My name’s Eloise and I am a middle-aged Registered Nurse working in the UK. I earn a decent wage – thirty-five to sixty thousand pounds a year depending on how much I work and the pay rates I’m offered by agencies. However, most of that goes towards paying bills and left-over debt from my time as a student which leaves me with little ability to save each month.
I grew up mostly in Cyprus due to my Dad having a career in the RAF [Royal Air Force] but we moved back to England just as I was finishing sixth form. I studied and was qualified in Midwifery but found that there were no roles in that field in my area at the time meaning I’d have to commute to Oxford in order to find a position offering sufficient pay to support me and my daughter. After only a short period of time I retrained in Adult Nursing at university because I’ve always thought a healthcare position would be a constant, stable career and after working in a care home as a teenager I had always known I wanted to work in a position where I could help people. Within my career, however, the stability of the industry has not been what I thought it would be – the gradual privatisation of the healthcare sector, delays in getting DBS [Disclosure and Barring Service] checks before being accepted for jobs and the innately slow recruitment and onboarding processes within the sector have all led to brief breaks in work availability throughout my career.
To be a legally practicing registered nurse in the UK you have to register with the Nursing and Midwifery Council. This costs about £120 a year. Also, really you need a union membership to protect you in any employment disputes which varies in price but of course it all adds up in the grand scheme of things. So, once I had begun the registration process, it took a few months for my registration to come through updating my status from Student Nurse to Registered Nurseso that I could get a job.
When first properly working as a qualified Nurse, I started out working shifts on hospital wards as most Nurses do. During this period, I worked in a variety of specialised wards in slightly varying roles. Eventually, due to NHS budget cuts and privatisation of some areas of it, many of us were forced to begin finding work through privately owned employment agencies, mostly as call operators for either 999 or 111. At first this seemed like it would be an improvement:choosing your own hours, not having a fixed schedule and generous pay rates on holidays (like Christmas or New Year’s) – as well as the bonus of missing out on the gross parts of the job.
The reality of my situation working for employment agencies isn’t quite the improvement I expected. I have to search around for which agencies are offering good enough pay rates, apply and often travel quite significant distances to get that wage. Specialist Nurses, like some of my friends at work get offered better pay to travel to where they’re needed – which seems like a bonus, but the distance may be really inconvenient and if the Nurse refuses they could be admonished by management and possibly create bad relations with contacts at the employment agencies.To make any significant reduction to the debt I have accrued up until this point I have to regularly work twelve-hour shifts culminating in 50-60 hour work weeks. This means choosing whether to work for the entire day, which would mean missing out on experiencing everyday life or the entire night meaning I often get very little sleep before or after my shifts. Whilst the regular pay isn’t that bad, it’s nothing special. This means when holiday shifts come up (accompanied by significant increases in hourly wage) they are taken swiftly because lots of people in this line of work need the extra money.
An average workday for me starts at around either 4am or 10pm and consists of me waking up,leaving my house to get to the office in Taunton which takes a couple of hours then spending 12-14 hours answering calls about possible health concerns the general public have. We’re not always treated well by some people; I think they just forget it’s a real person on the other end of the phone. Of course, there’s also always a couple of slightly unusual people or people with unusual situations every shift which can be entertaining but also sometimes a bit unsettling.
Most people aren’t too bad. Luckily, I enjoy the company of many of the people I work alongside at the office so in between calls we chat and that passes the time well enough. Finally,when my shift is over I either go and stay in a hotel room (if the pay rate makes it worth it and I’m especially tired) or commute back home to crawl into bed ready to sleep for as long as I can allow myself before starting the same schedule again.
The upper management of the agencies themselves show little concern for workers. Only a fewof the companies pay high enough wages to make a living off and even those don’t value you as they should. At the start of the pandemic (and for a large part of it), we were instructed to sit in close proximity to other workers without being supplied proper PPE [Personal Protective Equipment] like visors and masks. All of the office blocks are meant to be regularly inspected by the government because of the pandemic but I’ve only actually ever seen it happen once the entire time.
I can’t say I love my job as it is – answering calls to people all day, every day and trying to offer them whatever help you can. I’ve heard people say that 111 call operators have told them they need an ambulance or to go to hospital unnecessarily, but I don’t think they quite realise how difficult it is to gauge the severity of a medical situation from the other end of a phone. If we were to not send an ambulance or advise going to the hospital and that resulted in harm for the patient overall, then our qualifications could be called into question and we could lose our jobs.
The testimony Eloise provides highlights an unusual area of work within the provision ofsocially reproductive services as commodities associated, by many, with the shift from Liberal Capitalism to Neoliberalism (characterised by the state ‘stepping’ back and allowing market forces to organise labour) in the latter half of the 20th Century until the present day. The privatisation of certain areas of the UK’s National Health Service (NHS) has led to many roles within it becoming forms of precarious ‘gig’ work, accompanied by the issues associated with relying entirely on shifts through an agency to make a living. This type of work, along with much of the healthcare sector has a history of showing a clear gender division of labour, as well as divisions of class and ethnicity. Furthermore, healthcare work, as well as the care work mentioned by Eloise are forms of socially reproductive work, which are often undervalued and underpaid in a Capitalist society. The current COVID-19 pandemic also brings about some interesting perspectives on care work, its future and the implications that the pandemic has had for this industry, which will be considered alongside the possible implications of technological advancements on this type of work. This analysis will take a broad-ranging approach to the testimony provided and connect many of these elements involved within the sphere surrounding this kind of labour.
The healthcare sector has been one of the main pillars of the UK economy since the NHS was created by the passing of the National Health Service Act in 1948 (UKParliament.uk, 2021).
This legislation gave the Secretary of State for Health the duty of providing universal health care as part of changes made by the Labour government elected in 1945 after World War II.
The war had displayed to policy makers and the public the importance of healthcare due to the casualties the country had experienced in mainland European battles and in attacks on UK cities that had been carried out over the last four years. Despite technological advancements,criticism, and periods of austerity this core responsibility of the NHS and the Secretary of State for Health remained largely unchanged until the introduction of the 2012 Health and Social Care Act (UK Government, 2012). The Act was brought in by the Conservative-Liberal Democrat coalition of 2010 and was an element of a period of austerity experienced in the UK after the 2008 financial crisis. The passing of this legislation entailed the most extensive restructuring the NHS had endured since its conception and removed the responsibility of providing universal public healthcare from the Secretary of State for Health. Furthermore, it led to the creation of an executive agency – Public Health England – in 2013 as well as an estimated redundancy projection of around 21,000 NHS staff (Department of Health and Social Care, 2012). Due to this legislation’s Neoliberal leaning tendencies a market for private companies to commodify aspects of healthcare provision in the UK opened up.
This means that firms that can offer provision of the service for the lowest cost to the government whilst fulfilling the obligations of the proposed contract are paid to provide that service under the supervision of, and in cooperation with the NHS. The employment agencies Eloise is employed by are all examples of the result of this: privately owned, for-profit companies employing registered healthcare workers at the lowest possible cost in order to make as much profit as possible out of the price they negotiated with the NHS for providing the service. This is also the case with much of the care sector, including care homes and hospice care facilities as it has been commodified in line with the period of Neoliberalism that has been experienced in many UK government sectors in the last decade. This shift means agencies are likely attempting to encourage increased productivity from workers or a decrease in real wages to increase their profit much of the time. Eloise’s testimony alludes to this in the fact that she,along with many others it is presumed, have to travel to work for an agency that is offering a wage that is liveable. This further reduces real wages because travel costs are unlikely to be covered by their employers.This all culminates in a rather stressful work life for many within this industry, working long hours (as mentioned in the testimony ‘50-60’ hour weeks), dealing with stressful situations and not always being remunerated effectively for what they deal with every day. Due to the gender division of labour present in the care sector many of these workers are also women who due to patriarchal home dynamics fostered and proliferated by society after the Industrial Revolution are still expected to undertake the majority of unpaid, socially reproductive tasks within the home after completing their workday which for those in the sector entails both socially reproductive, but now also ‘productive’ labour completed for the profit of a private entity. This gender division is furthered by the view that women are naturally caring in disposition and can handle the stress that comes with caring for others in need. Many in the industry, including Eloise as she mentioned are in fact employed in their role due to an ambition to provide care for others which has been, in a way distorted by the Capitalist ideas behind privatising a public service sector.