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  • Writer's pictureDeborah Klayman

Death by a thousand cuts

Earier this month, NHS England chief Simon Stephens urged the govenment to change their mind on measures that would see an estimated 30,000 nurses deported. The preposterous decision not to include nurses on the list of “shortage occupations” would mean non-EEA workers who earn less than £35,000 after six years in the UK will be deported.

As someone who works in frontline NHS services in London, I immediately recognised that – in one fell swoop – this would bring the NHS to its knees. The vast majority of my qualified colleagues are from overseas. NHS staff have not had a pay increase in 5 years – because a 1% increase when the average rate of inflation is 2.67% is a pay cut.

The starting pay band for a qualified nurse is £21,692 (Band 5) – this would mean mass deportation of people who have chosen to train in the UK and remain to care for its population. Oh, and paying tax, which supports the very system they work within and we all use. The top of Band 5 is £28,180 and would take 7 years to attain – even with London weighting this disqualifies all non-EEA nurses. Only staff of Band 7 and above would earn enough to be permitted to remain. Outside of London, it becomes even more impossible to achieve. In addition, the government are proposing severe cuts to pay for junior doctors, driving even those who are UK born and bred to look to other countries for a living wage.

The nursing exodus already started. We are not only failing to recruit into the NHS, we are drastically failing to retain the experienced staff we have as pay remains static and the cost of living rises. Recruitment and Retention payments staff previously received have also been been cut. Many go to Australia, where their profession is respected and welcomed, and the standard of living is better.

There is an unhealthy conflation of immigration, migration, and those seeking refuge. There is a presumption that everyone is desperate to get into/stay in the UK: with the ungrateful way people who work all hours, day and night, 365 days a year (including bank holidays, weekends, Christmas and New Year) are treated is it any wonder they are looking to greener pastures? The government keep saying they are going to train more “home grown” nurses, but that does not happen overnight – plus do we benefit by losing all the experience our current nurses have?

The recent Joint union membership survey from the Royal College of Nurses (RCN) states:

The NHS trade unions’ latest joint survey of members across the UK highlights high levels of dissatisfaction with the level of pay awards, low levels of morale and motivation due to workplace stress.  NHS workers do not feel there is enough time and resources to carry out their jobs and regularly work in excess of their contracted hours in order to provide the best care they can for their patients. 

No news there…

So, in a spectacular but fairly predictable climbdown, it has been announced that the government have temporarily lifted restrictions on recruiting nurses from overseas.  What this means for the enormous number of care workers who do not have a nursing qualification (eg. heathcare assistants) is anyone’s guess. Simultaneously the government announced a “cap” on “expensive agency staff”. No Trust chooses to use agency staff instead of substantive staff! In Mental Health care a personal knowledge of your patients and a rapport with them is unbelievably important, as it is in all other areas of healthcare. Agency staff are filling the gap left by years of pay freezes, real-term pay cuts, removal of overtime payments…the list goes on. Substantive staff are resigning and going to work for agencies because they are paid more! Oh, and next Jeremy Hunt thinks abolishing unsociable hours payments is a grand old idea – but avoided a commons debate about the £1bn NHS deficit. This year MP’s got a 10% pay rise, while NHS staff again got only 1%. Would you work Christmas Day or New Year’s Day in A&E for £9.00 an hour? Well apparently that is a living wage my friend, so you best get used to it.

So now Nurses will temporarily be added to the government’s Shortage Occupation List, which means nurses from outside the European Economic Area will have their applications prioritised. So they are temporarily as necessary as ballerinas.

Meanwhile, the government’s obsession with kicking vulnerable people while they are down continues unabated. Following on from the outrageous “bedroom tax” and proposed cuts to working tax credits, it has now been confirmed that UN representatives will visit the UK to investigate “grave and systematic violations” of the rights of disabled people, alledged to have taken place under austerity measures. Mental Health services have been cut, at a time where they are more oversubscribed than ever. People are literally dying from the impact of austerity – a policy that has been repeatedly shown as counter-productive by economists. In Paul Krugman’s The Austerity Delusion he highlights:

Since the global turn to austerity in 2010, every country that introduced significant austerity has seen its economy suffer, with the depth of the suffering closely related to the harshness of the austerity…The economics of austerity are the same – and the intellectual case as bankrupt – in Britain as everywhere else.

You remember the Blairism “Tough on Crime, Tough on the Causes of Crime”? Whatever you think of the speaker, violent crime is currently at its lowest rate in twenty years. But not for long. Today, Met Police Commissioner Sir Bernard Hogan-Howe highlighted that the proposed cuts to Police budgets “will put London at risk”. With cuts estimated at a cool billion, Hogan-Howe estimates a loss of 8,000 officers in London alone.

In the meantime, while we continue to imprison more people, cut the number of prison staff to a minimum and do almost nothing to prevent reoffending we tax payers continue to pay more than it costs to go to Eton for each person we incarcerate. On average our prisons are currently at 97% capacity, but some are so overcrowded that they are running at 179% of the CNA level (Certified Normal Accommodation). Half of the world’s prison population of is held in the US, China or Russia; but you may be surprised to know that in England and Wales we incarcerate more people per head of population that the Chinese. 148 people in every 100,000 to be exact (in China it is 118 ). Heaven forbid we invest in adequate mental health provision, probation services, affordable housing and education to prevent people offending, reoffending or being recalled in the first place. No, far better to force people into abject poverty and just wait and see what happens.

But maybe if we can just push all those nurses out it’ll be okay.

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