The Government and the nursing unions are bracing themselves for tomorrow's Labour Court recommendation on nurses' pay. It will be the third and final award by the court in a dispute that extends back to 1995.
A national strike by 27,500 health service nurses was only narrowly averted in February 1997, when the Labour Court made an interim award of £85 million. This was primarily aimed at meeting the aspirations of staff nurses, who obtained pay increases worth up to 17 per cent at the top of the scale. It also led to the establishment of a Commission on Nursing with provision for further reviews of nursing pay.
Last February, nurses received a further £25 million in increased allowances for extra qualifications and for working in particularly stressful areas such as operating theatres, A&E and geriatric units. That particular award is now on hold until the remaining issues are resolved.
Tomorrow, the Labour Court will attempt to complete a hat trick of industrial relations successes with its recommendation on the outstanding issues. This will, in many ways, be the most difficult award of all.
The Health Service Employers Agency estimates the cost of conceding all the union demands at nearly £140 million. It would also mean the end of public service pay restraint. The prospect of a strike which could close the health services is not very palatable either. The court must therefore try to meet at least some of the nurses' expectations without allowing a renewed rash of public service pay claims.
The central issue of ward sisters' pay should not present problems. Their differential with staff nurses was reduced in the 1997 award to as little as 2.75 per cent.
In many cases sisters can earn significantly less than staff nurses when allowances and shift premiums are taken into account. Whether the court can meet the demand for increases in sisters' salaries of 20 to 25 per cent is another matter.
At present, junior ward sisters earn a maximum basic salary of £23,429 a year and senior ward sisters £24,650. The unions are seeking to raise the ceilings to £28,115 and £34,621 respectively.
In return, they point out that the job of ward sisters is to be changed radically with three new categories of clinical nurse managers (CNMs) being introduced. The CNM grade I will replace junior ward sisters and CNM grade II will replace senior ward sisters. A new grade of CNM III will be created to cover particularly onerous posts, such as A&E units in large acute hospitals.
The unions are also seeking increases for other groups with special responsibilities, such as public health nurses, nurse tutors, psychiatric nursing officers and nurse managers. Restructuring of the nurse tutor and psychiatric nursing grades present particularly thorny problems. However, these have as much to do with the changing nature of the nursing profession and health services as they do with industrial relations.
The real problem facing all parties to the dispute is a "political" one. The largest nursing union, the INO, has announced it will require a majority of nurses in every category to make the deal acceptable. Staff nurses make up 80 per cent of INO members and 75 per cent of all nurses. There is unlikely to be much more for them tomorrow.
They have, however, been the main beneficiaries of the previous two Labour Court awards. Many of them have also benefited from recent agreements on improvements in overtime rates and incremental credit for time spent working as temporary nurses, at home and abroad.
About a third of staff nurses are now at the maximum of the scale and are earning about £27,000 a year for a 39-hour week, compared with £16,000 in 1992. When the Labour Court allowances awarded last February come into effect, many staff nurses will be earning between £28,000 and £28,500 for a 39-hour week.
The unions are seeking another 18 per cent for staff nurses, phased in as three further long-service increments. In the unlikely event of the Labour Court conceding it, the other public service unions have put the Government on notice that they will be entering catch-up claims.
The nursing unions are on stronger grounds in their demand for longer annual leave. At present, nurses' annual holidays are about a week shorter. They also have a longer working week than other health professionals. Concessions could be made to staff nurses in both areas without having a knock-on effect elsewhere.
While the unions have claimed the extra week, their otherwise very comprehensive submission to the Labour Court says nothing about shortening the working week from 39 hours to the 35 hours standard in the health services. There is little likelihood, therefore, of the Labour Court recommendation referring to it.
For the present, the Government and health managers will hope the increases which will undoubtedly emerge for middle- and upper-management grades, plus the pay rises already given to staff nurses, will be enough to bring nurses and their unions back into the fold.