Feature

How the NHS harms health

NHS acceptance of low pay among contracted-out staff is unjust and worsens health inequality, reports Catherine Howarth

To help pay for rising nursing costs in 1996, Homerton Hospital in the East End of London decided to contract out portering, catering, and domestic services. What does a decision like this mean for the individuals who deliver these so-called ‘non-core’ services – and what does it mean for the wider health economy?

Today, these services at Homerton Hospital are run by ISS Mediclean, a Danish multinational operating in NHS trusts across the UK and a preferred bidder in many PFI schemes. Jose Estaves is a cook in the Homerton’s kitchens. Although he has worked in the NHS for over thirty years his take home pay is just over £150 per week. His contract with ISS Mediclean means Jose gets no London weighting; no sick pay if unwell (and he does suffer back problems); eight days less paid holiday annually than equivalent workers on NHS contracts; and a vastly inferior pension scheme.

Jose should have been transferred to the private sector on NHS conditions but was particularly unlucky – a period of sickness during the transfer left him reapplying for his old job on the new terms offered by the contractor. For most of Jose’s colleagues it isn’t so much a question of particularly bad luck – those terms and conditions are the new going rate for the job.

Estaves is a UNISON member and part of the Homerton Living Wage Action Committee which is fighting for the restitution of NHS terms and conditions for all staff at the hospital. A year of making the case to the trust board in alliance with community-based organisation TELCO has made little concrete progress, despite a public admission by trust chairman Rev Andrew Windross of the overwhelming justice of the argument presented.

As a result of this stalemate, the union branch has submitted a formal pay and conditions claim to ISS for parity across all staff doing the same jobs. This is part of a growing national pattern of local pay claims being submitted at NHS sites.

Staff at the Glasgow Royal Infirmary working for Sodexho, another notorious contractor, were recently victorious in restoring NHS pay levels to ward cleaners following strike action, ending one of the most pernicious effects of private contracting: the ‘two-tier’ workforce where ex-NHS staff and those recruited to work in the service since privatisation do the same jobs but take home different wages at the end of each month.

In high cost-of-living areas, dangerously long hours are one inevitable consequence of wages below £4.50 per hour. Junior doctors’ hours are recognised as a problem in the health service but the 60, and even 70-hour weeks of hospital domestics employed by contractors is not yet big news. The UK has the longest working hours in Europe and the consequences for health and well-being are well known.

The NHS must take a lead in promoting good practice on working hours for the whole workforce delivering health services, including those now employed by contractors. ‘Improving Working Lives’ is a Department of Health initiative which places a welcome emphasis on work-life balance in the NHS, but the standards trusts are supposed to monitor apply only to their own staff, and not contracted out staff. This leaves some of the most hard-pressed and needy workers in the health service out in the cold. At Whipps Cross hospital, for example, where new crèche facilities are one of the improvements being planned, contracted-out staff will not have access.

If that sounds a bit like workplace apartheid, consider this: the Race Relations Amendment Act puts an obligation on every NHS trust to produce a race equality plan demonstrating how they will actively promote racial equality in the workforce. Part of the plan is careful monitoring of the ethnic profile at different grades and occupations. But what if the greatest concentration of minority ethnic workers in the local health service is employed by an external contractor, as is the case in most London trusts?

They are ignored by the race equality plan. The greatest single contribution many trusts could make to promoting racial equality would be to bring low paid facilities services back in-house, so that the overwhelmingly black workforce would once again be on decent nationally negotiated NHS terms and conditions, and have access to the training and promotional opportunities which come with being inside, not outside, the system.

A recent King’s Fund report, Claiming the Health Dividend, examined the indirect impact on health which the NHS has as a result of being the largest organisation in the UK. It highlights a variety of ways in which the NHS could make better use of its resources – in particular, to help reduce health inequalities. But its role as a major purchaser of low-paying contract services is not tackled in any detail.

NHS trusts are often the single largest users of certain services, such as cleaning, in a locality. When they contract with employers offering barely above the national minimum wage, they help to cement local wage standards for unskilled jobs at poverty levels, and thereby contribute to the hardship and poor health of communities which are the target of their own health promotion projects.

For this craziness and injustice to stop, the NHS must either bring services back in-house, or insert ‘living wage’ clauses in their contracts for services. Until this happens the health service will continue to be accused of creating many of the problems it exists to cure.

More information at: www.livingwage.org.uk