If the Tories believe in ‘levelling up’, why not level up pay for outsourced NHS staff? | Polly Toynbee

Nothing will be the same again, say the silver-lining seekers. A BBC radio series is exploring big ideas in a “Rethink” of everything. YouGov polling this week shows most people want to “build back better” with a “fairer and greener economy”. Isn’t that what they said when the banks crashed the world economy in 2008?

Building Boris-branded status projects may restore some public investment axed in the last lost decade. But for a government talking of “levelling up”, as recession threatens the lowest paid, there’s a traditional Tory lack of interest in levelling up incomes. This week’s High Pay Centre research shows chief executives of top companies receiving state bailouts related to the Covid-19 pandemic are earning 80 times the median average of their employees. But if work is to be revalued, there’s no better place to start than the NHS – after all that clapping not just for nurses, but for care workers, cleaners, porters and security guards who kept hospitals going. As the Office for National Statistics registers the highest death toll among the lowest paid, the pandemic has become a national lightbulb moment: to be low paid only means to be undervalued, not of less value.

As in most of the NHS, at Hackney’s Homerton hospital manual jobs are outsourced, so the cleaners, caterers, security guards and porters are employees of a giant company, ISS Mediclean, which pays them less than employees on the NHS’s lowest pay band and with worse terms of employment. That contract has come up for renewal, and the hospital is set to sign up for another five years. These 300 outsourced workers – 80% ethnic minority – began campaigning to be taken back in-house early this year, but when Covid-19 struck they suspended all action. Like the hospital’s own staff, they worked flat out to cope with the crisis.

I spoke to three employees of ISS, each afraid to let me use their real names as they described a world of bullying and intimidation that I hear time and again from outsourced workers. Mia, a caterer, explained: “You might get six days, if you’re in favour. But make any complaint, and they can cut you down to two days and you can’t pay the rent. They have the whip hand in a way that can’t happen to NHS staff.”

Adam, a Homerton cleaner, caught Covid-19. He said: “I was coughing and crying, but I thought there’s no point going to hospital when it was so busy. I was back in work after two weeks, as cleaning in A&E is specialist and needs experience. Staff were very emotional when three of them died and the mortuary was full. These are our families and friends, everyone knows everyone.”

Arif, a caterer who has worked at the hospital for many years, told me: “Everyone was scared of Covid at first. But we all felt strangely proud and happy and we wanted to be working here, even though ethnic minorities are more at risk. It’s our community hospital.”

For this, they are paid £10.75 an hour, the London living wage, but as NHS staff the minimum would be £11.50. That 75p an hour makes a big difference to the lowest paid, and they don’t get NHS sick pay. Beyond money,* as NHS staff they would be on Agenda for Change, which is not just a pay scale but a ladder where extra training can help cleaners or caterers become healthcare assistants, who in turn can train up to be nurses. To be outsourced is to be outside, a disposable workforce with no career path. Their leverage is weak, according to Arif: “Everyone wants to work here. People come in every day asking, with more and more unemployed now.”

Outsourced workers’ frustrations have included a lack of cloths and basic equipment, broken disinfection-mix machines, competition to use damaged buffing machines and blame from supervisors for the subsequent delays. “In the ward, the senior sister should tell us what to clean when she needs it, but it’s all fixed in the contract,” Adam said. “We end up cleaning at busiest ward-round times. Anything not in the contract – carpet cleaning – and the company charges extra.” I discovered the same problems with inflexible working and equipment scarcity while working as an outsourced cleaner and porter for Carillion at Chelsea and Westminster hospital, doing research for my book Hard Work.

These workers had a great boost last week, when 170 Homerton doctors wrote to the chief executive, Tracey Fletcher, calling on her “not to just pay lip service to the NHS family”, saying Covid-19 “shone a light on our less valued colleagues, who are so important”. In her reply to staff, she suggested a new contract would improve sick pay.

She told them of the struggle to return services to “pre-emergency levels”, and her fears that “lack of clarity” over Brexit’s impact made this a bad time for change. Hackney MPs Meg Hillier and Diane Abbott, campaigning alongside the Unison and GMB unions, say the contract should only be rolled on for one year, to prepare for bringing staff back in-house. In the Commons last week Hillier, chair of the public accounts committee, made the same plea: inadequate NHS funding relies on underpaying outsourced manual workers.

It can be done: London’s Imperial College healthcare trust is just the latest to bring its workforce back in-house. There’s strong local sympathy for Homerton, a small, well-managed trust caught in the same harsh funding vice as all public services: this is a nationwide issue. Genuine levelling up starts here.

Polly Toynbee is a Guardian columnist