We say we value key workers, but their low pay is systematic, not accidental

If those who care for us are to be first, not last, we have to look at the conditions that drive wage stagnation and insecurity writes Zoe Williams in The Guardian  

 

Military personnel help administer Covid-19 tests for NHS workers at Edgbaston cricket ground in Birmingham. Photograph: Jacob King/PA


This weekend brought the news that two workers at London’s Pentonville prison, Bovil Peter and Patrick Beckford, had died with symptoms of Covid-19. “Symptoms” is nowadays a euphemism for “they weren’t tested”, and a grim reminder of the hundreds of thousands of key workers we are asking the world of, but whose selflessness is not being reciprocated.

These are tragedies laced with guilt for all of us: plainly, the most dangerous place to be during this epidemic is in a densely populated care environment, whether a hospital, school or prison. People work in them because they have a passion, but also because there is no alternative, and they do so on all our behalves.

Prison officers have always been the unsung heroes of public duty: never quite macho enough for the people who glorify the armed forces; always a bit too authoritarian for those who valorise nurses. They are some of the most inventive and diligent people working anywhere in the business of caring for others, but they have generally done so without much credit. 

This crisis is forcing an urgent re-evaluation of that, along with all those other jobs that were previously classed as low-value yet now turn out to be the most important in the country. Words are not enough, and nor is clapping; you can praise care workers to the skies, but if you’re paying them the minimum amount in 15-minute segments, without security of hours or of employment, without sick or holiday pay, then the praise is hollow.

You can wax sentimental about the holy vocation of nursing, but you cannot then bring second-year students on to the frontline to fight coronavirus and still expect them to pay their tuition fees. You cannot claim, as the health secretary, Matt Hancock, told Andrew Marr on Sunday, that this isn’t the right time to talk about pay rises; it is the best and only time to talk about pay rises, when we have finally realised, with a jolt, just how much we rely on people who put their jobs ahead of their own safety.

Yet this is about more than money: Keir Starmer accepted the Labour leadership on Saturday with the rousing Old Testament statement about all key workers, cleaners, paramedics, carers, porters: “For too long they’ve been taken for granted and poorly paid. They were last and now they should be first.” But what would it actually mean to put these jobs first? Money is some of the answer, but we also have to look at the conditions and assumptions that drive wage stagnation and the steady erosion of security.

There is nothing radical in the observation that jobs are often described as low-skill, when actually they are just poorly paid. More radical, yet still accurate, is the assertion that they are characterised as “low-skill” deliberately. Caring is a job of tremendous skill, hard as well as soft. And while there is a huge amount of bolt-on expertise that employers require, from administering medicines to dealing with dementia, this is not reflected in any career progression. It is not unusual for a carer in her 40s to be on the same hourly rate, adjusted for inflation, that she was on at 18.

This has been systematic, not accidental. Without progression, the wage bill can remain reliably static, which is the only way the financial architecture of the sector makes sense.

There is often better progression in public sector work, but the combination of the austerity-years pay freeze and a new normal (extending even to the police) of people at the start of their career being expected to work voluntarily, which itself erodes starting salaries, has had a striking effect on these jobs.

Ironically, Theresa May was right when she famously said that a nurse might use a food bank for “complicated reasons”. Of course there’s a very simple reason – that nurse is not being paid enough. But the feedback loop between the private and public sectors – low pay, insecurity and poor conditions legitimised in one sector and migrating to another – is actually quite complicated.

And there’s an overarching fallacy, that a job many people could do must be inherently low in value. By these lights, huge numbers of people – cleaners, drivers, shop assistants – are without prospects, being so replaceable. The times are testing this assumption to destruction – when you’re looking for the people whose courage we need in order for civilisation to survive, you don’t have to look much further than the postal worker or the hospital porter.
In the immediate term, putting key workers first means personal protective equipment; it means collective and determined effort to strip as much risk as possible out of essential jobs that simply wouldn’t get done if everyone looked out for themselves. But there will be an era after coronavirus; and one thing to carry into it will be a determination never again to think, talk about or treat people as though logic demands they should be screwed down to their lowest possible price.

The final offer made to junior doctors was too generous – they should stop striking and get on with it

Mary Dejevsky in The Independent

You know things have reached a pretty pass in any dispute when the combatants start to invoke the spirit of deceased politicians. But when two men who have reached the top of their political trees also start invoking their own mothers – as Jeremy Corbyn and David Cameron did at Prime Minister’s Questions – well, the possibility of any agreement looks remote indeed.

Yes, after a merciful, but all too brief, period of remission, we are back in the heat of the junior doctors’ dispute. The Labour leader accused the Government of showing bad faith and “misrepresenting” statistics (about hospital deaths at weekends); the Prime Minister returned to his mantra about people not getting sick only on weekdays. Whatever else the Government may be ready to compromise on, it appears not to be a “seven-day NHS”.

And quite right, too.

“Our” NHS is not run for the benefit of the staff, however long they have spent in training, however mountainous their student loans, however arduous and responsible their work. A great many people would probably like to work only Monday to Friday, 9 to 5, especially if highly-paid overtime for additional hours comes virtually guaranteed. But this is not the reality for most people, and there is no reason, when so much in this country now functions 24/7 – with the staff on rotas and little, if any, overtime paid – why it should still be such a struggle to get the emergency services to do the same. Yet it is here the overtime culture has proved most resilient.

There will be those – and I admit to being among them – who saw the final offer to the junior doctors as too generous. By preserving a system of overtime, for Saturdays after 5pm and all Sundays, it leaves in place the idea that doctors can expect to work something like traditional office or factory hours with additional rewards for anything else. Those expectations need to be scotched.

Junior doctors, and their many vocal supporters, have tried to turn the contested statistics about weekend fatalities to their advantage, suggesting that a “cut-price” seven-day NHS would simply raise death rates around the week. Anyone who visits hospitals on weekdays and at weekends, however, will be familiar with the glaring disparity in staffing – at every level, and what sometimes appears to be a surfeit of employees, especially in the least skilled jobs, during standard working hours. There is surely money to be saved here, that could offset the cost of more staff at weekends.

Nor can the junior doctors’ dispute be seen in isolation. Their new contract is just one part – if a large part – of reform of the NHS that is yet to come. If next in line are to be the consultants, for whom the junior doctors are often deputising at nights and weekends, you can understand why the Government might be keen to hold the line.

What occasioned the latest sword-crossing in the Commons was the announcement by the British Medical Association earlier this week that the junior doctors would hold three more days of strikes, and would fight the Health Secretary’s imposition of the new contract through the courts. In the first instance, this means seeking a judicial review.

On precisely what legal grounds the BMA intends to fight is not yet clear. For all the perception that the English judiciary has become more politically engaged in recent years, it is hard to see a judge ruling that an elected government is not within its rights to set the terms of a contract for public sector employees, particular when in line with a manifesto commitment. Going to court is only going to inject more poison into this already toxic dispute.

It is beyond time that the BMA called it a day and recognised that the junior doctors have won as much as they are going to – more than they could have expected at the outset and more, indeed, than may be wise for the future health of the NHS. The BMA’s continued insistence a “safe” seven-day NHS is somehow beyond the country’s means is defeatism of the first order, and really not junior doctors’ call to make. It is the stated policy of an elected government.

That said, the extent to which this dispute has become politicised has made it infinitely harder to resolve. Jeremy Hunt has not just been defending his government’s policy of a seven-day NHS, he has been engaged directly in negotiating the small print of a new contract. This has enabled junior doctors, and the BMA on their behalf, to cast the project as a heartless Tory plot.

The most senior non-politicians – the chief executive of NHS England, Simon Stevens, and the medical director, Sir Bruce Keogh – have both been conspicuously absent from the fray. This may be because, if heads had to roll, the Health Secretary is deemed more dispensable than either of them. But here, perhaps, also lies the key to change. For 10 years or more – most recently in the Conservatives’ 2010 election manifesto – proposals have been mooted to separate the NHS from politics by placing it under an independent board. Policy, such as the creation of seven-day service, and the overall NHS budget would be set by central government, leaving the rest to professionals. Each time, however, a consensus evolved to the effect that the NHS was so integral a part of national life and the sums of money allocated so vast, that there had to be direct political accountability. The scandal at Mid-Staffs augmented that view.

But the downside of the argument is again before us. Junior doctors and a Conservative government at loggerheads; there is talk of relations blighted for a generation. One solution might be for the Government to return to its election manifesto of 2010 and divest itself of managerial responsibility for the NHS. If junior doctors can cast that as a victory, so be it. But there is no reason why the sort of hands-off arrangement that is considered good for the BBC and – increasingly – for schools should not be good for the NHS, too.