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'Why would nurses vote for a government that removes student bursaries, cuts pay and pensions, closes services and reduces numbers?'


Here we are, just a few hours from our third national vote in two years (four in three if you’re in Scotland). And there are nurses asking, “What’s the point?”

I had a recent discussion with some senior nurses, all expressing various reasons for rejecting politics. There was the inevitable, “They’re all the same,” and “You can’t trust any of them.” One almost quizzically asked, “What have politicians ever done for me?”

It took a while, but eventually we decided politicians had created our education system, the health service, seen that roads, houses and ships were built, we had a transport system, there was social security and so on. And these things had been to enact the will of the people.

“Yeah, but that was years ago,” one muttered. “Politics makes no difference to me or my work now.”

Then one said, “I’m not sure about the Conservatives but I don’t know what would happen if the ‘other lot’ [Labour] got in.” He added, “What I do know is we cannot afford our health service. And anyone who says we can is either deluding themselves or not telling the truth.” We explored which party’s policies would most likely benefit him and, particularly, his children. He plumped for the Conservatives despite acknowledging their policies would be against his and his kids’ interests, concluding there was no alternative to the way things were.

At this point, I was reminded of the work of Steven Lukes, professor of politics and sociology at New York University. Having studied power and its application, he has provided one of the most coherent and compelling analyses yet.

Lukes concluded there are three dimensions of power. The first is pretty simple. People in power make decisions and people act on them, even when there is an obvious conflict of interest. An example would be a government giving nurses below inflation pay rises for seven years in a row, in effect, reducing their pay significantly in real terms.

The government argues this is in the national interest because the country is broke. We can all understand this, whether or not we agree with it. Nurses might even threaten industrial action to try and get more money i.e. there is actual conflict, but government power ensures the decision prevails.

“Government power ensures the decision prevails”

There is a second, deeper analysis of power. Critics demonstrated how it was not just a matter of imposing decisions. They focused on non decision making. This involves those with power influencing and shaping the agenda, creating barriers to, or preventing, any public discussion about policy or decision making crucial to the interests of those affected.

An example is seen in debates about our welfare state. It’s bloated and a drain on the economy. Our NHS is too costly. This analysis is widely accepted.

Theresa May and right wing fanatics are attempting to impose the same non decision making into the Brexit debate. We absolutely have to leave the internal market, we can’t be a part of the customs union. We cannot just grant EU citizens living here the right to stay. It can be summarised as “Brexit means Brexit” i.e. ‘it will mean what I say it means and there will be no debate’.

There are many examples of this in the way nurses’ work is organised, they’re managed and ‘rewarded’ but we’ll leave that for a later blog.

But Lukes pointed out that people willingly act in ways that appear contrary to their most basic and real interests. Moreover, this occurred when there was no obvious conflict. Why would this be?

He argues there’s a third dimension of power: those in power exert it in such a way as to prevent people from having grievances, shaping their thoughts and preferences so they accept their place in the order of things, either because they see no alternative to it, see it as natural and unchangeable or value it as divinely ordained and beneficial.

So those on benefits vote for a government that promises to cut benefits. Nurses vote for a government that removes student bursaries, cuts their pay and pensions, closes services and reduces nursing numbers, meaning they have to work harder and for longer, and then blames them when things go wrong. Parents vote for a government that charges ever higher university fees, creates a housing crisis that means their kids will struggle to have a roof over their heads. And so on.

“We spend significantly less on healthcare than most rich nations”

Yet there are alternative ways to see the world. The economist, Ha-Joon Chang, highlights our welfare spend is less of our GDP than most comparably rich countries and closer to that of countries like Turkey, Mexico and Chile. Similarly, we spend significantly less on healthcare than most rich nations.

Most welfare provision is also an investment. For example, free school meals, childcare provision and Sure Start programmes not only have a moral dimension, they equip the recipients – our children – with a platform on which they can develop and grow into productive citizens who contribute to, and benefit from, our wider society.

Money spent on the NHS, far from dragging down the economy, keeps it buoyant by allowing people to get back to work. It slows the impact of chronic conditions, meaning those who suffer with them are less disabled and will need other, more expensive, forms of care.

We’re told austerity is a necessity. We cannot afford better public services – a reason given for huge reductions in the numbers of police officer in the last seven years. Increasing taxes has been off the agenda until Labour’s manifesto for this election. Yet even they have been almost apologetic about it.

“Chang points out no one sees paying for a takeaway or getting a subscription to Netflix as ‘a burden’, because we get something in return”

Yet Chang points out no one sees paying for a takeaway or getting a subscription to Netflix as ‘a burden’, because we get something in return. Equally, we get something in return for paying tax e.g. our health service, roads, bridges, education etc. The real question is not about paying tax. It’s about the quality of service we get in return for what we pay and an honest realisation we cannot get Scandinavian levels of public services (high) for American rates of tax (low).

Richer people and companies from countries like Germany, Japan and Sweden where tax rates are higher, don’t flee to low tax economies. They see, and gain from, the benefits from higher taxation and effective public services.

Labour’s manifesto contains real meat and costed policies that have a chance of changing Britain for the better. The response of the Conservatives was to argue there’s no alternative to our – uncosted and ill defined - policies and we should trust them. When that didn’t work, they cried, “How will Labour pay for all these things?” talking about the need for a strong economy and their own economic competence.

Yet the Tories have missed almost all of their financial targets in the past seven years. Our national debt has risen to 81% of national output, and is set to peak this year at higher levels than we’ve seen for over 50 years. While the deficit has been reduced, tax receipts have only risen slightly since 2008, meaning any deficit reduction has almost exclusively been due to spending cuts on essential services, including the police and NHS.

Any economic growth under the Conservatives has been led by private debt, consumption led growth and not investment led growth. Now the ratio of private debt to disposable income is back at record levels - similar to just before the last financial crisis. Current Conservative economic policies threaten another crash, with devastating consequences for our NHS and other public services and all but the richest.

Yet none of this has had much place in the debate about our economic welfare or the kind of country we want to live in. There has been no alternative to the way things are.

Theresa May’s message is, ‘Always hang onto nurse for fear of finding something worse.’ This phrase comes from Hillaire Belloc’s cautionary tale about a boy who runs away from his nanny, or ‘nurse’, and is eaten by a lion. People always forget that the nanny wasn’t very good at her job, letting him run away in the first place and it’s this that leads to his demise.

“There are enough nurses in every marginal constituency to determine the makeup of the next government”

And there is now an alternative. We don’t have to vote against our basic and real interests.

A poet once asked, ‘What is the point of life if it is only for the business of living?’ But if government imposes on its citizens, in a country affluent beyond the imaginings of most people on the planet, a system that reduces life to no more than the business of surviving, it surely does not deserve our vote.

There has to be a place not just for dreams but also aspirations that rise above the material, that speak to the soul.

A victory for the Conservatives will be a defeat for genuine aspiration, for the belief that things can change, can be better, more equal, fairer and maybe even something basic like having public services that are more efficient. If they win, we lose.

We have the power to change everything. There are enough nurses in every marginal constituency to determine the makeup of the next government. Get out and vote on Thursday, aspire, and begin to change your world.





Readers' comments (2)

  • One day the nursing profession along with others in the NHS will surely hang itself. Since 1979 when Thatcher started us down this road Banding, P2K, Blair and AfC, Regrading, chasing the mandatory Degree.
    I am so glad I can look back and be grateful I am out of the NHS. From th e '90s the who shebang has gone down the pan

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  • Nurses is a force to be recon with they do maths every day #economics ,they advocates..they a force that with their hard earn sweat and you will loose your vote..

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