Last week it was announced that from April, outsourced cleaners, caterers and porters at St Mary’s Hospital in London are to be brought in-house as NHS employees after months of industrial action and negotiations. This is an unprecedented and well-earned victory for the staff and their union, United Voices of the World.
In November, along with 50 other doctors at St Mary’s, I wrote a letter in support of the strikes to the chief executive of Imperial College Healthcare NHS Trust, Prof Tim Orchard. We could not ignore the way the staff were treated by Sodexo, the French multinational outsourcing firm that is contracted to provide facilities services to the hospital.
Workers I talked to during the dispute spoke of the constant fear they live in. Fear that they would not be able to provide for their family on an hourly rate that was less than the London living wage. Fear of the dilemma of having to choose whether to work while unwell or to stomach the punitive statutory sick pay of just £94.25 a week. These terms of employment are unfair and unsafe, and no worker should be held to them, and certainly not within the NHS.
With such reasonable and sensible demands as a living wage, fair sick pay and clean working conditions, it is not surprising that soon after industrial action started, the trust announced it would expedite the introduction of the living wage originally planned for April 2020. And now, three months later, the board has capitulated to United Voices of the World’s primary demand: to bring more than 1,000 facilities workers in-house as NHS employees. Writing directly to the workers last week, Prof Orchard said: “I want you to feel properly valued and part of our wider team so that together we can provide the very best care for our patients.”
These words capture the significance of this victory. They acknowledge the value that a motivated and respected ancillary workforce can bring to a hospital and its patients.
Sadly, crippling cuts to NHS budgets over the past decade have led to situations where, time and again, decisions like the outsourcing of facilities services have been taken by hospital management to provide quick fixes for perilous financial situations. But these simply offer short-term budget relief that appease stakeholders but also have negative consequences that ultimately turn outsourcing into a false economy.
Take punitive sick pay, like that offered by Sodexo to my colleagues at St Mary’s. As a doctor I am actively discouraged from coming to work if I am sick with infectious symptoms. Thankfully, I can rely on a commonsense sick-pay policy that allows me to stay at home and recover, free of financial penalties. Outsourced cleaners and porters, however, have to chose between coming into work while still unwell or staying at home and being out of pocket. Such shortsighted policies are dangerous to both staff and patients, yet have been allowed to fester insidiously while our health service has been deprived of the investment it so desperately needs.
But last week’s victory offers a glimmer of hope. An estimated 40% of NHS trusts outsource their cleaning services, but outsourcing is not inevitable. Evidence also shows that while it tends to be a cheaper option, it is associated with poorer patient health outcomes.
United Voices of the World succeeded in bringing about this change because it combined the passion of its members with a negotiating strategy underpinned by a common-sense argument for change, offering a win-win solution for employer and staff alike. The importance of this approach should not be underestimated if we want to replicate this success elsewhere. Crucial to this will be encouraging outsourced workers to join a union that will stand up for their rights and amplify their voice.
I know from the messages I have had from outsourced NHS workers up and down the country that the appetite for change is there. We cannot afford to let them down. Writing a letter to my chief executive was nothing compared to what the striking workers went through, but acts of solidarity like this are essential to put pressure on decision-makers. We all want to do the best for our patients and so we should embrace any pursuit that aims to promote that ideal. If the NHS aspires to be a world-class health service, it must first commit to being a world-class employer.