Original Article on Labor Conflicts in the Health Sector
NURSES AND TRADE UNIONS IN BRITAIN Susan Scott Lewis The nature of the negotiating body for pay and conditions of nurses in Britain and some of the reasons for the body’s past failure to negotiate a substantial pay increase for nurses are described in this article. A description is given of a series of events, including strike action by nurses during 1974, which led to a substantial pay raise. The pay award, however, represented only a partial success for the trade unions and the negotiating body. Methods of nurses’ organization and the roles of their representative unions and professional body indicate some of the reasons for only a partial success. The lack of unity between the National Health Service trade unions and the reactionary role of the professional body were notable. However, many important political and organizational lessons were learned by nurses in this struggle. We are now facing savage cuts in National Health Service expenditure, leading to a reduction in the number of nurses employed. These lessons are clearly useful for the nurses and their organization with the labor movement in fighting these cuts in National Health Service expenditure.
THE FAILURE OF THE NURSES’ NEGOTIATING BODY The poor pay and conditions of nurses in Britain have received ample documentation in recent years (1, 2). Appalling and deteriorating conditions in hospitals, a 20 percent shortage of nursing staff, and falling standards of nursing care have all been exposed in the press. The Staff Side of the Whitley Council (the representative body of National Health Service employees) is responsible for the negotiations of pay and conditions for nurses. The failure of these negotiations to enable nurses to keep pace with the cost of living and to achieve a wage increase of any note has also been well reported in references 1 and 2. There are twelve member bodies of the Staff Side of the Whitley Council. Three unions together hold ten seats. They are the National Union of Public Employees (NUPE), the National Association of Local Government Officers (NALGO), and the Confederation of Health Service Employees (COHSE). Nine professional bodies hold nineteen seats. The Royal College of Nursing (RCN), which has not been known for its great concern for nurses’ pay in the past, has a monopoly of eight seats. The fact that in 1974 some ward sisters after deductions took home as little as 60 pence an hour for a work week of 40 hours, excluding breaks for meals, clearly demonstrates International Journal of Heslth Services, Volume 6 , Number 4,1976 0 1976. Baywood Publishing Co., Inc.
641 doi: 10.2190/V45L-W95F-YTHY-V1NL http://baywood.com
642 I Lewis the inadequacy of the Whitley Council as a negotiating body, as well as the total failure of successive governments, both Tory and Labour, to finance adequately the National Health Service (NHS). A number of factors have contributed to the failure of the Whitley Council negotiations in the past. The Health Service trade unions are poorly represented on the Council. They are not united and largely have right-wing leadership and policies. Vocational and professional aspects of nursing have, in the past, been presented in contradiction to trade union activity and political consciousness. The fact that nurses are predominately women lacking in trade union organization has militated against successful negotiations, for class and sexual oppression have operated t o good effect t o produce a cheap work force for the NHS. THE 1974 NURSES’ PAY CAMPAIGN The history of the 1974 pay claim began in 1971 when the Staff Side of the Whitley Council began their preparations for the submission of the 1972 pay claim at a time of severe staff shortages and inflation which lowered the real value of nurses’ wages. The major claim for revaluation and restructuring of nurses’ pay was submitted in January 1972, the most substantial claim being in respect t o two groups of nurses in training, the student and pupil nurses. In February 1972 the Staff Side of the Whitley Council accepted an interim award of 8 percent operative beginning April 1. In November 1972 the Tory Government announced a total pay freeze which effectively terminated discussion of the revaluation claim and reduced the real value of nurses’ wages even further. In September and November 1973, evidence was given to the pay board, which was asked to recommend an immediate independent inquiry into nurses’ pay. In December 1973 the government announced cuts of 111 million pounds in NHS expenditure. Prior to the February general election, a phase-three settlement was forced on the Staff Side of the Whitley Council, which feared another total pay freeze. Pay below 1,671 pounds per year was increased by 117 pounds and that over 1,671 pounds by 7 percent effective from April 1 , 1974. The Labour Government came into office in February 1974 and Mrs. Barbara Castle was appointed Secretary of State for Social Services. It was announced that the independent inquiry into nurses’ pay could not be set up at that time. In April COHSE launched its campaign for nurses’ pay with a demonstration outside the Department of Health and Social Security to demand an immediate full-scale inquiry into the whole salary structure and a target of 3,000 pounds per year for a ward sister. The Staff Side of the Whitley Council met with Mrs. Castle to discuss the plight of Britain’s 3 10,000 nurses. On May 13, moves were made to restrict hospital admissions. There was a mass rally of nurses at Hyde Park in London. An RCN delegation met with Mrs. Castle and the RCN president to state that unless an inquiry was announced within three weeks the RCN would turn itself into a private nursing agency for hire to the NHS. A document outlining the deterioration in nursing and demanding that the inquiry
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be set up free from any predetermined limitations on the cost of implementing its findings was presented to Mrs. Castle. The document went on to demand improvement in working conditions, relief from nonnursing duties, a full-scale review of standards of nursing care, and immediate positive action to put an end to a rapidly deteriorating situation. During this period the Whitley Council announced its decision not to negotiate on the 18 million pounds which had been offered for the implementation of the Briggs Report (3). The offer would only have benefited a minority of nurses involved in teaching and education. On May 16, the COHSE National Executive Committee met to discuss proposals from branches throughout the country calling for a national ballot among nurses in order to determine the amount of support for strike action. It was decided that industrial action would be imposed if the Prime Minister did not make a substantial cash offer on May 20. On May 20, the Prime Minister said that the government would reply to the request for an immediate inquiry and an interim cash settlement of 6 pounds a week through the normal Whitley Council machinery. The following day, COHSE regional officers met and called for a work to rule’ to start on May 27. This involved a ban on clerical duties unrelated to patient care, all nonnursing duties, acting up: and all overtime in excess of 40 hours; in addition, there would be selected short withdrawals of labor up to four hours in duration. Nonnursing members were instructed not to take on nursing duties. On May 23, Mrs. Castle announced the government decision to institute an independent inquiry into nurses’ pay under the chairmanship of Lord Halsbury, a member of the review body which makes periodic recommendations on the pay of doctors and dentists. Any increases announced were to be backdated to May 23. However, at that time no announcement was made as to the membership of the committee or the terms of reference on the time at which it should complete its report. At the May 25 meeting of COHSE executives it was decided that the work to rule would be implemented in support of the 6-pound interim award for lower-paid nurses, and a date by which the committee was to report was set. On the same day at a meeting of the Staff Side of the Whitley Council, COHSE was urged to call off all action pending the outcome of the report by the other member organizations. These appeals were rejected by COHSE. At this time, NUPE supported demonstrations among nurses in their off-duty time and called for a 55-percent wage increase, while awaiting the results of the inquiry. The RCN urged the committee to take as long as needed to be thorough. Interunion rivalry reached new heights when the NUPE secretary called the COHSE action the irresponsible act of amateur adventurers. During a work to rule only those duties listed in the job description are performed; e.g. serving patients’ meals and washing their clothes are not part of a nurse’s specified duties and thus would not be done during a work to rule. Acting up is d e f i e d as the taking on of duties usually performed by an individual of more senior rank with no remuneration for these services. Thus, a staff nurse may assume the duties of a ward sister in the absence of the sister and would not receive additional pay.
644 I Lewis During this period, nurses’ action committees were formed in many hospitals throughout the country. Some consisted of union members only while others included all sectors of nurses involving RCN and nonaligned nurses. Shop stewards committees were formed to unite all union members in the hospital and to coordinate the activities of other hospital workers involved in the action. Links were made with local trades councils, thus forming solidarity links with other groups of workers in the community. Solidarity action was taken by various sections of trade unionists, including miners. The militancy reached a peak in May and June. Demonstrations, strikes, and meetings of nurses and other trade unionists were organized. Public support for the nurses’ action and claim was expressed in the media. The campaign was discussed at a variety of conferences, including one organized by the paper Hospital Worker in Manchester. On June 7 , the membership of the Halsbury Committee was announced. It included three members of the doctors’ and dentists’ review body, an industrial sociologist, a member of the London Cooperative Society, and a member of the Department of Health and Social Security Staff Committee for Nurses and Midwives. There was no trade union representative or anyone who had particular experience with nursing services. An inaugural meeting of the National Nurses Action Group Coordinating Committee was held in London June 15. They decided to press for 35 pounds for a 35hour week, a freeze on canteen food prices at April levels, a ban on agency nurses and private patients in the NHS, and an increase in the London weighting (the latter refers to a sum of money paid in addition to the basic yearly salary to those who reside in London to cover the increased cost of living in the capital city). The need for official trade union support was stressed as well as the need to strengthen rank-andfile organization within the union structure. The meeting also called for a national day of action on July 8. By the end of June action by health workers had resulted in the closure of many private and NHS wards and the expulsion of agency staffs from some hospitals. On July 1 , Mrs. Castle announced that if the Halsbury Committee report was delayed she would consider an interim award of an unstated amount. As a result of this indefinite statement, COHSE decided to call off all action except its ban on the admission of all but emergency patients. The day of action called by the Nurses Action Committee received little support. Nationally, militant action declined because many nurses were disappointed by the lack of official support from their respective leaders. THE PAY AWARD The Halsbury Committee fmally reported on September 17, 1974, and recommended that an extra 170 million pounds be spent on nurses’ wages per year. The response of the unions was a qualified acceptance of the offer. Although a target salary of 3,000 pounds per year was reached for ward sisters, some student nurses received increases of only 5.6 percent, giving them a salary of between 1,125 and 1,323 pounds a year. Though wages for some nurses were substantially increased, the unions continued to negotiate for increased salaries for the lower-paid nurses, a reduced working week, a ban on agency nurses in the NHS, improved accommoda-
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tions, increased specialduty payments, and total abolition of split-shift working. After the award it soon became apparent that much of the increase was to be eroded again by inflation, the discontinuation of “living out” allowances, increased taxation, and increases in lodging and meal charges. THE ATTITUDE OF THE UNIONS The origins of COHSE lie in the establishment of the National Union of Asylum Workers in 1910. In the 1930s this became the Mental Hospital and Institutional Workers Union. Because at this time many psychiatric nurses were male and therefore were not eligible to join the RCN, the union had its base in this sector. In 1946, the union amalgamated with the Hospital and Welfare Union to become COHSE. At present it has about 80,000 nursing members. Traditionally COHSE has been far from militant. It was one of the first unions to voluntarily register under the Industrial Relations Act and was expelled from the Trades Union Congress (TUC) for doing so. However, in December 1974 COHSE executives voted to deregister under the Industrial Relations Act and reaffiliate with the TUC. The recent militancy of the union could well be interpreted as an attempt to gain prestige and membership after so many years of reaction, as well as to demonstrate its credentials and desire to become the only health service trade union. It has many right-wingers among its executives, and in 1975 the TUC gave its support to the government policy of wage restraint in the form of the 6-pound wage limit. COHSE holds a contradictory position. As a member of the TUC, on the one hand, it supports a form of wage constraint in the social contract and a 6-pound wage limit, while on the other hand supporting a minimum wage for workers aged 18 and over. Nurses’ wages, especially those of students, remain far below the TUC-approved minimum of 30 pounds a week. The National Union of Public Employees also has about 80,000 nursing members, but unlike COHSE it has had a more militant history. It was active in the hospital auxiliary workers strike in 1972. A considerable proportion of its membership lies outside the NHS in local government and municipal work. The lack of official support given to the nurses’ strike by NUPE is difficult to explain except that at that time it, like COHSE, had many right-wingers among its leadership who supported the social contract in 1974. However, in 1975 NUPE became more progressive in its policies. At the Trades Union Congress, the Secretary, Alan Fisher, supported a 40-pound-aweek minimum wage and seconded the opposition to the Labour Party 6-pound wage limit. NUPE also created five new executive posts for women and elected a number of Communists to its executive committee. The effects of interunion rivalry during this period in 1974 were destructive to the nurses’ cause. The negotiating strength of the unions was reduced to less than half as a result. The nurses were divided and disillusioned by the lack of a united front from NUPE, the National and Local Government Officers Association (NALGO), and COHSE leadership. This fighting only served to provide ammunition against the nurses. It is impossible to defend any of the unions on this issue.
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NUPE executives gave no official support for industrial action except for demonstrations in off-duty time. Although COHSE nurses were prepared to demonstrate on May 20 as a result of their strike ballot, and had prepared emergency cover for the wards, the leadership, without any real discussion of the reasons, postponed any action until the work to rule began on the 27th. Again official action was called off prior to the July 8 day of action which, although initiated unofficially, had received the official support of many trade union branches. The effect was to lower the morale and confidence of nurses in their union leadership. Explanations of the decision to call off all action after Mrs. Castle’s offer of an interim award of an unstated amount were not forthcoming. The official work to rule called by COHSE was difficult to implement because members were working in wards where NUPE and RCN members worked but did not support it. No solidarity was achieved and COHSE nurses suffered a good deal of victimization. When they took action, it was, however, effective enough to close wards in many hospitals. United short periods of strike action, though possibly premature at this stage, would have been easier t o implement and more effective than isolated members of one union operating a work to rule. Phases one, two, and three of the Threshold Agreements were used to make nurses feel that there was no need to fight for increases in real wages. Eighteen million pounds and 40 million pounds were offered in an attempt t o pacify them, yet these offers did not even compensate for the 111-million-pound cuts made in the NHS budget by the Tories at the end of 1974.
THE ROLE OF THE PROFESSIONAL BODY, THE RCN A profession may be defined as a select grouping drawn from the ruling class and their allies, controlling skills and knowledge which are used t o maintain the extension of the established social order. The ostensible goals of the profession, autonomy of practice, provision of service, and the maintenance of standards, obscure its objective function and its relationships to the state of which it is a part. For the individual, “professional” goals are singular and not collective. Emancipation is viewed in terms of individual careers, wealth, and personal prestige. For the workingclass member of a union, however, emancipation can only be viewed in collective terms. Emancipation for members of the working class only exists in their emancipation as the working class. The RCN proposal that their members resign from the NHS and contract individually through a private agency run by the RCN exemplifies the political position of professional bodies, for they are prepared to ally themselves with precisely those forces which are in part responsible for the present situation in the NHS, the private nursing agencies. For their part, the unions, while threatening strike action in support of their claim, were not at any time prepared to ally themselves with the forces of reaction in doing so. Far from it, they refused to work with agency staffs. While the unions took a principled stand on their claim, the professional body, the
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RCN, was content to adopt a purely economic and opportunistic attitude in pursuit of its goals. Emancipation for union members lays in collective industrial action supported by other sectors of the working class. Emancipation for the RCN supposedly lays in their own narrow, sectional and reactionary action. The development of such polarization with such "professional" action by RCN members, on the one hand, and increased union militancy, on the other, represents a crucial stage in the development of class alignment among nurses. LESSONS OF THE 1974 PAY CAMPAIGN There were many positive aspects of the struggle. The whole question of the deterioration of the NHS and the need for a large-scale injection of money into it was highlighted. The question of the need to abolish agency nursing and private practice in the NHS was also raised. Many nurses joined their trade unions and many already unionized aligned with the working class to defend the concept of a fully socialized system of health care and a decent standard of living for the working population. Nurses with other trade unionists made a positive stand to improve conditions and standards of health care and attempted to avert the evolution of two-tier health service through bans on private patients and agency nurses in the NHS. Nurses became conscious of the political and social nature of the state services and institutions. They became conscious of the fact that defense of their conditions and the NHS was a political struggle by becoming involved in it. Through their alignment with the trade unions, the function of unions and the nature of solidarity, as well as their common interests as members of the working class, became more clearly understood. If this process is to continue, nurses must increase their strength through improving their own organizations and building alliances with all sectors of the labor movement through their organizations. For it is members of the entire labor movement and not just health workers that have an interest in defending the NHS. It is a service for the working class. More nurses must be drawn into the unions and into activity with union members. Local conditions of work and service can be discussed and improvements negotiated. For example, union facilities, working conditions, pay, and standards of patient care all need to be improved. There are still a few hospitals employing agency nurses, and private beds remain in the NHS. The ban on working with them should continue. Joint shop stewards committees in hospitals should be formed, and links can be made with local trades councils and union branches, as well as community health councils. There is great potential for organization within the organs of the labor movement to increase the political understanding of nurses and magnify their negotiating strength to defend the NHS. Female nurses who suffer doubly from the oppressive forces of this society-on the one hand by virtue of their sex and on the other by virtue of the vocational nature of their work-must use this opportunity to become active in the trade union movement.
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Lewis UNEMPLOYED NURSES AND THE UNION RESPONSE TO CUTS IN NHS EXPENDITURE
During this period of capitalist economic crisis and inflation, the Labour Government is attempting to introduce right-wing counter-inflation policies which affect the Health Service and its workers. The Labour Party Manifesto of 1974 stated that “Labour created the NHS and is determined to defend it. Immense damage has been done to it by Tory cuts in public expenditure and by the Tory policy of rigid pay control.” In spite of this, the Labour Government is imposing a 6-pound wage increase limit on all workers, including poorly paid health service workers, and making massive cuts in Health Service expenditure at a time when Britain spends more of its gross national product on defense than on the NHS. The Labour Party Manifesto of 1974 also states, “We reject entirely the policy put forward by some Tories of fighting inflation by throwing millions of people out of work.” Many newly qualified nurses have recently been informed by the hospital authorities that no jobs are available for them. Health Service unions have recently reported a 10 percent cut in nursing staff resulting from natural wastage and nonreplacement of staff who leave or retire. NHS auxiliary staff are also being told that no jobs are available for them, and all grades of staff suffer delays in replacement as a result of cuts in expenditure on all NHS staff, services, and building programs. There are already forecasts of hospital closures and it is obvious that there wilI be a reduction in standards of patient care when these cuts are fully implemented. It is unfortunate that the need to increase in organization and strength to oppose these cuts has made it necessary to make use of the lessons learned by health workers in 1974 so soon. In November 1975, COHSE national executives met in response to motions from the regions expressing concern at the effects of the cuts. An ultimatum was issued to Mrs. Castle that unless action was taken within a month against the hospital cuts, industrial action would be taken. NALGO executives also met in November and authorized a major campaign against the cuts involving rallies, marches, demonstrations, and public meetings. NALGO branches were urged by the executives to work with other unions and organs of the labor movement. NUPE executives have instructed its branches to pursue a union policy of no redundancies and no reduction in levels of services. They are urged to cooperate with other unions and organizations of the trade union and labor movement. The unions have advanced in putting forward policies of cooperation with other unions and labor movement organizations to build a broad alliance with greater strength to fight these cuts. This present situation demonstrates a number of things. There is a contradiction between an advanced capitalist economy and the provision for the health needs of the people. The maintenance and improvement of the NHS, standards of patient care, and employment and conditions for NHS workers depend on pressure from the organized trade unions, labor movement, and political parties against the right-wing policies of any government.
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The fight for nurses’ wages and their full employment is clearly only a part of this battle. Unity between the health service unions and the labor movement is paramount in this struggle. Already in some areas, broad committees comprising all trade union branches, trade councils, shop stewards committees, political parties, community health councils, tenants associations, patients, and members of the public are writing to take action to organize and lead the struggle against the cuts in the NHS. REFERENCES 1. COHSE from Phase Three to Halsbury. A Study of the 1974 Pay Campaign for Nurses (pamphlet). Confederation of Health Services Employees, London, 1974. 2. Evidence Submitted to the Committee o n Nurses Pay and Conditions by the National Union of Public Employees (pamphlet). National Union of Public Employees, London, 1974. 3. Report of the Committee on Nursing. Her Majesty’s Stationery Office, London, 1972.
Manuscript submitted for publication, December 19, I975 Direct reprint requests to:
Ms.Susan Scott Lewis 32 Northlands Street Camberwell London SE5, England
NURSES AND TRADE UNIONS IN BRITAIN Susan Scott Lewis The nature of the negotiating body for pay and conditions of nurses in Britain and some of the reasons for the body’s past failure to negotiate a substantial pay increase for nurses are described in this article. A description is given of a series of events, including strike action by nurses during 1974, which led to a substantial pay raise. The pay award, however, represented only a partial success for the trade unions and the negotiating body. Methods of nurses’ organization and the roles of their representative unions and professional body indicate some of the reasons for only a partial success. The lack of unity between the National Health Service trade unions and the reactionary role of the professional body were notable. However, many important political and organizational lessons were learned by nurses in this struggle. We are now facing savage cuts in National Health Service expenditure, leading to a reduction in the number of nurses employed. These lessons are clearly useful for the nurses and their organization with the labor movement in fighting these cuts in National Health Service expenditure.
THE FAILURE OF THE NURSES’ NEGOTIATING BODY The poor pay and conditions of nurses in Britain have received ample documentation in recent years (1, 2). Appalling and deteriorating conditions in hospitals, a 20 percent shortage of nursing staff, and falling standards of nursing care have all been exposed in the press. The Staff Side of the Whitley Council (the representative body of National Health Service employees) is responsible for the negotiations of pay and conditions for nurses. The failure of these negotiations to enable nurses to keep pace with the cost of living and to achieve a wage increase of any note has also been well reported in references 1 and 2. There are twelve member bodies of the Staff Side of the Whitley Council. Three unions together hold ten seats. They are the National Union of Public Employees (NUPE), the National Association of Local Government Officers (NALGO), and the Confederation of Health Service Employees (COHSE). Nine professional bodies hold nineteen seats. The Royal College of Nursing (RCN), which has not been known for its great concern for nurses’ pay in the past, has a monopoly of eight seats. The fact that in 1974 some ward sisters after deductions took home as little as 60 pence an hour for a work week of 40 hours, excluding breaks for meals, clearly demonstrates International Journal of Heslth Services, Volume 6 , Number 4,1976 0 1976. Baywood Publishing Co., Inc.
641 doi: 10.2190/V45L-W95F-YTHY-V1NL http://baywood.com
642 I Lewis the inadequacy of the Whitley Council as a negotiating body, as well as the total failure of successive governments, both Tory and Labour, to finance adequately the National Health Service (NHS). A number of factors have contributed to the failure of the Whitley Council negotiations in the past. The Health Service trade unions are poorly represented on the Council. They are not united and largely have right-wing leadership and policies. Vocational and professional aspects of nursing have, in the past, been presented in contradiction to trade union activity and political consciousness. The fact that nurses are predominately women lacking in trade union organization has militated against successful negotiations, for class and sexual oppression have operated t o good effect t o produce a cheap work force for the NHS. THE 1974 NURSES’ PAY CAMPAIGN The history of the 1974 pay claim began in 1971 when the Staff Side of the Whitley Council began their preparations for the submission of the 1972 pay claim at a time of severe staff shortages and inflation which lowered the real value of nurses’ wages. The major claim for revaluation and restructuring of nurses’ pay was submitted in January 1972, the most substantial claim being in respect t o two groups of nurses in training, the student and pupil nurses. In February 1972 the Staff Side of the Whitley Council accepted an interim award of 8 percent operative beginning April 1. In November 1972 the Tory Government announced a total pay freeze which effectively terminated discussion of the revaluation claim and reduced the real value of nurses’ wages even further. In September and November 1973, evidence was given to the pay board, which was asked to recommend an immediate independent inquiry into nurses’ pay. In December 1973 the government announced cuts of 111 million pounds in NHS expenditure. Prior to the February general election, a phase-three settlement was forced on the Staff Side of the Whitley Council, which feared another total pay freeze. Pay below 1,671 pounds per year was increased by 117 pounds and that over 1,671 pounds by 7 percent effective from April 1 , 1974. The Labour Government came into office in February 1974 and Mrs. Barbara Castle was appointed Secretary of State for Social Services. It was announced that the independent inquiry into nurses’ pay could not be set up at that time. In April COHSE launched its campaign for nurses’ pay with a demonstration outside the Department of Health and Social Security to demand an immediate full-scale inquiry into the whole salary structure and a target of 3,000 pounds per year for a ward sister. The Staff Side of the Whitley Council met with Mrs. Castle to discuss the plight of Britain’s 3 10,000 nurses. On May 13, moves were made to restrict hospital admissions. There was a mass rally of nurses at Hyde Park in London. An RCN delegation met with Mrs. Castle and the RCN president to state that unless an inquiry was announced within three weeks the RCN would turn itself into a private nursing agency for hire to the NHS. A document outlining the deterioration in nursing and demanding that the inquiry
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be set up free from any predetermined limitations on the cost of implementing its findings was presented to Mrs. Castle. The document went on to demand improvement in working conditions, relief from nonnursing duties, a full-scale review of standards of nursing care, and immediate positive action to put an end to a rapidly deteriorating situation. During this period the Whitley Council announced its decision not to negotiate on the 18 million pounds which had been offered for the implementation of the Briggs Report (3). The offer would only have benefited a minority of nurses involved in teaching and education. On May 16, the COHSE National Executive Committee met to discuss proposals from branches throughout the country calling for a national ballot among nurses in order to determine the amount of support for strike action. It was decided that industrial action would be imposed if the Prime Minister did not make a substantial cash offer on May 20. On May 20, the Prime Minister said that the government would reply to the request for an immediate inquiry and an interim cash settlement of 6 pounds a week through the normal Whitley Council machinery. The following day, COHSE regional officers met and called for a work to rule’ to start on May 27. This involved a ban on clerical duties unrelated to patient care, all nonnursing duties, acting up: and all overtime in excess of 40 hours; in addition, there would be selected short withdrawals of labor up to four hours in duration. Nonnursing members were instructed not to take on nursing duties. On May 23, Mrs. Castle announced the government decision to institute an independent inquiry into nurses’ pay under the chairmanship of Lord Halsbury, a member of the review body which makes periodic recommendations on the pay of doctors and dentists. Any increases announced were to be backdated to May 23. However, at that time no announcement was made as to the membership of the committee or the terms of reference on the time at which it should complete its report. At the May 25 meeting of COHSE executives it was decided that the work to rule would be implemented in support of the 6-pound interim award for lower-paid nurses, and a date by which the committee was to report was set. On the same day at a meeting of the Staff Side of the Whitley Council, COHSE was urged to call off all action pending the outcome of the report by the other member organizations. These appeals were rejected by COHSE. At this time, NUPE supported demonstrations among nurses in their off-duty time and called for a 55-percent wage increase, while awaiting the results of the inquiry. The RCN urged the committee to take as long as needed to be thorough. Interunion rivalry reached new heights when the NUPE secretary called the COHSE action the irresponsible act of amateur adventurers. During a work to rule only those duties listed in the job description are performed; e.g. serving patients’ meals and washing their clothes are not part of a nurse’s specified duties and thus would not be done during a work to rule. Acting up is d e f i e d as the taking on of duties usually performed by an individual of more senior rank with no remuneration for these services. Thus, a staff nurse may assume the duties of a ward sister in the absence of the sister and would not receive additional pay.
644 I Lewis During this period, nurses’ action committees were formed in many hospitals throughout the country. Some consisted of union members only while others included all sectors of nurses involving RCN and nonaligned nurses. Shop stewards committees were formed to unite all union members in the hospital and to coordinate the activities of other hospital workers involved in the action. Links were made with local trades councils, thus forming solidarity links with other groups of workers in the community. Solidarity action was taken by various sections of trade unionists, including miners. The militancy reached a peak in May and June. Demonstrations, strikes, and meetings of nurses and other trade unionists were organized. Public support for the nurses’ action and claim was expressed in the media. The campaign was discussed at a variety of conferences, including one organized by the paper Hospital Worker in Manchester. On June 7 , the membership of the Halsbury Committee was announced. It included three members of the doctors’ and dentists’ review body, an industrial sociologist, a member of the London Cooperative Society, and a member of the Department of Health and Social Security Staff Committee for Nurses and Midwives. There was no trade union representative or anyone who had particular experience with nursing services. An inaugural meeting of the National Nurses Action Group Coordinating Committee was held in London June 15. They decided to press for 35 pounds for a 35hour week, a freeze on canteen food prices at April levels, a ban on agency nurses and private patients in the NHS, and an increase in the London weighting (the latter refers to a sum of money paid in addition to the basic yearly salary to those who reside in London to cover the increased cost of living in the capital city). The need for official trade union support was stressed as well as the need to strengthen rank-andfile organization within the union structure. The meeting also called for a national day of action on July 8. By the end of June action by health workers had resulted in the closure of many private and NHS wards and the expulsion of agency staffs from some hospitals. On July 1 , Mrs. Castle announced that if the Halsbury Committee report was delayed she would consider an interim award of an unstated amount. As a result of this indefinite statement, COHSE decided to call off all action except its ban on the admission of all but emergency patients. The day of action called by the Nurses Action Committee received little support. Nationally, militant action declined because many nurses were disappointed by the lack of official support from their respective leaders. THE PAY AWARD The Halsbury Committee fmally reported on September 17, 1974, and recommended that an extra 170 million pounds be spent on nurses’ wages per year. The response of the unions was a qualified acceptance of the offer. Although a target salary of 3,000 pounds per year was reached for ward sisters, some student nurses received increases of only 5.6 percent, giving them a salary of between 1,125 and 1,323 pounds a year. Though wages for some nurses were substantially increased, the unions continued to negotiate for increased salaries for the lower-paid nurses, a reduced working week, a ban on agency nurses in the NHS, improved accommoda-
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tions, increased specialduty payments, and total abolition of split-shift working. After the award it soon became apparent that much of the increase was to be eroded again by inflation, the discontinuation of “living out” allowances, increased taxation, and increases in lodging and meal charges. THE ATTITUDE OF THE UNIONS The origins of COHSE lie in the establishment of the National Union of Asylum Workers in 1910. In the 1930s this became the Mental Hospital and Institutional Workers Union. Because at this time many psychiatric nurses were male and therefore were not eligible to join the RCN, the union had its base in this sector. In 1946, the union amalgamated with the Hospital and Welfare Union to become COHSE. At present it has about 80,000 nursing members. Traditionally COHSE has been far from militant. It was one of the first unions to voluntarily register under the Industrial Relations Act and was expelled from the Trades Union Congress (TUC) for doing so. However, in December 1974 COHSE executives voted to deregister under the Industrial Relations Act and reaffiliate with the TUC. The recent militancy of the union could well be interpreted as an attempt to gain prestige and membership after so many years of reaction, as well as to demonstrate its credentials and desire to become the only health service trade union. It has many right-wingers among its executives, and in 1975 the TUC gave its support to the government policy of wage restraint in the form of the 6-pound wage limit. COHSE holds a contradictory position. As a member of the TUC, on the one hand, it supports a form of wage constraint in the social contract and a 6-pound wage limit, while on the other hand supporting a minimum wage for workers aged 18 and over. Nurses’ wages, especially those of students, remain far below the TUC-approved minimum of 30 pounds a week. The National Union of Public Employees also has about 80,000 nursing members, but unlike COHSE it has had a more militant history. It was active in the hospital auxiliary workers strike in 1972. A considerable proportion of its membership lies outside the NHS in local government and municipal work. The lack of official support given to the nurses’ strike by NUPE is difficult to explain except that at that time it, like COHSE, had many right-wingers among its leadership who supported the social contract in 1974. However, in 1975 NUPE became more progressive in its policies. At the Trades Union Congress, the Secretary, Alan Fisher, supported a 40-pound-aweek minimum wage and seconded the opposition to the Labour Party 6-pound wage limit. NUPE also created five new executive posts for women and elected a number of Communists to its executive committee. The effects of interunion rivalry during this period in 1974 were destructive to the nurses’ cause. The negotiating strength of the unions was reduced to less than half as a result. The nurses were divided and disillusioned by the lack of a united front from NUPE, the National and Local Government Officers Association (NALGO), and COHSE leadership. This fighting only served to provide ammunition against the nurses. It is impossible to defend any of the unions on this issue.
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NUPE executives gave no official support for industrial action except for demonstrations in off-duty time. Although COHSE nurses were prepared to demonstrate on May 20 as a result of their strike ballot, and had prepared emergency cover for the wards, the leadership, without any real discussion of the reasons, postponed any action until the work to rule began on the 27th. Again official action was called off prior to the July 8 day of action which, although initiated unofficially, had received the official support of many trade union branches. The effect was to lower the morale and confidence of nurses in their union leadership. Explanations of the decision to call off all action after Mrs. Castle’s offer of an interim award of an unstated amount were not forthcoming. The official work to rule called by COHSE was difficult to implement because members were working in wards where NUPE and RCN members worked but did not support it. No solidarity was achieved and COHSE nurses suffered a good deal of victimization. When they took action, it was, however, effective enough to close wards in many hospitals. United short periods of strike action, though possibly premature at this stage, would have been easier t o implement and more effective than isolated members of one union operating a work to rule. Phases one, two, and three of the Threshold Agreements were used to make nurses feel that there was no need to fight for increases in real wages. Eighteen million pounds and 40 million pounds were offered in an attempt t o pacify them, yet these offers did not even compensate for the 111-million-pound cuts made in the NHS budget by the Tories at the end of 1974.
THE ROLE OF THE PROFESSIONAL BODY, THE RCN A profession may be defined as a select grouping drawn from the ruling class and their allies, controlling skills and knowledge which are used t o maintain the extension of the established social order. The ostensible goals of the profession, autonomy of practice, provision of service, and the maintenance of standards, obscure its objective function and its relationships to the state of which it is a part. For the individual, “professional” goals are singular and not collective. Emancipation is viewed in terms of individual careers, wealth, and personal prestige. For the workingclass member of a union, however, emancipation can only be viewed in collective terms. Emancipation for members of the working class only exists in their emancipation as the working class. The RCN proposal that their members resign from the NHS and contract individually through a private agency run by the RCN exemplifies the political position of professional bodies, for they are prepared to ally themselves with precisely those forces which are in part responsible for the present situation in the NHS, the private nursing agencies. For their part, the unions, while threatening strike action in support of their claim, were not at any time prepared to ally themselves with the forces of reaction in doing so. Far from it, they refused to work with agency staffs. While the unions took a principled stand on their claim, the professional body, the
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RCN, was content to adopt a purely economic and opportunistic attitude in pursuit of its goals. Emancipation for union members lays in collective industrial action supported by other sectors of the working class. Emancipation for the RCN supposedly lays in their own narrow, sectional and reactionary action. The development of such polarization with such "professional" action by RCN members, on the one hand, and increased union militancy, on the other, represents a crucial stage in the development of class alignment among nurses. LESSONS OF THE 1974 PAY CAMPAIGN There were many positive aspects of the struggle. The whole question of the deterioration of the NHS and the need for a large-scale injection of money into it was highlighted. The question of the need to abolish agency nursing and private practice in the NHS was also raised. Many nurses joined their trade unions and many already unionized aligned with the working class to defend the concept of a fully socialized system of health care and a decent standard of living for the working population. Nurses with other trade unionists made a positive stand to improve conditions and standards of health care and attempted to avert the evolution of two-tier health service through bans on private patients and agency nurses in the NHS. Nurses became conscious of the political and social nature of the state services and institutions. They became conscious of the fact that defense of their conditions and the NHS was a political struggle by becoming involved in it. Through their alignment with the trade unions, the function of unions and the nature of solidarity, as well as their common interests as members of the working class, became more clearly understood. If this process is to continue, nurses must increase their strength through improving their own organizations and building alliances with all sectors of the labor movement through their organizations. For it is members of the entire labor movement and not just health workers that have an interest in defending the NHS. It is a service for the working class. More nurses must be drawn into the unions and into activity with union members. Local conditions of work and service can be discussed and improvements negotiated. For example, union facilities, working conditions, pay, and standards of patient care all need to be improved. There are still a few hospitals employing agency nurses, and private beds remain in the NHS. The ban on working with them should continue. Joint shop stewards committees in hospitals should be formed, and links can be made with local trades councils and union branches, as well as community health councils. There is great potential for organization within the organs of the labor movement to increase the political understanding of nurses and magnify their negotiating strength to defend the NHS. Female nurses who suffer doubly from the oppressive forces of this society-on the one hand by virtue of their sex and on the other by virtue of the vocational nature of their work-must use this opportunity to become active in the trade union movement.
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During this period of capitalist economic crisis and inflation, the Labour Government is attempting to introduce right-wing counter-inflation policies which affect the Health Service and its workers. The Labour Party Manifesto of 1974 stated that “Labour created the NHS and is determined to defend it. Immense damage has been done to it by Tory cuts in public expenditure and by the Tory policy of rigid pay control.” In spite of this, the Labour Government is imposing a 6-pound wage increase limit on all workers, including poorly paid health service workers, and making massive cuts in Health Service expenditure at a time when Britain spends more of its gross national product on defense than on the NHS. The Labour Party Manifesto of 1974 also states, “We reject entirely the policy put forward by some Tories of fighting inflation by throwing millions of people out of work.” Many newly qualified nurses have recently been informed by the hospital authorities that no jobs are available for them. Health Service unions have recently reported a 10 percent cut in nursing staff resulting from natural wastage and nonreplacement of staff who leave or retire. NHS auxiliary staff are also being told that no jobs are available for them, and all grades of staff suffer delays in replacement as a result of cuts in expenditure on all NHS staff, services, and building programs. There are already forecasts of hospital closures and it is obvious that there wilI be a reduction in standards of patient care when these cuts are fully implemented. It is unfortunate that the need to increase in organization and strength to oppose these cuts has made it necessary to make use of the lessons learned by health workers in 1974 so soon. In November 1975, COHSE national executives met in response to motions from the regions expressing concern at the effects of the cuts. An ultimatum was issued to Mrs. Castle that unless action was taken within a month against the hospital cuts, industrial action would be taken. NALGO executives also met in November and authorized a major campaign against the cuts involving rallies, marches, demonstrations, and public meetings. NALGO branches were urged by the executives to work with other unions and organs of the labor movement. NUPE executives have instructed its branches to pursue a union policy of no redundancies and no reduction in levels of services. They are urged to cooperate with other unions and organizations of the trade union and labor movement. The unions have advanced in putting forward policies of cooperation with other unions and labor movement organizations to build a broad alliance with greater strength to fight these cuts. This present situation demonstrates a number of things. There is a contradiction between an advanced capitalist economy and the provision for the health needs of the people. The maintenance and improvement of the NHS, standards of patient care, and employment and conditions for NHS workers depend on pressure from the organized trade unions, labor movement, and political parties against the right-wing policies of any government.
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The fight for nurses’ wages and their full employment is clearly only a part of this battle. Unity between the health service unions and the labor movement is paramount in this struggle. Already in some areas, broad committees comprising all trade union branches, trade councils, shop stewards committees, political parties, community health councils, tenants associations, patients, and members of the public are writing to take action to organize and lead the struggle against the cuts in the NHS. REFERENCES 1. COHSE from Phase Three to Halsbury. A Study of the 1974 Pay Campaign for Nurses (pamphlet). Confederation of Health Services Employees, London, 1974. 2. Evidence Submitted to the Committee o n Nurses Pay and Conditions by the National Union of Public Employees (pamphlet). National Union of Public Employees, London, 1974. 3. Report of the Committee on Nursing. Her Majesty’s Stationery Office, London, 1972.
Manuscript submitted for publication, December 19, I975 Direct reprint requests to:
Ms.Susan Scott Lewis 32 Northlands Street Camberwell London SE5, England
