The last few years under David Cameron saw high-profile strike action and industrial unrest. Junior doctors, teachers, university lecturers, nurses, rail workers and steel workers are just some of the people who have been affected by cuts and layoffs, and many of them responded by downing tools or assembling behind picket lines.
And there’s a strong link between Cameron’s austerity measures and this unrest. For example, then-chancellor George Osborne’s cut-heavy budget in March (a £3.5bn reduction in public spending) was met by further talk of strikes, which was countered with a promise to curb strike action in health, education, fire and transport in the Queen’s Speech just two months later.
Here, teachers, nurses and doctors tell The Pool what Cameron’s successor, Theresa May, will need to do to ensure that these professions don’t just survive, but thrive.
On July 5, teachers in England held a one-day strike in protest over cuts to school budgets and concerns over workload. Teachers last went on strike in 2014.
“The main thing any teacher will talk to you about is workload,” Kevin Courtney, general secretary of the National Union of Teachers tells me. “Teaching has always been a long-hours profession, but not as many hours as we’ve got now. Those long hours used to be spent preparing exciting lessons for your class, but now you have to spend that time proving you’re doing your job. For example, primary-school teachers are told they have to take photographs of children doing practical maths, print them out and stick them in the children’s books in order to prove that you’re doing the work.”
Lesson planning is also too rigorous and done too far in advance, Courtney says, and there’s no way that, when you’re teaching a room full of young people, you can accurately predict exactly what they will need to learn a week in advance, meaning lots of wasted teacher time. “It’s also the lack of trust that is implied by that workload,” he says. “The assumption isn’t that you’re doing your job, and teachers feel they aren’t trusted. And that workload is getting in the way of planning the exciting lessons, and stopping teachers from being effective.”
The enormous amount of chop-change under Cameron has also been injurious to the profession and to students. As education secretary from 2010 to 2014, Michael Gove made changes to the curriculum and even threatened to axe GCSEs in favour of an international Baccalaureate-style system. He left office having infuriated many teachers, who felt he was constantly criticising them.
Courtney complains of a political culture of “moving goalposts” and ministers making decisions on a whim. “I don’t think education can ever be not-political, in the sense that we’re spending billions of pounds of the country’s money on it,” he says. “Ministers changing curricula without taking expert advice is quite a dangerous thing. They don’t tell surgeons how to do their operations, but they feel very free to tell teachers how to teach reading, how to teach maths – and there’s expertise they can listen to, but they don’t. As a consequence, teachers feel disregarded by politicians and as though they have no voice.” A case in point is the controversial Key Stage 2 English grammar, punctuation and spelling test for children aged seven to 11. “It’s grammar most graduates in the country don’t know unless they’ve done a modern-languages degree – people don’t need it to be competent writers,” Courtney argues.
Worrying about the level of grammar of young pupils basically amounts to rearranging the deckchairs on the Titanic. Courtney warns of an eight per cent funding cut threatening schools and is wary of the acadamisation of comprehensives, saying that, for teachers, it means less certainty when it comes to things such as sick leave and maternity pay, which affect women more than men.
Theresa May and new education secretary Justine Greening need to “from the top, change what’s going so badly wrong with the way teachers are held accountable. They need to address the culture that makes teachers act paranoid,” Courtney says. “And that’s a big change.”
Looking after our most frail and vulnerable citizens, nurses perform an invaluable job. However, they are under absolutely enormous pressure, says Jenni Middleton, editor of Nursing Times. Nurses are usually docile but, in 2014, they were denied a one per cent incremental pay rise (that was afforded to MPs) and some midwives, nurses and other NHS workers went on strike.
“Nurses, historically, don’t tend to strike,” Middleton says, but “they have been beleaguered – pensions, pay conditions, constant underresourcing in the NHS; those are the things that really do upset them. The strength of feeling is so much that people say they want to quit, or work in the private sector or go overseas.”
It’s not just pay, but also immigration policy that could threaten the future of nursing. “Most of the NHS is propped up by people from Spain, Europe, Philippines, Sri Lanka – we have a lot of overseas nurses without whom the NHS would not be able to provide the care that it does. However, Theresa May did not put nurses on the shortage list for the migration advisory cap, and what that meant was that if you earned less than £35,000, you had to leave the country,” Middleton says. “The average nurse does not earn that – the average wage is £28,000 for a band-five nurse. What the government is saying is that nurses aren’t important enough to be on that list. I think Theresa May’s views on immigration are therefore very pertinent, as she was home secretary when that was decided.”
Nurses, historically, don’t tend to strike, but they have been beleaguered – pensions, pay conditions, constant underresourcing in the NHS; those are the things that really do upset them
Demand for nursing care may be going up, but the numbers of nurses are going down, thanks to budget cuts, leading to a nursing shortage. In response to this shortage, the government has said that it will scrap bursaries for nursing students from 2017, meaning they will have to pay to train. “Nursing is a very expensive degree to do, says Middleton. “Nurses end up having to work on placement as part of their degree, so it’s very hard for you to get another job while studying.” This will mean that nursing becomes another white, middle-class job, Middleton says, which won’t benefit anybody in the long run.
The financial pressure of university is one thing, but another is the risky potential of replacing qualified nurses with a “nursing associate” role, which will be a bridging role between a healthcare supporter and a registered nurse. “And that will mean that you will be provided with care by a non-graduate,” says Middleton. “There was a tonne of mortality data done by the RN4Cast, which found that if you have a graduate workforce, that improves outcomes. You can have a healthcare support worker going around and mopping peoples’ brows, but they’re got to know what’s going on underneath the flannel.”
On top of this, the Department of Health is removing all its nursing and midwifery advisors. “This means that there is nobody in the policy unit who will actually advise ministers on policy decisions they make, and how they will affect nurses,” says Middleton. “There is an independent voice for doctors, but the one for nursing will be removed in September. So my view is to reverse that decision and make sure you’re getting fantastic advice on what policy will mean for nurses.”
“Whoever is looking after health – and it looks like it will be Jeremy Hunt for some time – makes sure that health is prioritised on the agenda. May needs to make decisions on pay and pensions and conditions for staff that we’ve got – we need to make sure that we retain our staff, because we can’t afford to lose any more. Who wants to be operated on by a grumpy surgeon or cared for by an unhappy, demoralised nurse?”
It has been one of the most extraordinary and hostile clashes between the government and workers in recent memory, and the row between the Department of Health and junior doctors rumbles on. The British Medical Association put a contract to the junior doctors in England and senior medical students to see if they thought it was agreeable – but 58 per cent rejected it. The BMA is consulting with junior doctors to decide what to do next.
Ellen McCourt works in emergency medicine and is chair of the Junior Doctors Committee at the BMA. She says: “The difficulties junior doctors have had is a reflection of problems across the NHS – not enough doctors or beds; social care is underfunded. It’s one part of that ongoing problem of the NHS just not being taken seriously.”
The dispute over contract changes goes back three years, McCourt explains, with talks beginning in 2013. “The main issues, really, have been the government not listening to what junior doctors were saying, which meant they had to take unprecedented industrial action in order to bring government back to negotiations,” she adds.
The idea of the so-called “seven-day NHS” in the new contract implies that doctors don’t already work weekends, McCourt argues. “As someone who’s worked three out of the last five weekends, this is ridiculous,” she says. “Systematically, undervalued health professionals need to stay working in the NHS so the NHS can continue. It’s a phrase thrown around a lot, but the NHS is one of our greatest institutions – but, without the staff, it will struggle to survive.”
McCourt has concerns about the pay gap under the latest proposals, saying that, under the new system, people who go less than full time are primarily women, and “compared with our current contract, there will be quite a financial hit”.