Privilege of working for the NHS

So it seems I wrote a very controversial and divisive facebook post last week. I was commenting on what I’ve been reading from NHS staff who were expressing that they don’t usually have any ‘perks’ in their jobs so getting discounts offered, freebies sent to work and being able to queue jump was OK. It is OK. NHS staff are doing a remarkably hard job, it’s hard in ‘normal’ times let alone at the moment. But I do think we should also be thinking about other colleagues who don’t get the limelight or recognition, much less the offer of freebies. Staff who work in the voluntary sector, who’s funding has dried up due to fundraising being impossible. Staff who work with the most vulnerable in society who don’t have access to services in the same way the rest of us do. Staff who work on much less favourable terms and conditions than those of us in the NHS. They are also on the front line, putting themselves at risk, working long hours often in more challenging environments than NHS settings. My post is below.

“I’ve seen quite a few posts on here referring to NHS staff not having any perks to justify taking up the discounts and offers from retailers.
I know NHS staff work incredibly hard. But we also have pretty generous holiday allowances, carers leave, permanent contracts (mostly), access to car lease schemes, many get 5 days volunteering allowance etc.. etc… No NHS staff have been furloughed or lost their jobs due to this.
Charity and voluntary sector staff tend to earn significantly less, have insecure contacts as they are always subject to funding being identified, less holiday, less access to training and development (as funders don’t like to cover those costs), often have to fundraise to keep their services open and so on. These organisations tend to work with the most vulnerable, stigmatised and marginalised people in society – people who are homeless, people with addictions, people living in poverty, people who are sexually abused – without these organisations our society would have even worse health inequalities and the pressure on the NHS would be even greater. We don’t hear anything about these people. No one is offering them discounts and no one is clapping for them.

I think we have to remember the privilege and security we do have as NHS employees. Public and corporate donations to charities have reduced significantly whilst public and corporate donations to the NHS have gone through the roof. I recently asked a corporate that is donating food to NHS staff if they would consider a similar donation for people who are homeless. Their response was a flat out no as it’s the NHS they want to be seen to be supporting.”

What a small number of responses highlighted was how misunderstood the voluntary sector is. So many assumptions or mis-perceptions – everyone is a volunteer, that they didn’t have to train for years, that they don’t do clinical work etc.. etc.. It highlighted the hierarchy that whether we like it or not exists. NHS staff are at the top of that hierarchy and they deserve the applause, the accolades, the ‘perks’. Within the NHS there’s also a hierarchy – mental health and learning disability services come somewhere close the the bottom of it. Social Care (for that read care homes looking after the elderly) probably comes next. Care for people outside ‘elderly care homes’ possibly comes next, followed by ‘other emergency services’ and ‘other local government staff’, bus and train drivers, supermarket staff, delivery drivers. Then, if you really think hard, you might remember ‘others’ – usually volunteers. There’s almost never a mention of voluntary sector staff. People who work for not-for-profit organisations, charities, social enterprises.

Who are these organisations of which I speak? Refuges, domestic violence services, hospices, substance use services, homeless services, refugee and asylum seeker services … I could carry on. Ah, but they don’t provide ‘clinical care’ I’m told. Interestingly they do. Hospices care for people at the end of their lives. Doctors of the World and Medicines Sans Frontiere provide primary care services for those who can’t get registered with a GP practice, even though they are entitled to be registered and receive the same access to care as the rest of us. Sexual Health services including those providing HIV care and treatment. These organisations care for people at their most vulnerable, who are the most stigmatised by society, who often can’t get access to the same services you or I can.

There’s an issue here that the people who are most marginalised, stigmatised and invisible to the rest of society are cared for by the most marginalised and hidden sector – the voluntary sector. They have to fund raise and fight for public service contracts through expensive procurement processes that often cost more than the value of the contract being tendered. Contracts that are then micromanaged to make sure that none of the funding is used for management, admin or other such frivolous things that public sector organisations have included as their core costs automatically paid for my the tax payer.

There is a huge inequity that simply has to be addressed. There are glimmers of hope in pockets around the country. Glimmers that we need to learn from, especially at the moment as we start to think about what the future looks like. There has been radical and rapid change, driven by a public health pandemic, that we need to keep. Areas where the boundaries between organisations have become more fluid, partnerships focused on action and delivery, leadership that’s explicitly given permission to act. I hope that the positives stay but with some reflection and honesty about how it’s been resourced and what the impact on the voluntary sector has been. Our recovery phase needs to understand the precarious position these vital social sector organisations are in and find ways to allow them to flourish in a brave new world that is prepared to continue action to support those most vulnerable and enable action through their trusted organisations who truly understand what needs to be done for lasting change.

We can’t change the different terms and conditions that each sector has applied to them. But we can stand together. Recognise and name the inequities and change practice to equalise funding relationships and the power dynamic that drives them. So take the freebies and discounts but ask about others, share these where possible and, if nothing else, open your eyes to how other sectors and organisations work and value them as much as we value the NHS.

p.s If you want to find out about voluntary sector activity in your area NAVCA (National Association of Voluntary and Community Action) have a searchable database so you can connect with those working in your area – https://navca.org.uk/find-a-member-1

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