Absolutely the most important thing to do about the NHS, far more important than GP commissioning, internal markets and all the rest, is to break the national pay awards.
We do have regional and local labour markets, with different prices in them. That the NHS runs a national labour market means that high cost areas cannot get the staff they need: yes, this does kill people.
There are also plans for hospitals to become mutuals, adopting a John Lewis-style model where a medical centre would be owned by the staff. However, such a move would be fiercely resisted by trade unions as new employees would be shut out of the NHS pension scheme and the plan would introduce variable pay schemes across the NHS. Some have pointed out that the one-size-fits-all model has cost lives. Recent research shows that not being able to vary pay has meant that hospitals \”in tight labour markets\” have higher death rates and lower productivity.
However, simply announcing the end to national pay bargaining would produce a national strike.
Which means that Lansley\’s being rather clever here. If hospitals are to become mutuals, something which every lefty seems to desire in other areas of the economy, then the end of national pay bargaining comes as a side effect of that. Which sets up an interesting tension for those who would protest about it really.
So, you prepared to give up 1.4 million people getting control of their working lives, ownership even of their workplace, purely to oppose the end of national pay bargaining?
Well, he’s not being that smart, because the majority of hospitals are already Foundation Trust hospitals. They are governed by staff, public and what are horribly referred to as ‘stakeholder’ governors (as Rodney Bickerstaffe used to say about Thatcher’s desire to involve ‘stakeholders’… you hold the stake, I’ll hit it).
Foundation Trusts have been in a position to go outside of national pay bargaining for years, as have local authorities. But very few have. Why? Because the management don’t want the responsibility of negotiating a pay rise, nor the risk of a localised strike. If you are a hospital CEO and your staff are on strike… that is a national strike to you.
Hopefully they’ll ditch the annual increment as well.
“We do have regional and local labour markets,..”: good old Portugal. So do we, Tim.
Bob’s partially right, of course, but I do think it’ll happen as more open up, and I think it’d be more likely if they were proper mutuals. Bob, Foundation Trusts aren’t run by the employees alone, and their remit is rather weird.
If they’re proper mutuals, and it’s done as a national prject, then there’s potential to solve that particular problem.
Obviously this might affect me mid term, as it’ll also be something to move out in education, and I’ve moved to Yorkshire where lower pay is likely.
But it might improve the chances of getting a teaching job, if I do quaify, back in Devon, where every school job is horribly oversubscribed.
Tim, unions have tended to oppose the creation of mutuals, if the staff become the bosses, what role for the unions?