Tag: pay

Pay – who pays?

“Taken together, a picture emerges of earnings stagnation or decline for most occupations since 2005. The big difference between Pay Review Body employees and those in non-Pay Review Body occupations in the private sector is that PRB employees are public servants. As such, the government can determine their annual pay settlement.”

These figures of course don’t say anything about absolute pay. I’d be rather less bothered if my pay was £500,000 in 2005 and stagnated to be the same in 2017. I might be forced to buy a little less champagne or not visit Tuscany quite so often. For those at the low end, however, stagnation or decline in pay really bites and have pushed some to use food banks (or borrow more). The counter is always: “yes well, but there is no money and we have to balance deficit reduction and pay increases to ensure a stronger economy and jobs growth”. I leave you to consider what those banal phrases actually mean.

In short, nurses, firefighters et al have been asked shoulder some of the burden for the Financial crash that put us into the mess in the first place, while at the same time asset values have increased along with the levels of wealth of the top 0.01%. Yes, I know its complex, its a dynamic complex system….but you ignore social consequences of technically/econometric based ‘solutions’ at your peril. By that that I mean using tools such as the Laffer curve (tax rate v tax take) might seem superficially a good idea, but it operates in a social and political world where perceptions matter and where experience hurts.

Joseph Schumpeter once described an aspect of capitalism as ‘creative destruction’ – the old and inefficient must make way for the new and better (e.g. canals v railways, landlines v mobiles, internal combustion v electric). All good stuff unless you are a canal owner/worker. The answer? Retrain, Education (Blair’s ‘third way)…it is also Macron’s approach: let the old die and be reformed (labour laws, certain industries) but don’t let the losers fester…invest in them. You decide if the current losers are able to adapt and adopt quickly enough.
This is of course another unresolvable ‘inner contradiction of capitalism’, unresolvable because that is what capitalism is. Governments that get too technocratic, relying on mathematical models, theoretical concepts (e.g. the Laffer curve and neoclassical economic modelling) and inductive logic derived from historical data, can get their fingers burned…or turn on their populations to control potential and actual simmering unrest through various processes of social control (Greece, China, India) or before they go and elect the ‘wrong person’ (Trump, Erdogan, Putin).

This is a warning to both Left and Right – each will try and solve the inner contradictions of global capitalism from their own perspectives (Chavez in Venezuela – Löfven of Sweden – Obama/Trump in the US) but will run into problems that just don’t go away.

Meanwhile, the Planet burns.

Have a nice day, at least there is Wimbledon and the Tour de France on the telly!

Care, Compassion and the Social Structures of Oppression

Care, Compassion and the Social Structures of Oppression


Nurses are asked to consider dignity and compassion as nursing issues. However if media reports such as ‘my husband died like a battery hen in hospital’ are correct , and  there are far too many to be dismissed, certain practices can squeeze compassion out of nursing care.  We therefore need to be critically self-reflective and critically thinking (Morrall and Goodman 2012) of the ‘social structures of oppression’ (Harden 1996).  Jeremy Hunt has recently described ‘the normalisation of cruelty’ in NHS organisations. If this is correct we need to analyse why this might be so. However, and accepting that there is poor care,  this phrase is part of a campaign of criticising public sector organisations in order to soften up the public mood for privatisations. It is part of this wider public relations exercise. That being said, we cannot overlook the real pain and suffering of patients as being only down to ‘them’ (whoever ‘they’ may be).


Thus, it is necessary for nurses to reflect upon the reasons we see such poor quality care. This is not just or only a case of failing, uncaring individuals which require calling them to account, although there is truth to this. There will always be individuals who ‘do not give a stuff’ and see care work as only a means to an end, i.e. the pay.

Up to the point when the struggle for material conditions no longer becomes an issue, money is an extrinsic reward and motivator. The fundamental basis of most work in a capitalist system is the ‘cash nexus’ i.e. the starting point for work is the pay. This is an extrinsic motivator. Take away this extrinsic motivation, and then take way all other intrinsic motivations (to care, be compassionate, to make a difference, because it is fun….) work then becomes meaningless. Many nurses and care assistants are relatively low paid and this is their sole extrinsic motivator. Nurses don’t get much in the way of other extrinsic motivators such as status or privileged/free access to important goods and people (perks). Thus to keep working they rely on their intrinsic motivators just mentioned.

To demonstrate the importance of pay, just consider how many nurses would stay at their posts if they a) won the lottery b) came into a decent inheritance c) were independently wealthy. There would no longer be the extrinsic reward and motivator to work.  Would any intrinsic motivator that one still has (the sheer love of caring) still make one go to work? So let’s be honest with ourselves first. Without pay many of us would not nurse. That being said nurses do then bring into their daily lives their intrinsic motivators. Then they are paid just enough to care, just enough so that any innate compassion can be exercised. However that is a fine line.

Nursing work is often dirty ‘body work’ that few would willingly take on just for the love of it. The ’emotional labour’ involved also takes its toll. However, there is still a caring ethic underpinning nursing and most nurses wish to be compassionate and nurse because of the pay yes, but also because they want their work to ‘mean something’. This compassion can be trampled upon by the context in which it has to operate – job losses, poor staffing levels, poor skill mix, lack of clinical supervision, poor access to professional development, lack of social status and esteem, patient complexity and consumerism,  hierarchical, patriarchal and bureaucratic managerialism to name just a few oppressive social structures.  So, in essence, poor care is a political and social issue not just an individual one. Too often we pick on the failing individual nurse(s) when we should be stripping away the layers of context which promotes uncaring attitudes or does nothing to weed it out. The Francis Report into Mid Staffordshire NHS Trust, for example, shows certain management cultures that hardly supported good care, and the Margaret Haywood case shows what happens to whistleblowers.

However, we also need to consider the fact that within similar organisations experiencing the same funding and staffing issues, why there are differences in compassion and care? What are some ward managers and individual nurses doing that demonstrates that care is not being compromised? I suspect there is a complex interplay of various social and local factors which play out in hospital and care homes that results in horrific experiences for one and superb care in another. I also suspect that articulate, confident, intelligent nurses give high quality care despite and not because of the social and organisational contexts they find themselves. As nurses and care assistants in the NHS come under increasing pressures, the bad apples will have more space to operate and compassion fatigue could set in even further.

So students of nursing and nurses are being exposed to savage criticism of nursing care, we have to be honest and say that in some cases this is justified. However this is complex and the analysis of the antecedents of poor care must take us beyond simply blaming failing individuals. Indeed a recent, February 2013, Nursing Times survey indicates that nearly 50% of staff consider ward staffing levels to be dangerous. This is part of the context ‘failing’ individuals find themselves.

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