A rock and a hard place: cartels, low morale, FOIs – and government strategy on the NHS

I had an interesting chat with my wife last night. She’s a nurse, and I was giving her the latest update on the government-sanctioned cartel of NHS trusts in the south-west of England, formed to corral the the region’s NHS workers into a situation where they have no real choice but to accept the imposition of drastically worsened pay and conditions, including longer hours, a cut in pay, shorter holidays and the loss of ‘unsocial hours’ pay for working nights and weekends – all backed by the threat of dismissal and re-hiring at the worsened rates if the unions won’t accept them through ‘negotiation’.

First, the update. As the post linked above shows, I’ve already submitted an ‘Freedom of Information’ request to the Dept of Health about its communications with the Trusts and the private company ‘hosting’ the cartel in the run-up to its creation. I’ve had no response so far, but the 20-working-day time limit on that FOI isn’t over yet.

However, since my experience of DH FOI responses isn’t that great, I’m co-ordinating with someone fairly highly placed within one of the south-west NHS trusts, whom I won’t name here, to send in a series of FOI requests to each of the 19 trusts participating in the cartel as well, requiring details of their own meetings with the DH and the company co-ordinating the cartel. Since the information required by each request will be smaller than the overall one to the DH, it will be much harder for the respondent to hide behind the £600 cost-limit on responses.

If we can prove collusion among the government, the Trusts and the company charging them £10,000 each to be members of the cartel, then at the least it should be extremely politically damaging for the Tories and may even raise questions of illegal conduct. As the DH is using the cartel as a backdoor route to imposing the insanely counter-productive regional pay that it wants to, while being able to deny responsibility (something of a pattern for Lansley!) and claim that the Trusts are acting autonomously and it can’t interfere, the responses should also expose the lie in the DH’s statements on the matter.

Lansley has publicly backed regional pay as an efficiency measure, but now seeks to hold the cartel’s activities at arms-length by claiming that cuts in pay and conditions are not ‘necessary or desirable’ to achieve it. Well, maybe it’s just me, but I can only see two ways of achieving differentiated pay and conditions between different regions – you either cut one, or increase the other. Since there’s absolutely no way that Lansley is going to increase NHS pay in richer regions, because that would destroy his already-risible claims that the NHS needs to be more ‘efficient’ and that current spending is unaffordable. I’ll let you decide whether you think Lansley’s denials are the purest hogwash that I think they are, or not – but I think it’s pretty self-evident that Lansley’s words and his intentions are two entirely different things.

Now, to the discussion with my wife. She wasn’t telling me anything I didn’t already know, but it did serve to add context to the matter that shines a clear light on the strategy that Lansley and the Tory party are trying to implement against the NHS.

After I told her about the latest developments, my wife, who is a very diligent and committed NHS staff nurse, started telling me how low morale is among nurses, and without question among other groups of NHS workers. In spite of this, because of their high level of commitment, it’s routine for her and her colleagues to stay on at the end of shifts to cover for short-staffing and ensure that patients’ care is not compromised during handover periods, medicine rounds etc. Hardly ever is overtime claimed for this additional work – which may not be a good thing, as it allows management to claim that staffing levels are adequate. It’s a quandary NHS staff face regularly – but if overtime is rationed and the alternative is letting patients suffer, the staff will usually bite the bullet and do what’s good for patients.

However, everyone has a breaking point. If the south-west cartel is successful, the practice will be taken up by groups of trusts in all lower-paid regions. As referenced in the first article linked at the top of this post, other regional trusts are already making similar plans to proceed. So whether you live in the south-west or not, if you care about the NHS and its staff you should be paying very close attention to what’s happening there and doing whatever you can to resist it, or to support those who are resisting.

In my wife’s eyes, the cynical move to create a cartel with the express aim of reducing the pay and terms of the NHS staff – anything but perfect, but so committed and used to going the extra mile – is not just the ‘straw that breaks the camel’s back’. It’s like hitting the camel across the spine with a two-by-four. Her opinion was that, in any hospital affected by such a move, many if not all of the staff would stop going the extra mile, stop doing extra work for free, stop doing anything beyond what they’re paid for.

They wouldn’t stop caring about their patients, but a person can only take so much – and to be treated in a way that shows your commitment, hard work and professionalism are so un-valued by those ‘above’ you that they’re happy to take advantage of you with suc calculation and cynicism would just be too much for the already-strained morale of many staff to take. The people who take care of us in our illness and our dotage will find themselves manoeuvred between a rock and a hard place – into a lose-lose situation where they either allow themselves to be robbed, or they say ‘enough’ but then patients suffer.

And therein lies the even greater evil intent of the Conservatives and their Health hit-man Lansley. In playing this game, they see themselves in a ‘win-win’ situation. Having shown themselves politically incapable – so far – of pushing through regional pay plans for the NHS directly, if they succeed in using this back-door method of achieving it, they kill two birds with one stone: cutting costs so they can funnel even greater funds to their friends and backers, and at the same time setting up the NHS to fail.

As morale breaks, as staff cease to work unpaid to hold together the straining seams of under-resourced, under-staffed NHS services, it becomes far easier for the government to hold up its hands in mock-horror, lament the ‘inability’ of the NHS to care for the health of the British people – and accelerate and extend the great privatisation give-away that they’re already conducting in as covert a manner as they can.

The only counter-measures (short of a genuine revolution, which is becoming a greater risk with the passing of every day under these robber-barons) against this cynical strategy are two-fold: inform and resist.


Tell everyone you know. So what if you become an NHS or public-sector bore. Get informed yourself and make people listen. If enough of us do it, awareness will spread and the government’s calculated hypocrisy can be exposed for what it is.


Find out what’s being done to the NHS in your area and what measures are being taken to combat it. Then join in. And if nothing’s being done, start something. Submit your own FOi requests, write letters to your local paper, join your local NHS trust, talk to local union representatives and to organisations committed to keeping the NHS truly public, and find out what you can do to help. Or anything else you can think of. The alternative is to allow the Tories to get away with their theft – and that’s not something that any right-thinking person should be able to countenance.


  1. I have to say, I am not a great fan of the current NHS. No fault of the staff at the ‘front end’ as it were, but more with mismanagement higher up. Like many city councils, the more useless people seem to have migrated upwards above their level of incompetence. Of course, removing them would be the best course of action, but they are the ones who actually control who stays and who goes, and they are not likely to sack themselves. (Not without a massive golden handshake anyway)

    1. I’m no great fan of additional layers of NHS management, but replacing them with a system of CCGs run by GPs who have no experience at all of running hospital services seems foolhardy to say the least. Or are you referring to a different type of manager?

  2. It seems to me that a mass resignation by all health care staff in affected regions might make a difference. I know staff will baulk at the idea re patient care but if they all give notice the authorities will have to step in. I know this patient would fully support such drastic action

    1. I’d suggest a slightly different tack. The unions should steadfastly refuse any worsening in pay or conditions, to call the bluff of the cartel. If they follow through on their threat to sack & rehire everyone, staff should decline to be rehired – and sue for wrongful dismissal.

      The responsibility for providing care and cover lies with the Trusts’ management, and they’ll have painted themselves into an inescapable corner – it would be an impossibility to restaff 19 entire hospitals at zero notice, and as the wronged parties, the staff would have all of the public sympathy if the PR was managed effectively. A high-risk strategy, but better than lying down and taking it.

  3. See, I don’t get it, senior figures in government service seem to think differently to everyone else. They don’t seem to value their own integrity. It’s like what can we get away within the rules, what rules can we bend and how far can we bend them. It’s not like they say what’s the best we can do. Of course I can’t see their side of things but it still sounds like they think “it’s not that it’s wrong it’s just that it’s not right” or something; which means nothing really but you know what I mean … probably. Perhaps they could try some ECT on themselves, maybe it will help! Ooh, that was a bad thing to say …

  4. Stuart,i think these guys are going for broke.They dont care about anything except pushing through as much privatisation of the public sector as possible.They are employees of the corporations and doing their work,certainly not working for the electorate.No matter how many times this is said,no matter how rotten they are,no matter how many petitions are signed,how many experts cry foul,these fifth columnists will keep on privatising[they cant even understand the delicacies of the Blood transfusion Service-soulless zoids].
    Democracy,politics,constituency mean absolutely nothing to them.They are so in bed with the corporations that they are immune to the political process or the feelings of the electorate.
    I think the electorate will have to campaign to close the door on this kind of corruption by developing robust constitutional means to remove corrupt mps/lords.
    In the mean time people should use their economic ‘vote’and stop buying products and services from companies,businesses and their affiliates/subsidiaries/holding companies that A.are moving in on the NHS like Virgin,and
    B.Stop buying products and services from companies who employ mps/lords,or who they are directors or advisers to,or who donate to their party or constituency[???] office.
    The severity of lansley and cos’ tactics have made political procedure meaningless and worse than ineffective,with them walking in conspicuously corrupt policy on the backs of mps/lords with vested interests.As oft repeated,politics is broken and corrupt in the ‘Mother of all Parliaments’.
    This nest of mps/lords are a disgrace,and so shameless they dont even know it.

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