In late 1971, as the Staff Side of the Nurses and Midwives Whitley Council began their preparations for the submission of the 1972 pay claim, some of its members and their organisations were becoming increasingly worried about the impact of a number of factors on the overall pay position of British nurses.
Not only were serious manpower shortages becoming more than usually apparent, but a rather higher rate of inflation was beginning to depress nurses' salaries in their comparability within the scale of professionally qualified staff, both within and outside the National Health Service.
In addition, both the Government's consultative document on the reorganisation of the NHS (issued in May 1971) and the Committee on Nursing under the chairmanship of Professor Asa Briggs (established in March 1970) posed problems of uncertainty. It was against this background that the Staff Side decided to submit a major claim for revaluation and restructuring of nurses' pay, a decision in which COHSE and its chief negotiator Albert Spanswick, then COHSE Assistant General Secretary, were instrumental.
The claim, shown in Table 1 in much simplified form alongside the then existing ranges of pay, was finally submitted on
— including temporary stoppages, withdrawals of labour and restrictions on working practices. It was a unique claim, and was to prove a unique campaign, noted for its exploration and discovery of the sanctions and measures which could be taken by those working in the area of patient care and life and death — an area previously thought immune from industrial action.
Unique, too, in the determination, frustration and desperation which had built up over the years.
The most substantial claim was in respect of student and pupil nurses, who, although unqualified, were involved for a large part of their time in practical nursing and frequently took a great deal of responsibility. The claim for them was between 41% and 49% and was crucial in particular to the nursing trade unions represented on the Staff Side. The claim gave substantial rises to senior qualified staff (nursing officer and above: those largely involved in administration), but in every case gave more to the minimum than the maximum of the range of scales. In the case of clinical nurses, staff nurses, enrolled nurses and ward sisters, however, the revaluation claim attempted to make scale maximums far more generous, particularly at ward sister level, by introducing a second and senior
level which, it was hoped, might provide the basis for a career structure in clinical rather than administrative nursing. In the case of ward sisters, the claim varied from 32 per cent to 48 per cent at minimum and maximum, 26 per cent to 39 per cent in the case of staff nurses, and 25
Management Side to discuss the revaluation claim and in a joint statement of that date, it was declared that 'agreement was expected in the autumn'. This was a major landmark, as the Staff Side had raised the question of revaluation on the agenda and Management Side had agreed to consider it; thus major pay discussions would continue on throughout the year instead of being shelved until the following spring.
The 8 per cent award provided new ranges of salaries for various grades:
Ward sister 1,407 1,821
Staff nurse 1,089 1,299
Enrolled nurse 954 1,134
But the priority of the Staff Side was clear, as Albert Spanswick spelt out to COHSE's Scarborough Conference in June
. '...but what is vital is to complete the revaluation of the salaries, because this will give the greatest benefit to the greatest number of nurses...'
Discussions on smaller items attached to the revaluation claim extended during the summer and agreement to take effect on 1 October was reached on long-service increments (after three years in post), stand-by and on-call payments, and payment between the passing of exams and registration, but still no news emerged about the substantial revaluation of pay. And then disaster struck.
The Conservative Government announced a total pay-freeze on Tuesday 5 November 1972 'which had the dramatic effect of terminating substantial discussion on the revaluation claim. The detailed effect of that statutory incomes policy is examined elsewhere and shows that nurses, far from gaining their expected revaluation, lost substantial ground in their relative position, or in other words, nurses' earnings declined even more steeply than the national average.
In an urgent attempt to remedy this development, COHSE with others argued for an up-grading revision of the revaluation claim which was eventually agreed at an additional 15 per cent, which was lodged with Management Side on
Ward sister 1,971 2,844
Staff nurse 1,464 1,920
Enrolled nurse 1,263 1,674
The claim for the ward sister's salary range was now nearing COHSE's long-established salary target of £3,000 per annum. In accordance with Phase Two of the statutory policy. Management Side on 13 February offered £1 plus 4 per cent which amounted to £35.7 million (or about 8 per cent of the gross pay bill of £446 million).
The impact of incomes policy supposedly designed to assist the lower paid had been severe and accordingly the offer was referred back to the COHSE executive committees of the nursing organisations. The day before the next meeting of the Staff Side, the Confederation's National Executive Committee decided, after a long meeting, to argue for equal distribution of the global sum to all nurses. On the following day (3 April) the Royal College of Nursing and the professional associations used their voting majority to defeat COHSE's proposal, which had been supported by all the other nursing trade unions. An increase giving a minimum £102 per annum but then £1 plus 4 percent to all nurses was agreed, with COHSE and the other nursing unions voting against, because the effect of the agreement was to give over £220 to the top of the chief nursing officer scale, while only giving £78 to a first year student/pupil (under 21), and £102 to a staff nurse.
A senior enrolled nurse grade was introduced for psychiatric hospitals on the same scale as for general hospitals but including the psychiatric 'lead'. It was agreed to refer nurses' pay to the Pay Board established by the counter- inflation legislation and to ask for an immediate independent inquiry.
The Government had still to make a move over the Briggs Report — published the previous October — and moreover, two controversies within NHS Reorganisation broke out over the summer: firstly, the argument over 'top posts' (the new regional and area nursing posts were to be paid less than equivalent administrators); and secondly, because special payments for extra work involved in NHS Reorganisation were vetoed by the Pay Board. So, in September 1973 when the Staff Side came to the Pay Board Relativities Inquiry (the procedure whereby nurses could request 'special treatment' under the counter-inflation legislation), morale was low and the pay position even worse than when the revaluation claim had first been lodged.
Evidence was given to the Pay Board on 24 September and
which was asked to recommend an immediate independent inquiry into nurses' pay because 'at present, many trained nurses — including some ward sisters — have take home pay of less than 60p per hour; less than the take home pay of some women workers in factories and of many women in secretarial and clerical jobs.'
The Pay Board 'should look at whether these levels of pay accurately reflect the responsibilities carried out by nurses and midwives.'
The Pay Board was told that the inquiry should be a broad-ranging one comparing salaries both in and outside the NHS; 'the top of the scale for a ward sister (£1.947) attained after eight years is about the same as the starting salary of the most junior house officer (£1,914)' and 'even the most casual empiricism suggests that this is not a fair reflection of relative responsibilities'. In community nursing 'there should be comparisons between the attached nurse and the general practitioner'. The evidence went on to argue the case in terms of fairness and manpower difficulties, including those caused by agency nurses and night-staff shortages. There was no effective way to discuss manpower within Whitley and as a result 'all the pressures in nursing have been towards dealing with manpower problems by means other than raising pay'.
The Department of Health and Social Security has not produced statistics on manpower shortages for over ten years, but a survey carried out by COHSE's Research Department in September 1973 indicated, on a 10 per cent sample, that the shortage could be as high as 17.3 per cent nationally and as high as 25.2 per cent in Greater London—in other words the nurse in four short. Nationally, this indicated that the NHS required 46,000 full-time and 28,000 part-time nurses.
On 12 December COHSE's National Executive Committee decided unanimously to recommend deregistration under the 1971 Industrial Relations Act and indicated its intention to reaffiliate to the Trades Union Congress and hence reinforce the discussion of NHS problems within the TUC. But within a few days came the worst blow of all. On 17 December the Government announced cuts in public expenditure which would remove £69 million from the capital building budget and £42 million from the current expenditure budget within the NHS. Building contracts of long-overdue hospital development were frozen, decorations postponed and staff replacement trimmed. The effect on morale was dramatic and in many respects, this was the final blow.
In February 1974, COHSE, as the main NHS union, ran a recruiting campaign for nurses. Albert Spanswick, by this time General Secretary-Elect, argued in the union journal: 'unions have a reputation of getting things done' and that 'COHSE is determined to fight'. He was also able to report that the balance between psychiatric and general nurse members in COHSE was evening out.
The recruitment returns for this period showed a marked increase and were about 73 per cent up on the previous month, at 6,087 compared with 3,509.
In the run-up to the February General Election, a Phase Three settlement was forced on the Staff Side which feared yet another total pay-freeze. Pay below £1,671 per annum was increased by £117 and that over £1,671 by 7 per cent, effective from
The Prime Minister called the General Election on 7 February and during the course of that campaign, several Conservative speakers and election broadcasts presented nurses as having quite happily accepted their Phase Three increase — in other words, as model acceptors of Government policy. COHSE was quick to release strongly worded statements emphasising the contrary, and that agreements were made under duress.
After polling on general election day,
Michael Foot's announcement was followed by a quick succession of events: