We are all thrown into a mix of long hours, while being short staffed, with colleagues we might not know that well. At the same time we are confronted with the results of decisions that affect us, but that we have little control over. The wards, theatres, hospital kitchens, pharmacies, porter lodges and store rooms would not run if we hadn’t learnt to juggle with our co-workers. It sometimes really is like a circus. In order to juggle together you have to trust each other, have each other’s back, be pals. But it is hard to be close and friendly under stress. If we don’t stick together and stand up for ourselves against stress and low wages, the bitching will start sooner or later. We will look for the ones who supposedly “don’t pull their weight”. We feel like competitors, rather than fellow jugglers. In the end the patients will suffer, too, because care workers who don’t work together cannot take good care. That’s why it is important to form communities of friendliness and resistance. Resistance against a system that expects everything from us, but gives us little resources and control over our lives.
The big nurses’ strikes in 2023 were important. They pushed the government to pay us more. But they often didn’t manage to create that community of friendliness and resistance, because we were not in control of the strike either. It was managed far away in some trade union offices. That’s why it is important for us to look also at smaller actions and struggles, some open, some hidden. We can learn a lot from each other. Let’s take the maternity care assistants at Southmead as an example. In October 2023 they went on several days of strike. They were not happy that special incentives for overtime were only paid to registered staff. It was so beautiful to see them all together. But they remained alone. How many colleagues in the Brunel building knew about the strike, how many came over in support? And what happened with the dispute, how do our MCA colleagues feel about the strike, what are their lessons for the future? We don’t know, because we don’t have an independent forum to talk about these things. This series is a little step towards the creation of such a forum.
Below you can find the write-up of a conversation between two health care assistants. The first HCA, Jack, is working in Bristol, the other, Jones, somewhere around London. They chat about surviving at work and the struggle to survive. The dispute around the question if HCAs should be paid Band 2 or Band 3 is a widespread one. In 2023/24 a long strike of HCAs took place in Liverpool around the same issue and currently HCAs in Plymouth and Leicester are protesting. It is a complicated issue. Don’t we all need and deserve more money? What is more complicated, changing a wet bed sheet safely under a patient with bed sores (Band 2) or checking their glucose level (Band 3)? What is a greater and riskier responsibility, hoisting a poorly obese patient out of bed or taking their blood pressure? In our hospitals most of the permanent HCAs were paid a back payment for Band 3 tasks, while the Bank HCAs were excluded. Let’s not be divided over these issues – whether HCA or domestic, whether substantial or Bank, we all work our socks off. If you and your colleagues find ways to create solidarity and resistance, write to us.
Jack: In our Trust the qualification of an HCA is very arbitrary. They used to say that even if you have some care experience, if you don’t have a care certificate they encourage you to go on an apprenticeship for Band 2, which is the lowest paid and lowest skilled Band. That would take a year, often one and a half years where you are paid the minimum wage. The training was pretty bad, you didn’t get the 20% off-the-job training – 20% of your working time that is – that you are entitled to according to government guidelines for apprenticeships. You would get 1 or 2%, which you would get anyway, as part of the usual on the job courses. That created some tension and a collective grievance against the apprenticeship scheme, which resulted in some people getting back payment of the difference between minimum wage and Band 2 wages. During the apprenticeship scheme for Band 2 they also added a lot of medical tasks, such as glucose testing, medical observations, taking out cannulas and so on, which should be paid Band 3. So the next step was to demand back payment for Band 3 wages, which we also managed to get.
Jones: All this is now part of the Band 3 pay dispute across the country which my Trust is a part of. Otherwise we do our medical tasks, like ECGs, taking blood samples, putting cannulas in, but we are still paid Band 2. When people are in special breathing machines, such as CPAP or BIPAP, we record the details on the machines when doing medical observations. That should be a Band 3 job, because you have to know what is going on. Originally only trained nurses would do that. Currently we’re organising a collective grievance to bring to the trust CEO. The HCA reps are not actually ‘union reps’, they are more like contacts for the campaign, normally two or three for each ward. They can take turns in delegating. What worked well was that if one ward didn’t have a rep, people from another ward would go there and explain what’s going on. Now we circulate information about disputes elsewhere. We have handed over a signed collective grievance and given statements to the Chief Nurse and Chief Executive, highlighting how many have actually worked above their band undertaking in band 3 clinical duties. After this all HCAs involved in this campaign elected 6 delegates to negotiate our terms with the Chiefs and then the board further up. Now, we are going through a collective vote for potential strike action if our demands are not met and our delegates have met with both the Deputy Chief Executive and Chief Nurse.
Jack: That sounds better than our situation where there are perhaps three, four HCAs in the entire hospital that would walk around and visit other wards. I mean, it’s huge, there are forty, fifty different wards or sections, it takes you more than three hours if you want to visit all the staff rooms – I have done that several times. At the moment mainly the Bank HCAs are upset, because for a while there were not many shifts. They also cut the ‘allocation on arrival’ shifts, which is a bit like your ‘rapid response’, where they only tell you in the morning where you are going to work that day. These shifts pay 30% to 50% extra. All of this also affects the nurses, because if they only pay Band 2 for a bank shift then we won’t do things that help them, such as blood sugar tests, medical observations or taking out cannulas. I had a situation where the nurse I worked with asked the staff nurse to call the Bank office to change my shift from Band 2 to Band 3, just because she was so overworked. And they did it straightaway! If you don’t ask, you won’t get!
Jones: In Germany you had strikes around staffing levels. As an outcome, if you work a certain number of understaffed shifts you are supposed to get extra days off or financial compensation. That puts at least a bit of pressure on management to sort things out. The problem is that people tend to take the money, but are still stressed. Here the unions tend to argue around three corners: we want more money and more money will mean more staff, because more people will want to do the job. I don’t think that this argument is very effective. The nurses strike in our Trust was a mixed bag, the derogation was done pretty much top down, which meant you had more staff on certain wards during strike days then during normal days. Only some nurses had the courage to leave these wards and come to the picket. The picket was lively, but many people came on their day off. From our ward, with a total of around 40 nurses only three came – three nurses from the Philippines, who arrived two years ago, who are the most hard working, but are also pissed off with the pay level in the UK. That was good to see.
Jack: Absolutely!
