Nursing, politics and social enterprise

Saturday, 10 April 2010

One of the areas I find really interesting is the way that both Labour and Conservative have come out in favour of social enterprises. Not sure where the Liberal Democrats and the other parties are on this subject but whenever parties seem to agree on an issue, they then immediately try and establish battle lines between each other. At the moment, within the overall consensus on social enterprise is a division about a very specific type of social enterprise, namely the “worker co-operative”. This is where staff get together and collectively own an organisation and democratically determine how that organisation will be run and who sits on the board. The Conservatives are advocating more of these in the NHS whilst Labour are arguing against it, even though they have been promoting examples of this as the way forward for community provider services.

So what does all this mean and what’s it got to do with nursing?

To understand that, I think you need to understand two things: where worker co-operatives came from and what nurses hate about the NHS.

So where did worker co-operatives come from? Well although they are now an international movement, they were born in Rochdale, Lancashire about 300 years ago as a way of workers making sure that they had good working conditions, were paid a decent wage and as a direct response to the traditional company owners simply exploiting them to make as much profit as possible. From these roots were born the trade union movement and latterly the Labour Party and there are still Labour Party MPs who are technically members of the Co-operative Party (which joined with labour a few decades ago). So worker co-operatives are a response to workers feeling underpaid, undervalued, disempowered and exploited. The way they work is that every person who works for them has a single vote and these votes are used to democratically elected the governing board and make key decisions about how the organisation is run.

OK, but what do nurses hate about the NHS? The NHS is like family members who quarrel and fight but will defend each other from any attacks from outside. We often spend so long defending the NHS that there is very little attention given to what’s wrong with it and particularly what many nurses experiences are like in the NHS. Staff survey after staff survey shows that nurses are very often treated very poorly by their organisations whether by overt bullying, poor working conditions, lack of support, no training and education opportunities, etc. Having spent much of the last 9 years working with nurses from across the whole NHS, it is common complaint that nurses don’t feel valued or listened to by heir managers and that they feel that their organisations board puts money ahead of clinical care.

I have seen many nurses interested in the idea of worker co-operatives as a direct response to this lack of control, lack of empowerment and poor management practice. At its simplest, it is a way of saying “we think we could run this organisation better than the people who currently do”.

The focus on using social enterprises as a vehicle has drawn up battle lines between the unions and between some of the political parties; and has focussed on the mechanics such as pensions, TUPE (transfer of undertakings legislation), legal structures and whether these new entities represent “the privatisation of the NHS”. What all of these fail to realise is that this is not a response to large-scale economic shifts or changes in political policies but a very local response to how valued and empowered nurses feel. What is striking about talking to nurses who have left the NHS to establish nurse-led social enterprises is not only how much happier and empowered they are but how they are able to improve clinical services the way they also wanted to. Until the NHS gets better at treating its nurses properly then this is a movement which is likely continue whatever party takes control after the election.


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