every single one has come back with over ninety percent of people that voted, voting reject. I guess the concern is the turnout – the members that turned out to vote. That’s where we need a bit of a shift, mainly hovering around the twenty-five percent mark. I know that GMB in some regions had over fifty percent, but that was only in some regions, not all of them. So there’s a lot of work to be done. RCN have announced that they’re going to be doing another indicative ballot, and we’re waiting to hear what the rest of the unions are doing as their next steps. I’d hope that we’re going to hear some more stuff imminently.

R: Yeah, and that’s the difficult thing around labour laws as well, isn’t it, around having to have now a certain amount of turnout and a certain amount of percentage that are voting and all of this. And I found it really interesting: me and Holly actually messaged each other about- have you watched the Owen Jones video from the Tory party conference?

L: Not yet, it’s on my to-watch list.

R: It’s so worth the watch, just purely because you’ve got the members of the Tory party who are saying, you know, “we want stronger trade unions”, or disagreeing with the pay- well, the offered pay increase. And these were the members of the party who actually brought these trade union laws in, that actually really silenced and limited the work that unions are able to do in fighting for pay disputes and things like that. So it’s a very interesting time, I think, to be going up against the Tories on this. What were your thoughts from that, Holly? Once you got through the rage. Once you’d battled through that wall.

H: I mean, that was a tough twenty-two and a half minute watch.

R: Yeah, I mean, let’s not fully celebrate everything in that video – it was- some of the stuff that they came out with was fucking disgusting.

H: Yeah, but it is an interesting time like you say, to be going up against the Tories. But I think workers are mobilising, and I think a lot of workers are seeing the importance of being in a trade union, and the importance of – that’s how we’re going to take our fight to the government, because I don’t think we can say we’ve got much of an opposition at the moment, going up against them. That’s why workers are getting organised. And it’s going to be really interesting to see how the next ballot results come out, and what steps we take next.

R: So you’re involved obviously in both grassroots activism, and unions, and the Labour party, so where do you feel is most effective platform, or which avenue?

H: Yeah, I think the trade union engagement is where we’ve got to be building at the moment. We’ve tried to lobby the Opposition, the Labour party, a lot around pay, and getting them to back what workers are demanding, fifteen percent restorative pay increase, and we haven’t really had much response. So I think it’s that trade union engagement that’s where we’re going to be able to push it forward, isn’t it? And engagement is increasing. I talk about the ballot turnouts like they weren’t great, but for RCN, the Royal College of Nursing, their turnout was around twenty-five percent, and a lot of people are quite disappointed by that.

L: That sounds quite good!

H: That’s the biggest turnout RCN have ever had in an indicative ballot. And that’s incredible. That’s really something to be building on, and that’s something that should be boosting us and pushing forward, that organising’s working. It is increasing the turnout; it is making more people vote. And it is pushing the unions, I think, to engage with members. I can’t really a remember where I’ve seen unions taking this much action over pay, and engaging with members as much. I guess I’m- I suppose, fully living it at the moment, because I’m so involved in a lot of the pay campaigning, so I don’t know how it looks from your side – I’d be interested to know if from your side, Lindsay, does it look like the unions are engaging as much, or is it just because I’m living in a bit of a bubble of it.

L: Yeah, I’ve not seen much union engagement on our floor. One of our HDUs has a couple of people who are really, really involved in unions, and I think they’ve brought in- and so there are a lot there, but I think for the ones where you’ve kind of got your apolitical, or people who just don’t know a lot – because I will speak up that I do think that it can be quite confusing, and fifty-seven ballots you’ve got to do before you even get to say hello, that sort of thing, can all be really confusing. And I think when you’ve got a workforce that is so burnt out and so stressed, having another thing to engage in – they just don’t want to, or can’t, which I think is very reasonable.

R: Especially when the thing that you’re staring at is so negative, and is like- actually you’re so angry about it, you’re like, “you know what, I don’t have the capacity; I don’t have the bandwidth to be able to tune in to stuff right now”.

L: Absolutely, and I think we’ve all seen so much, to not feel like it doesn’t really make a difference. That’s not true, but that’s how it can feel. And I would say on those units, where you haven’t got someone who’s engaged, other than essentially me who tells everyone to vote, no. Sorry Holly.

H: No, I can imagine that. And you hear people coming at it from so many different angles. I was speaking to a nurse colleague yesterday, and she was saying to me, “well, I don’t feel like I could take much time out on strike, if we got to that point, because I don’t think one day on strike would do anything”-

L: There’s that as well.

H: And I would probably agree with that. So she said, “to take any longer out, my caseload would really suffer”. There’s concerns for people around pay. You know, we’re talking about pay because people don’t have enough money to live, and then we’re asking people to go out on unpaid strike, you know. So there’s so many different things to think about. And then thinking about your patients as well: there’s so many factors that come into it.

L: Well that was it. We could be- You’d like to think we would be supported by our colleagues, such as the junior doctors whose pay, although shit, isn’t currently in dispute. But they did have the benefits of the consultants, whose pay wasn’t in dispute, when they were getting their pay evaluated, to step in and almost pick up their work. Which they did. Nurses, physios, OTs, all that kind of- just don’t have that. And like you say, yeah, any more than one day, and people who have got caseloads gets really big. All that sort of- yeah.

R: And I guess this might be another topic for another episode, but for me, because I also worked during the junior doctors’ strike, and I remember thinking, there’s too much safety net here with this strike. And I think that’s part of why it didn’t work. And maybe there needed to be so that the workers could go out and stand on the picket lines, knowing that the work they were expected to do was being covered, that patients weren’t dying as a result of them withdrawing their labour. But I think it didn’t have enough of an impact because we all support- the NHS supported the junior doctors’ strike, and I mean the NHS as in the workers on the ground, supported the junior doctors going out on strike, and so that mean we stepped in for them. I came in for them, because I did a load of blood-taking and cannulas, and all of these kind of things. And the consultants came in and did the ward rounds, and kept some of their clinics open. And really that didn’t have the impact that a strike normally does. And like I say, this can be a whole other episode, but I think that is such a sticky wicket for nurses, when we think about taking strike action, or think about taking any industrial action.

L: Well I think it’s a really interesting point, and it does once again come to “this could be a whole other episode”. But there is an argument for saying, “do we need to start re-framing how we picture ‘striking’ from a nursing perspective?” - all those things that you-

R: But there are different forms of industrial action that we could be taking [Lindsay and Holly: Yeah.] that isn’t an all-out strike, but would still have a direct effect.

L: That’s it, because you need it to have a palpable effect that people go, “oh shit, if these people don’t work, we’re a bit fucked”. But you can’t ask people who are already worrying about pay to suddenly take a week off without any pay, to suddenly have their caseloads go up by another fifty people and fifty visits that they’ve still got to fit into the same amount of time: to not do nursing.

H: And as you say, there’s different forms of industrial action that can be taken: working to rule – that is a form of industrial action, and that’s something that I hear a lot of conversations about, you know, could the unions ballot on us working to rule. But for anyone that’s been a nurse and has worked in healthcare, it’s all very well saying you would work to rule, but if one of your- if you needed to stay late to do something with a patient, or help one of your colleagues out, or skip your break.

L: Sorry I stopped that CPR, but I had a lunch ready to take. Sorry, you know, I was-

R: Yeah, sorry, it’s seven o’clock, I’m off. Yeah.

L: Good luck! Yeah, it just wouldn’t happen, would it?

R: It wouldn’t. And I think it’s also really difficult in an age where we document everything on line, and a lot of work to rule is that you don’t escalate stuff upwards, so you don’t tell management what’s going on; you don’t tell the execs of the trust what’s going on. But they’re going to be able to access patient records, so it kind of takes away that chaos that we throw management into while keeping the service running itself.

H: Yeah, but it does feel like we need some prolonged action and opposition to this government. As we’ve already said, one day out on strike isn’t going to push them into what they need to be doing to safeguard the workforce. And ultimately it’s the future of our NHS, isn’t it? That’s what we’re talking about here.

L: Yeah.

R: So we’ve touched on a lot there around the role of unions in the pay dispute at the moment, and I think for a lot of us, and from what you two have described, there is this real disparity between what’s actually happening on the ground and what I think the unions are often, maybe trying to achieve? Do you think that’s fair? So going forward with this podcast, the next episode we have is looking in more depth at the role of unions for nurses, and in terms of going up against the government. We’ll hopefully have that episode out for you shortly.

L: And finally make strike action sexy.

R: I think strike action’s really sexy. Nothing gets me going more than a picket line. Mm! [Holly laughs] Do we just want to sign off?

L: Yeah. So, I think we should end this here, because we’ve been talking for two hours and Ruby’s got to edit all this: me and Holly lucked out there. I think we’ll just want to say a big thank you for listening to us – I hope you enjoyed. If you want to hear any further, if you search Feminist Nursing Pod on your social medias you’ll find us, and we look forward to speaking to you next time. Bye!

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