8 July 2021
The George Cross
Sanctification and 1%.
By Lynda Goetz
Last summer, people stood on their doorsteps once a week and clapped the NHS (well, there wasn’t a great deal else to do). Now, the George Cross Committee and the Prime Minister have, through the offices and instrument of the Queen, granted the NHS a corporate George Cross.
For those not familiar with the awards system (that’s most of us, I would guess), the George Cross is awarded for “acts of the greatest heroism or of the most courage in circumstances of extreme danger”. Instituted by King George VI in 1940 during the height of the Blitz in World War Two, it can be awarded posthumously and is generally given, as you would expect, to individuals. (Only 409 have been given out in the 80 years since its inception). It is the highest award given by the British Government for gallantry not in the presence of an enemy, or non-operational gallantry. It has the same ranking as the Victoria Cross, its military equivalent.
Awarding this honour, on the 73rd anniversary of the founding of the NHS, marks only the third occasion on which it has been awarded to a collective body, country or organisation. In 1942, the George Cross was conferred on Malta by George VI, in recognition of the fortitude displayed by the island’s inhabitants during enemy bombardments in the Second World War; and in 1999 the Queen conferred it on the Royal Ulster Constabulary in Northern Ireland, in recognition of the force’s bravery, including the families of those serving.
Reaction to this latest, very clearly political, move has not been entirely favourable. Some have, as with the clapping, been ‘thrilled’ at this attempt to honour, as the Queen put it in her handwritten message, ‘NHS staff past and present, across all disciplines and all four nations’. Others, including many NHS staff, have dismissed it as an ‘another empty gesture’ which, frankly, it is.
The NHS is a bureaucratic behemoth which the people of this country seem to regard with almost religious devotion. As the power and influence of the Church has waned, so the status and sanctity of ‘our NHS’ has risen. The more it appears to struggle to fulfil its remit of looking after the health of all the people in this country, the more the general public seems to hold it in ever higher esteem. No other country seems to revere its health service the way we do ours. And yet… and yet… Although most would happily acknowledge that if you have a serious health emergency of any sort, the NHS provides an impressive service, it also has to be admitted that there are deficiencies and failings throughout this overly bureaucratic system. It currently seems almost impossible to get a GP appointment in most areas within any reasonable amount of time; experts appear concerned about a cancer crisis and there is increasing disillusion amongst NHS employees. Individual staff members have worked and continue to work incredibly hard, not just over the last 15 months, but in general. At the same time (whisper it) many have been under-employed as the total focus on Covid has left some departments unable to take in patients or perform operations. We know this has caused a massive backlog of patients awaiting treatment in all sorts of areas.
Morale amongst NHS staff is at an all-time low. Senior doctors and nursing staff are retiring early and junior staff are either leaving completely or moving abroad to work, in particular to Australia and New Zealand. Many staff are having to self-isolate because of contact with people who have tested positive for Covid, and before that a number of EU staff returned to their own countries faced with the uncertainties of Brexit. As staffing levels have become critical, those left are increasingly stressed and over-tired, although many would hardly describe themselves as having been in ‘circumstances of extreme danger’. They do however feel under-valued – and underpaid. As several NHS employees have pointed out rather wryly on social media, ‘Clapping and medals do not pay bills’.
This week, Change.org sent me an email requesting I sign a petition for a 15% pay rise for NHS staff. As most people are aware, they have been offered 1%. This week it was reported that the BMA (British Medical Association), the doctor’s union, had announced it was going to ask members about stopping paid and unpaid overtime if that figure was not increased to a figure nearer 4%. The Royal College of Nursing has already said it is looking for an increase in the region of 12.5% and is considering balloting over industrial action. Many are shocked at the idea of these public service workers taking industrial action and feel that such action should be legislated against, even where they have a lot of sympathy for them. Consultants have not taken industrial action since the 1970s (apart from a day in 2012 over pensions), but even those who may consider medicine a vocation cannot expect endless below-inflation pay rises to be accepted meekly when work/life balance for so many has become untenable and all the years of experience and endless exams appear to be undervalued. Consultants are weary, and seeing lists which they had managed to reduce from 2 years to 6 months back up at 2 years is demoralising and depressing. Refusing to do overtime will affect patient clinics and attempts to reduce waiting lists, but many doctors feel they have little alternative. Some will retire, of course; the stress, more difficult working conditions due to Covid and erosion of salaries having taken its toll. This, as pointed out earlier, will make life even more difficult for those who are left.
To put it bluntly, the NHS is not only understaffed and underfunded, but also inflexible. It does not encourage, in any significant way, ‘going the extra mile’, although that is what staff are expected and have to do the entire time. The hierarchy is rigid in all departments from physiotherapy to neurology and no experience outside the system (i.e. abroad, outside the NHS or even outside training programmes) counts in terms of seniority or pay. Junior doctors have to take endless exams at their own expense whilst also working full-time, including disruptive night shifts. Clearly CPE (Continuing Professional Education) is vital these days in all profession to keep up with scientific, technological and legislative changes, but should it be expected to be undertaken at such a cost to the individuals? Companies frequently contribute to the costs of such CPE and grant some time to fulfil those requirements. Why are there no such concessions in the medical profession in this country?
As for how to fund pay rises, staff support and scientific and technological advances, why on earth do we not in this country take any notice of how other countries fund their medical care? We seem totally wedded to the idea of it being ‘free at the point of delivery’ – even where this is for foreign visitors to this country who have paid nothing into the system. One wealthy American was so bowled over by the ‘incredible’ service she received for free when she was taken seriously ill over here that she donated an MRI scanner to the hospital where she was treated. We should not be relying for these things on the benevolence of those who can afford it. Those who can afford it, both citizens and visitors, should be contributing. The insurance system which operates in most European countries and ‘Down Under’ sees a sliding scale of extra (usually monthly) contributions to top up what the governments puts in. Why on earth are we so averse to considering this, when it is quite clear that the present funding system is insufficient and cannot continue to sustain a population that is increasingly elderly and with increasing expectations?
The general public needs re-educating about the NHS. It is not a substitute for religion. Those who work in it are not saints. They are dedicated people doing their stressful, highly-trained jobs, for which they would like respect and reasonable financial recognition – not public clapping or corporate medals which they will never see. They would like the money to go into the system so that they can do those jobs, not into more bureaucracy which cannot even seem to plan rotas which take account of holiday requirements but leave staff to organise their own ‘swaps’ to get time off for weddings, honeymoons, funerals and family gatherings. Yet again, no private sector organisation would even attempt to treat its staff in this way.
I did not sign that petition demanding NHS workers get a 15% pay rise. That is idealistic and unrealistic at a time when the government has spent billions trying to prop up an economy devastated by lockdowns and furloughs. It is, however, worth a thought that a better-funded, better-staffed, more flexible NHS might have come through this pandemic in better shape. One of the lessons we should perhaps take away from the current worldwide chaos is that we need an improved method of maintaining our general national health next time we are faced with anything like this. Self-evidently, this is not going to be easy, but if the best minds in the public sector, in the worlds of politics and science, start addressing this problem now, we may be better placed in the future. Medals are a pointless sop; also, possibly, faintly insulting to those 409 individuals whose own achievements have been diluted by the additions of all those millions of NHS workers past and present[i] who have been namelessly added to the roll of honour.
[i] According to the KIngsfund some 1.6 million are currently employed throughout the UK, of which just over half are clinical staff.
Cover page photo: Ehimetalor Akhere Unuabona (Unsplash).