Saturday, December 30, 2006

NHS staff: are they really so hard done by?

It is rare for me to disagree with the venerable Doctor Crippen, but I really cannot let this one go.
I think the pay rates at the top end of the NHS are poor. Whether or not you agree with that, I do not think anyone will dispute that the pay rates at the bottom end are disgraceful.

How do you retain such a huge work force when you are paying them not much above the basic minimum wage, when many of them are living in poverty?

The current minimum wage is £5.35 per hour; for a standard 40 hour week, that translates to a salary of £11,128 per annum.

If we look at the Nurse Pay Scale here (and accompanying Pay Scale translator), we can see that a nurse starts on a salary somewhere between £12,177 and £15,107 (one must assume that this scale does not include London-weighting).

The good Doctor is correct that this is by no means a massive starting salary; however I started my first job on £12,500 and managed perfectly well in Edinburgh, a city which is, bar accommodation, not much cheaper to live in than London. In fact, my (admittedly limited) research has determined that, on average, a pint of ale in London is rather cheaper than one in Edinburgh.

However, as I have pointed out endlessly, what nurses do get, that I do not, is a very lovely final salary pension, underwritten by we generous taxpayers. They also get a security of tenure that we private sector workers do not get (although, as I am sure Crippen will point out, due to government incompetence this job security is less assured than once it was).

In other words, what nurses (and other public sector workers) get is jam tomorrow as opposed to jam today. I really don't see the problem with this.

It is far from ideal: I think that we should pay nurses more; after all, if we have a shortage of nurses—as interested parties continually claim—then surely the market would determine that we should pay more in order to encourage more people into the profession.

Fine, let's pay nurses more from the off, but here's the kicker: they forego the final salary pension. You can have your jam today but, since there are limited resources, there will be no jam tomorrow: that's the deal, OK?

This would free up a lot of money in the NHS; something like 80% of the increased NHS funding has been consumed by pay. A good deal of this has been consumed by the pensions: if you raise a nurse's pay by £1,000 a year, a great deal more than one grand then has to go into the final salary pension kitty.

So, all you nurses out there, what do you want: jam today or jam tomorrow?


Rigger Mortice said...

the reality is that in twenty years a large proportion of gvot spending will be going to cover the pensions bill for all the public sector workers-anyone who thinks there's a separate pot that won't need topping up is living in cuckoo land.

what I don't get with all this public sector stuff is if it's so fucking bad, leave and make way for someone who'd like a secure job. and the basic pay is way above 15k.

the fact is we're training people at the mo,doctors and nurses, who are heading off abroad to work as there are no spare jobs.all the fucking whingers are clinging on to them.they know it's a good thing.

look at the firemen.40 applicants for every job and this govt caves in and gives them inflation busting rises for five years.

and in my experience nurses no longer wipe arses like they used,it's left to auxilaries who do deserve more.

sorry for the rant but had to endure some lefty fucker at dinner last night -teacher,doesn't believe there should be any private education,more tax,more asylum seekers.course she's safe,she can afford to be generous with other peoples money

niconoclast said...

I hope for his patient's sake that the good Crippen has a better understanding of medicine than he does of free market economics.

Anonymous said...


Glad to see you are back - and a serious post for narry a rude word.

It's not just the nurses; it's the tpists, the porters, the cleaners, the tech staff and so on and so forth...

And NICONOCLAST - the whole bloody problem with the NHS is that it is NOT run by free market economics; it is an insulated soviet style monolith that is pledged to deliver the impossible - free medical care on demand at any time of the day or night for any condition, however trivial.

Privatise it. Let TRUE market economics control the NHS. You will not find me complaining, provided you design a way to safety net the genuinely poor. Look at the % of GDP that the UK spends on healthcare and then compare it with most of Europe and the USA.


niconoclast said...

Hallellulah! St Paul on his Damascene conversion ain't got nothing on this.Last time I visited your hallowed blog you were on the NHS Titanic and advocating a rearrangement of the deckchairs.

I'll leave it to the Devil to address your last concerns. (The Devil is after all, in the details....)

Anonymous said...

My God, no swearing. I had to read that twice, just to be sure...

Thoughtful post, DK. The irony (for all y'all free-marketeers) is that nursing is now global labour par excellence. In the UK, we are now heavily reliant upon a foreign (and highly experienced - esp Filipino) workforce. If you are trained in emergency or critical care specialties, then every developed nation on earth (and HM Forces - they are 70% understrength in ITU) wants you. Badly.

I wouldn't put too much faith in privatising healthcare, either. Serious carnage and tricky stuff(RTAs, MIs, triple-As etc) favours "all-in-one-place" - something which the private sector has little interest in (compared to production line elective surgery). A more realistic model would be a mixed provision of personal insurance/state funding, with major infrastructure operating on a non-profit basis (a la France, Germany). Not bizarre notions of supermarket healthcare (how does one "compete" in major trauma? Or mental health? Competition in insurance markets is one thing - getting joe public's head injury sorted is another thing altogether. The potentially infinite costs of healthcare warn against both monolithic provision and the kind of insurance-based medico-legal paralysis that characterises the US).

When the NHS is finally gone - and replaced by mad Patsy's fragmented mish-mash - even its detractors might realise how good it was (especially in an emergency). The - generally - sterling work of clinical staff is being fecked up by mendacious politicos and an ever growing army of consultancy goons, anxious to profit from the taxpayer (not least via PFI). It doesn't help that the debate in this country is so dislocated from hard reality. Given your past experiences, DK, would you agree that *everybody would benefit from a bit of work experience as an HCA/Aux Nurse? It might do wonders...

Anonymous said...

Fine, let's pay nurses more from the off, but here's the kicker: they forego the final salary pension. You can have your jam today but, since there are limited resources, there will be no jam tomorrow: that's the deal, OK?


bit more detail please. whats your solution for those who have already worked for 30 years plus of jam tomorrow? a few years of jam today is not recompense for the years of jam tomorrow.
and yes, I've worked as an auxiliary, so i do know what it's like at the bottom (no pun intended)

Anonymous said...


I have not really had any sort of conversion on NHS Economics; I am sure if you fisk every post I have done, you will find lots of contradictions but that is because it is such a diffiuclt area. And it is easy to piss take. Being absolutely serious about it, I think it is essential NOT to start from any doctrinal economic theory. I HATE the "free at the point of entry" shibboleth. It is not true in reality, and probably never has been. The NHS is only "free at the point of entry" if you can get in .... right post code, no waiting list, fashionable disease and so on.

I start from the general principal that all UK citizens should have a decent standard of health care, and should not be prevented from accessing that health care by poverty. So, immediatly, the US system is out. I believe strongly that there should be a charge at the point of entry, and a charge related to the amount of and complexity of medical care that you need. The system needs to be safety netted so that the geninely poor would still have their needs met, but they should still pay something. Even a front end charge of as little as £10 would prevent a lot of abuse. And I would charge all the people who failed to turn up for appointments, and charge them the full economic cost of the appointment.

Provided all the above could be acheived, I do not care what economic system is used. From personal experience however I know that the current government controlled Soviet monolith does not work. Then I look at the USA and see that the private sector insurance companies have control just as invidious as the government. I think that a system where private companies and private hospitals tendered for government work would be better, so that there would be genuine competition between the suppliers.

I WOULD have a system where patients could vote with their feet and avoid hospitals and doctors they did not like.

It is not easy. There is no profit in healthcare. The most economic way to treat the NHS would be to abolish it, and abolish all state sponsored health care.

I do believe that nurses are underpaid - which is why we have to import so many from the third world (thus effectively exporting our health care problems) - and as the baby boomers hit old age there will be a crisis of lack of nursing care. I believe that many other NHS workers are even worse off than the nurses.


Anonymous said...

Nurses are overpaid !

I haven't been able to stop chuckling since reading this piece of bullshit.

Dr Rant has already suested a a vaccine for stupidity - I guess we have already found at least one prospective candidate

the A&E Charge Nurse

niconoclast said...

PLEASE be doctrinal doc! Would you offer real medicine and voodoo medicine as complimentaries? What would be the results? Ditto with economics. You ain't never gonna square that circle -even if it is virtuous of you to try.

Devil's Kitchen said...


"Nurses are overpaid !"

I don't believe that I said that. I believe that I may have implied that their starting pay is no worse than that of the majority of other jobs.

What I also definitely said was that, given limited resources, they could either have higher pay or salary-linked pensions. Why is the idea that if you have higher salaries, then the pension is going to cost a fucking fortune so difficult to grasp?

Here's an illustration: I was told, at the age of 23 that, if I wished to retire at 65 on £16,000 a year, I needed to be paying £250 a month from now until retirement (and even that is not guaranteed). Does the scale of the nurses' pension bonus hit home yet? They get a guaranteed, salary-linked pension: in return, they get paid less. That's it.

Oh, and while we are about it, could someone explain to me precisely why nurses -- who are, after all, menial staff -- should be paid any more than other menial staff? Why is nursing raised to this kind of sacred, mythological high? We pay people virtually nothing to clean public toilets: why should we grant higher wages to those who simply clean straight at the source?


"bit more detail please. whats your solution for those who have already worked for 30 years plus of jam tomorrow? a few years of jam today is not recompense for the years of jam tomorrow."

Well, from the above comment, it would seem that you've made your choice. It would be good if we could give people a choice: would you like the higher salary now, or the pension tomorrow?

However, you are correct. We would need to form a cut-off point: how about the 16 April, the new tax year?


Anonymous said...

Now we learn that as well as being fat-cats, nurses are just menial workers to boot.

Honestly, you couldnt make it up

the A&E Charge Nurse

Devil's Kitchen said...

Charge Nurse,

I never said that nurses were fat cats; I merely pointed out that the pay is hardly tuppence ha'penny a week. So, instead of borrowing trite sceptical remarks from Private Eye, how about you tell me why, precisely, a nurse is not a menial worker?

Yes, they are trained: so are many people. Yes, they often have an unpleasant job to do: so do many people. Yes, they often have to work long hours but (and I know that this is going to surprise you) so do many other people.

If you really cannot tell me why nurses should be paid more, especially given their very generous future benefits, then they should not be paid more. Can you imagine me going into my boss's office like this:

"I should be paid more."


"Because I should. And because I am a nice person and I do all of the shitty jobs."

"So what? Why should I pay you more? You took the job knowing that the pay was shitty. Justify, to me, why I should raise your pay."


See? Silly, isn't it? So, go on; justify yourself to me, a person who last visited a doctor, for less than the standard 7 minutes (despite waiting for three and a half hours), 5 years ago (to get a prescription for antibiotics for which I paid £6.50) and who does not get ill (and if I do, I will probably not be treated as I smoke). Justify why I should live in poverty so that you do not have to.

Go on, Charge Nurse, what makes you so very, very special?



Anonymous said...

Have you ever heard of the expression, if you need to ask then I can't tell you ?

You admit to being a smoker, statistics suggest a 50% probability of significant disease if you continue long enough.

If you ever require medical treatment for COPD, ischamic heart disease, stroke or cancer to name just a few potential conditions your view of nursing as a 'menial' job may change - I hope of course that none do.

And by the way, you will find little support amongst nurses for limiting access to care or treatment based purely on life style choices.

the A&E Charge Nurse

Devil's Kitchen said...

Charge Nurse,

"Have you ever heard of the expression, if you need to ask then I can't tell you ?"

Yes, I have. It is usually used when someone feels that they are hard done by, but can't actually express why. I, and the rest of we taxpayers, are effectively your employers. Thus, you need to justify your increased wages (especially since about 80% of the increased spending in the NHS has gone on pay rather than patient care).

"And by the way, you will find little support amongst nurses for limiting access to care or treatment based purely on life style choices."

Absolutely; that is understood.


Anonymous said...

Prove our economic value - a strike for a week or so might do it.

Not everything can be reduced a crude economic formula.

Nurses may appear as menial workers in your balance book but I doubt if there is much support for this type of simplistic assertion.

Anyway, time to go, New Years and all - unlike Xmas I'm not at work, so time to unveil the new whistle & flute.

Best wishes to you for 2007, will continue to visit the kitchen in the new year.

the A&E Charge Nurse

Anonymous said...

"why should we grant higher wages to those who simply clean straight at the source?"

Ha - I'd like to see you walk into ITU and say that out loud. "Menial" is fairly non-descript term - an average day on a ward defies such simple quantification. Simply helping somebody to move can transform their whole day - and five minutes later you'll be poring over infusion charts that would make even hardened fund managers weak with fear.

Anyway, as to how much a nurse is "worth": at the risk of sounding like a particularly sanctimonious Mastercard advert: on certain shifts, they are priceless. Besides, I hate the term "worth" - a much abused word. Ask soldiers.

"Justify why I should live in poverty so that you do not have to."

Hmm. That might suffice as a general peasant cry about the evils of taxation - but when the shit really hits the fan, taxpayers still do pretty well out of the NHS. Unless they want to live in the woods, libertarians cannot evade the headache of how you organise the whole shebang. Something tells me that you will find just as-much to rail against in the kind of insurance-dominated system that will eventually prevail.

Anyway, Happy New Year. Let the robustness continue...

Anonymous said...

Many nurses are exhausted ---

---------- by the bluddy big chip they carry on their shoulder.

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