Britain’s National Health Service: a round of applause for the price of a latte?

Incompetence springs from many sources. Thinking without evidence that you know better than anybody else. Making decisions without taking advice. Failure to anticipate the likely consequences of a decision. Groupthink, wherein decisions are derived through ideology rather than known facts. Cultures where loyalty is valued more highly than ability.

I could go on. But I leave it up to you to determine wherein lies the stupidity of the British government in determining that National Health Service workers deserve a 1% pay rise. Let’s explore the decision a little further.

The government’s justification is that the state can’t afford a higher rise. All fine and logical, except that for the past year we have been relying on the NHS to keep more of us alive than at any time in its history. To do so, it has asked more of its staff – more hours, more danger, more stress – than they have ever experienced for a sustained period throughout their working lives. Exceptional times, exceptional demands.

Pay rises have long-term consequences. They raise the running costs of an organisation not just for the year in which they are awarded, but for the years to come. They are hard numbers that affect what can be spent on other aspects of the service – infrastructure, equipment, drugs and so forth. These costs are, to an extent, quantifiable.

So also are costs on an individual level which determine whether people can afford to work for the organisation. Costs of housing, transportation, food and clothing, for example. These are practical considerations that dictate whether a person chooses to become a nurse, a paramedic, a soldier, a police officer or a bus driver.

The question of what people deserve is entirely another matter. Do NHS staff deserve 1%, 5% or 10% increases? That depends on your perspective. If you’re a COVID patient whom the NHS has kept alive against the odds, you might argue for the higher figure. But if you’re a police officer whose mission is to keep the public safe in less dramatic fashion, and you’re told there will be no pay increase this year, you might feel aggrieved and undervalued if the paramedics with whom you work closely are given, say, a 3% rise and you get nothing.

Public sector pay is a rat’s nest of competing claims. How do you tell a police officer who confronted knife-wielding killers at Borough Market, or a fire fighter who saved a young family in a house fire that they are less deserving than a nurse struggling to keep four people alive in intensive care when normal protocols require them to look after only one patient?

So in the small picture, what people deserve is impossible to calculate and, in practical terms, should form no part of the determinations of a government haemorrhaging money in order to keep the economy afloat.

In the big picture, it’s a political issue, and it’s huge. Every spending decision for the foreseeable future is likely to be framed against what nurses, paramedics, cleaners, and junior doctors deserve for their heroic efforts over the past year. You can afford a £2 million communications centre in Downing Street but not more than 1% for the NHS? You can spend money on aircraft carriers, nukes and drones? You can build endless railway links and roads? You can pay head teachers six-figure salaries? Increase the salaries of Members of Parliament? Yet you can’t give the nurse who kept me alive more than a £3.50 a week pay rise. The price of a latte at Starbucks.

Worse still, you splurge public money on a 30-minute video extolling the success of the vaccination programme, which is immediately condemned as government propaganda. Your Test and Trace programme, at the cost of £37 billion is condemned by a former senior Treasury official as the “most wasteful and inept public spending programme of all time”. And we’re not even talking about those PPE procurement deals, which, even if they turn out not to have been corrupt, still have the smell of cronyism about them. It doesn’t make the government look good, does it?

Going back to the fundamental issue of rewarding NHS staff, here’s another thing to consider about pay rises. I know from bitter experience as an employer that the motivational value of a pay rise is short lived. Give someone 10%, and the result might be a rush of pleasure at increased earning power and a temporary boost to self-esteem. But before long it becomes the new normal. But if the pay rise is seen as unfair, and particularly if it can be perceived as an effective pay cut, the demotivation and discontent it can generate can be long-lasting even if the recipient chooses not to leave. There is an argument, of course, that in public service money is not the prime source of job satisfaction. But if it’s seen as inadequate or unfair, it’s often the main cause of dissatisfaction. Dan Pink makes that argument very persuasively in his book Drive – the Surprising Truth About What Motivates Us.

But the government can only influence non-financial motivation by tweaking the organisation and putting appropriate leadership in place. Which it tries to do with monotonous regularity, assisted by its stable of extremely expensive consultants. So when thinking about what it can do to satisfy both public opinion and the bean-counters at the Treasury, we come back to money.

There is, it seems to me, a solution of sorts. I have no idea whether the government has considered and rejected it, or whether it simply hasn’t occurred to them. If I was world king, I would stay with the 1%, or possibly raise closer to the 2.5% that the NHS was recommending before the pandemic struck. But I would award every single NHS employee – from cleaner to consultant – a one-off bonus of £1,000 in recognition of their outstanding work in our hour of need.

Given that there are 1.3 million people who work for the NHS, the cost would be £1.3 billion, or approximately 3.5% of the cost of the Test and Trace programme. In the big scheme of things, hardly an economy-wrecking number. But a lump sum of £1000, tax free, would make a big difference, especially to the lower-paid staff on whom the service relies. I would also award the same bonus to contractors who work alongside front-line NHS staff. Nobody who played their part in helping us weather the pandemic should be excluded.

You would no doubt get a chorus of complaints from other public service workers who might claim that they also played their part. If you wanted to be more discriminating, you could restrict the payment to those who worked on the front line with COVID patients. Either way, this would be a political decision. And who would begrudge the recognition of a section of the community that day-in, day-out, risked their lives and worked interminable hours to provide us with medical help when we needed it?

In this way, you separate the political from the practical. You recognise achievement beyond the call of duty and set aside the ongoing pay issue for another day, another year. And by making the same payment to everybody, you recognise that this was a crisis that demanded teamwork, where normal roles, status and hierarchies were cast aside in a common effort.

You may come up with a hundred reasons why such an initiative might not have the desired effect. To which I can only reply with a single question: would such a measure have the effect of driving motivation and morale within the NHS lower than it is today?

I humbly rest my case.