We celebrated the 72nd anniversary of the founding of the NHS last weekend. There was well-deserved acclaim and clapping. There is no doubt that NHS workers have stepped up magnificently in the fight against Covid-19. But clapping is not enough. We need to pay attention to how underfunding and outsourcing have hollowed out our NHS over the decades.
The NHS met the challenge of Covid-19 – but only just. As the public accounts committee (PAC) has highlighted repeatedly, NHS funding is not sustainable. There have been raids on capital budgets to prop up day-to-day spending, leaving a backlog of spending needed on equipment and buildings.
The additional funding for Covid-19 is only short term. On its current record this government will not follow through with a proper, sustainable long-term funding strategy. Early in the pandemic, the Department of Health and Social Care wrote off £13bn in loans to trusts. But the underlying, systemic funding weaknesses that see trusts with an £827m deficit (in 2018/19) is not being tackled.
Underfunding and outsourcing are closely linked. It is sometimes claimed that private companies managing outsourced NHS services save money because of superior management skills. The truth is that underfunding relies on underpaying outsourced manual labour. And the PAC has had companies admit that they have bid low to win contracts. It’s quite simply baked into an unsustainable funding model.
In London and elsewhere, these workers are disproportionately from black, Asian and minority ethnic backgrounds. And we see hospitals employing new temporary staff with Covid-19 funding on NHS pay and conditions. People with less experience in the NHS paid more than many cleaners and porters who have years in their role and are part of their local team but on outsourced contracts.
We have a clear example of the injustice that goes with outsourcing: the proposal of Hackney’s Homerton Hospital management to extend an existing outsourcing contract for a further five years. The hospital’s manual jobs are outsourced. This means that the cleaners, caterers, security guards and porters are employees of a giant company, ISS Mediclean, which pays them less than employees on the NHS’s lowest pay band and with worse terms of employment.
170 doctors at the Homerton recently wrote to management to express their concerns. They said: “We are writing as Homerton employed doctors in support of our ISS colleagues. We understand that a further five year contract is to be signed with ISS at the end of this month. We have been proud to work alongside colleagues in cleaning, portering, catering and security services during the Covid-19 pandemic. They have gone above and beyond in their commitment and hard work, but these employees… by being employed through ISS… receive worse pay and worse terms and conditions, including only statutory sick pay.”
The key issue is that the ISS workers don’t have the same entitlement to sick pay as NHS workers. In the middle of a coronavirus pandemic, this can cost lives. Without proper sick pay workers come to work ill because they can’t afford the time. The Guardian quoted a Homerton cleaner who caught Covid as saying: “I was coughing and crying, but I thought there’s no point going to hospital when it was so busy. I was back in work after two weeks, as cleaning in A&E is specialist and needs experience. Staff were very emotional when three of them died and the mortuary was full. These are our families and friends, everyone knows everyone.”
NHS workers need genuine respect. A hospital like the Homerton, even if it insists on outsourcing the contract for cleaners and others, should fund it so those frontline workers get the same pay and conditions as workers employed directly by the NHS. This government needs to fund the NHS properly. And an incoming Labour government needs to be working now on how it brings these contracts back in house. Most of the NHS has been outsourcing for so long that there is a gap in capability. It takes time, and we need a clear direction so that planning starts now.
We have between us nearly 50 years’ experience as MPs. We are all too aware that the support for health workers because of Covid-19 and awareness of the impact on black staff magnified by the Black Lives Matter movement raises public awareness, but it does not mean that the government will deliver. The Treasury is never keen to back more money when it sees no additional benefit. That’s why as Labour MPs we want fair pay to be unequivocally Labour policy. And we will do all we can to shift the dial today. The coronavirus pandemic has taught us all that cleaners, caterers, porters and security guards are all key frontline workers. And they deserve justice. It’s simply the right thing to do.