Column

Goodbye to all that?

In this brand new column, Charles Webster will look back at the important events of 50 years ago. What lessons should today’s policymakers learn from the past?

The national pay structure in the NHS is under threat of elimination. The Whitley system of pay determination was introduced in 1948. It secured better compatibility with other occupations and paved the way to improved professional status. It underlined the degree to which the previous free-for-all of local pay bargaining had contributed to proletarianising the health workforce and holding back the development of healthcare in Britain.

One of the worst defects of the voluntary system that dominated British healthcare before 1948 was its exploitation of labour. Medical staff gave their services free, but were amply compensated by private fees. Nurses and other hospital workers were subjected to long hours and low pay but with no compensation from other sources.

The Nightingale image of self-sacrificing service was used unscrupulously to legitimise exploitation and, once applied successfully to nurses, became the dominant culture of the voluntary hospital system. During the interwar period, exploitation became an economic necessity because the big voluntary hospitals were drifting into bankruptcy. Even during the Depression, nursing failed to attract recruits because of its low pay, long hours and punitive working conditions.

Hospital workers were additionally handicapped by slow unionisation. After 1918, Whitley Councils were successfully introduced in many areas of public service. But in the health sector, the only significant advances towards uniform pay determination were made in local authority services, where unions were most developed.

It was not until 1939 that the Athlone Committee recommended for nurses the equivalent of the Burnham committee for teachers. This was resisted by the British Hospitals Association on the grounds that it would ‘encourage trades union organisation among nurses and therefore be bad for hospital practice’.

The RCN was equally hostile because of the threat to the traditional independence and hierarchy of authority within hospitals.

The impasse was broken when, for the sake of wartime emergency, it was necessary to introduce national arrangements for recruitment, pay and conditions. By 1945, a shadow national system covering most groups of healthcare workers was in existence.

On 2 May 1946 the Labour government promised to extend this system by creating a Whitley Council structure for the entire NHS. This was essential because the nursing shortage was again becoming acute. Aneurin Bevan described the Whitley Councils as a huge, complex ‘piece of conciliation machinery’ which would play its part in making the NHS into ‘a vast co-operative enterprise’.

Whitleyism was by no means perfect but it immediately eliminated a mass of historical injustices, and injected optimism for the future. This national pay structure was vindicated by the important Clegg and Chester reports in 1957, and McCarthy report in 1976. They warned that ending national pay arrangements would have disastrous consequences for health workers and the NHS; it would also not save money.

As health workers now realise, the national pay structure has protected them from the anxieties and instabilities associated with the operation of market forces. The chaos of proletarianisation produced by the interwar market serves as a powerful warning about future prospects under the market system.