Dear Jeremy, thanks for your promise on NHS regional pay

Dear Jeremy Hunt,

I hope you’ll excuse me writing you this rather public letter. It’s just that I’ve expected the worst of you as Health Secretary, and you’ve surprised me, so it seems only write that I say this in a way that everyone can see it.

You see, I’ve been one of the most vocal critics of the Tories’ actions and attitudes toward the NHS and I consider Andrew Lansley to have been a disaster. Given your statements that the NHS is irrelevant and a mistake, I could only see things getting worse with you as Health Secretary. But it seems I may owe you an apology.

On 23 October, your Shadow Andy Burnham welcomed you to your post. I thought his welcome was perhaps just a fraction insincere, and it soon turned into some fairly robust criticism. You and your team fought back equally vigorously.

Now, I know from watching your testimony to the Leveson enquiry that your memory can be a little shaky. So, in case you need to check what you all said, here’s a link to the Hansard record of the debate.

The part of the debate that most interested and encouraged me was actually said by your Under-Secretary, Dr Daniel Poulter. But I consider those words as coming straight from your mouth, since I’m sure you’re very diligent and extremely vigilant, so I’m certain that nobody working under you would get away with doing or saying anything unless it had your approval. Well, there was your Special Advisor Adam Smith – but he ‘fell on his sword’ for conducting all those intimate discussions with News International, and I’m sure you’ve learned your lesson and would never allow anything similar to happen again.

Besides, you were sitting right there in the House as he said what he said, and you didn’t cut him off or drag him back down to his seat, so I feel safe in taking it as a given that what he said had your approval. And all I can say is ‘Wow!’ and ‘Thank you!’

So, what was it that so encouraged me – blew me away, even?

Well, challenged by some of those nasty, plebby Labour types about regional pay – the idea that people in poorer areas should be paid less because it’s less expensive – and about the New Economics Foundation’s findings that this would suck £9.7 billion a year out of struggling regional economies, Dr Poulter (how could I ever have thought that a doctor becoming a Tory MP must be a heartless turncoat who’s forgotten that one of the most crucial precepts of medical ethics is ‘First, do no harm‘?!) turned the proposition on its head in a manner that I can only describe as breathtakingly brilliant:

Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.

Dr Poulter was even magnanimous enough to give Labour the credit for introducing the weighting! Again, ‘Wow!’

What makes this so brilliant is that it’s subtle but unmistakable. Subtle enough to slip unnoticed past those in your party of a neoliberal persuasion who want to dismantle the NHS by cheapening it until it’s a bargain for private companies to snap up – but unmistakable enough to be an uncompromising commitment to a wonderful principle:

You’re only going to make NHS pay regionally variable… by putting it UP in some places.

You see, you and Dr Poulter are intelligent men. You know, as I do – as any right-thinking person must – that putting pay down in a poorer area can’t in any way ‘reward’ those who work in a more expensive area. Someone stealing money from your pocket doesn’t make my rent, bills, mortgage, food etc any cheaper, so how can making health-workers poorer in the provinces reward those in, for example, the South-East? That would be like claiming to ‘make work pay’ by cutting benefits instead, er, making work pay. And the government wouldn’t do that, surely.

So, the only possible interpretation of Dr Poulter’s statement – authorised, naturally, by you since there’s no way anyone working for you is getting away with that again! – is that any introduction (sorry, extension!) of regional pay is only going to be implemented by increasing the pay of those working in more expensive areas. Now that is worthy of the term ‘reward’. Bravo – masterfully done!

It’s heart-warming, even inspiring, and I thank you.

Now, in view of your newly-revealed commitment to increasing NHS pay in areas with a higher cost of living, I thought I’d better let you know about some things that are happening on your patch that you may not be aware of (or might have forgotten about – that patchy memory must really be a pain in the gluteus maximus!), and which definitely don’t fit with your laudable aim:

The South-West

In the South-West NHS region, 20 trusts have banded together with the express aim of driving down the pay of their workers by over £6,000 and stripping away terms and conditions. So determined are they to do this that they’ve put together a list of 28 measures that they’re considering to achieve this goal.

Not only this, but they’re ignoring the fact that the national Agenda for Change provision, which your team referred to in the debate, that allows regional variations in pay, terms and conditions insist that any departures from AfC conditions can only be made with the agreement of unions. Your predecessor even referred to this in previous debates, so I know it’s a condition recognised by your government. And the unions have been absolutely clear in rejecting any such changes and even the very validity of the 20-trust ‘cartel’.

I’m sure you’re now as incensed about this as I am.

The North-East

On Teesside, North Tees & Hartlepool NHS Trust has decided to remove unsocial hours enhancements from sick pay – and is trying to bully staff into accepting the change by issuing a 90-day notice of dismissal and threatening to sack any doctor, nurse, healthcare assistant or other hard-working staff-member who refuses to sign the variation of contract, and then re-hire them on the new terms.

The Trust is trying to convince staff that signing this variation will safeguard employment. But in answer to an FOI request I sent in, it had to admit that it’s planning to reduce staff numbers by at least 9%, even if everyone signs.

Moreover, the Trust is also planning to change to Trust-based contracts instead of hospital-based contracts, so that it can send staff to a different hospital without paying them any travel costs.

Unions are vigorously resisting these and other measures, and have certainly not agreed them with the Trust – so again, an NHS Trust is acting illegally by making unilateral, un-negotiated changes to AfC pay and conditions.

What’s worse, the contagion is spreading. On the other side of the river, South Tees Hospitals NHS Trust has now announced that it is considering similar measures to its northern companion – forming a de facto cartel just like in the South-West. In a region that has been hammered by your government and earlier Tory governments, the combined measures will hurt the finances of over 14,000 people – and suck desperately-needed cash out of an already impoverished economy.

I’m sure you’re as shocked and appalled as I am.

If I had time, I’m sure I could list dozens more such instances all around the country – but if you’re interested to see the extent of what’s happening on your watch in direct contravention of your commitment to only increasing pay, please visit Dr Eoin Clarke’s excellent ‘Green Benches‘ blog, where there is a wealth of excellent information. Or even browse other articles on this blog of mine, for my own humble contribution.

Well, if you’ve read this far, I’d just like to express my thanks to you once again for surprising me with such an emphatic display of commitment to recognising and valuing the effort and commitment of our wonderful, hard-working, underpaid NHS workers.

But, just to double-check, that was what you meant, wasn’t it? I’d hate to think it wasn’t – because if it wasn’t, then it can only mean that you and your team were cynically and disingenuously using a positive example of regional pay variations as a ‘dodge’ to avoid admitting that the plan is to reduce NHS pay in as many areas as possible, so you can continue to turn a blind eye to what’s being done on your patch, in your name.

And I’d hate to think something like that. I truly would.

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