Leading Article: It's not just about money

EVERY GOVERNMENT wants to appear strong yet compassionate; but most end up by appearing weak and self-serving. The Government's award of a pay rise of 11 per cent to the most junior nurses, while awarding more senior nurses a considerably smaller pay rise, is an attempt to satisfy everyone at once. Like most such attempts, it will probably backfire. Generosity and fiscal prudence are among the most difficult qualities to reconcile. Whatever the truth of the matter, the Government appears to have acted not from conviction alone, but because a certain newspaper with very large circulation has run a concerted campaign on behalf of the nurses: a campaign that appeals to the fathomless sentimentality of the British public about those who look after them when they are ill. The timing of the award thus appears to be a propitiation of the newspaper as much as an attempt to recruit more nurses.

There are, of course, problems both with the recruitment of nurses and with their retention in the health service once they have trained. Whether it is a matter of pay alone may be disputed: as Frank Dobson, the Health Secretary, has recognised, the new methods of training nurses, which treat nursing as if it were a sub-discipline of sub-marxist sociology, have not been helpful. He may yet find it more difficult than his recent statement implies to reverse this unfortunate development, since a powerful interest group of nurse-educators has been created, which will not lightly step aside. It is far easier to ruin a profession than to restore it to health.

The wisdom of reducing the pay differential of qualified nurses and nurses in training - which is what the proposed award actually does - may also be questioned. It will certainly do nothing to retain nurses once they have trained, and may actually increase conflict, bitterness and resentment within the profession. It could easily restart the cycle of competitive wage claims that did so much damage in the recent past. It also raises the alarming prospect that future increases of expenditure on the health service will fund wage increases for the staff rather than genuine improvements for patients.

But what is a nurse actually worth? Her price in gold, of course, when you are ill and cannot look after yourself. The Government, alas, has to be a little more hard-headed, and put a price upon her head. This is determined by three considerations: what the Government can afford, what the labour market indicates, and the intrinsic attractiveness of the profession. The problem for the Government is that the first two considerations may lead to radically different conclusions. At the very least, however, disincentives to a nursing career should be removed. Among these is a career structure that implicitly devalues the very skills a nurse has learnt, in so far as there comes a point in her career when she (and nurses are still more than 90 per cent she) must abandon the care of patients altogether if she wants to improve her financial prospects. A surgeon earns far more by continuing to practise than by any other way available to him; in nursing, it is quite otherwise. A common complaint among nurses in training nowadays is that they are being trained for management rather than for nursing. Since most of them went into nursing with an idealistic desire to help people, disillusionment is the swift and natural result.

Moreover, contempt for the managers is almost universal among nurses still working in hospital wards. This is corrosive and demoralising, even where it is not fully justified, as it usually is. Morale cannot be high in an organisation whose senior staff are deemed unworthy of respect. It is thus essential that the nurse managers who pullulate in every hospital should be removed, and Matron must return.

There are other disincentives to a nursing career. Despite the public's sentimentality towards nurses, a large part of that public treats them abominably, subjecting them to verbal and even physical abuse, usually with impunity: for despite the proliferation of management, it is quite beyond the capacity or the will of most hospitals to prevent such abuse. Nor is the law much better: in one recent case, a judge ruled that being assaulted was part of a nurse's everyday duty. And anyone who observes casualty departments of a Friday or Saturday night must marvel not that there are too few nurses, but that there are any left at all.

There is much more to the crisis in nursing than low pay, and it will not be solved by a divisive pay rise, which seeks to lure recruits but offers them nothing thereafter. Young people will not so easily be fooled. Moreover, it is unlikely that nursing will ever be able to compete with other careers in purely financial terms. That is why the managerial revolution in the health service has been so disastrous.