UNDERNEATH the slick advertising and company logos lies a hidden world of precarious work driven by corporate greed as hospital cleaners, porters and catering staff lose their pay security.

Pay is frequently incorrect and workers no longer get hired on full-time contracts. NHS pay progression, NHS pensions, NHS sick pay, overtime pay, weekend pay enhancements and yearly automatic pay rises have all been removed for the vast majority of outsourced workers.

A multi-tier workforce is emerging in hospitals as each Tupe transfer to a new employer sees pay, terms and conditions diminish even further for the new influx of hospital ancillary staff.

The facilities management companies give with one hand as long as they can take away with the other. If they do raise the pay up from the minimum wage (£8.72 an hour in London) to the real living wage (£10.75) that cost is covered with cuts in hours and staffing. This leads to a diminished service and impossible workloads for the remaining staff. Let’s take a look at some of them.

Carlos cleans London hospitals for a living. Carlos must clock on at 6am for his first job to make sure he has enough time to change into his work uniform. Carlos knows that if he is even 10 minutes late to clock for any of his shifts he will be docked 30 minutes of his pay for that shift.

This hourly rate for this job has gone up to £10.55 but it is busier than ever before and Carlos has been asked to cover more cleaning areas over his four-hour shift. Today Carlos has got a file note from the supervisor who told him his areas are dirty and he is scared that he will have to go to another disciplinary.

Facilities management companies are more likely to cover work by using a combination of part time, overtime and agency staff. Outsourced workers are desperate for overtime or extra part-time jobs so that they can make ends meet.

This casualisation of the workforce enables ruthless managers to misuse the allocation of overtime to bully the workers into silence about the daily injustices they face.

Ade is a hospital domestic. On a good day Ade starts early and doesn’t finish until 11pm. The children are sleeping when Ade leaves the house and they are in bed when he gets in too. It makes him feel sad to be treated like a stranger in his own home.

Ade is contracted to work 20 hours each week and as he finishes his set hours he is torn between wanting to go home to be with his kids and hoping he will be chosen to work overtime so that he can have pay that covers his bills.

Ade would like full-time regular hours but he has been told that there are no extra contracted hours for him so he relies on getting overtime to top up his wages. Ade sees temporary staff come in every day to clean but he never makes a fuss.

Ade gets his overtime when he asks for it because he asks nicely and he isn’t a troublemaker. He gets very annoyed at the ones who complain about everything because he knows that they will also complain when they are refused the overtime. He tries to help his friends and he tells them to be quiet and then the manager will give them the overtime.

If a worker happens to realise that they have not been paid for the hours they have worked they are invited to fill out a form as part of the “pay query system.” If the worker has the ability, the courage and the tenacity to chase up their pay query they might or may not get some of the pay back after two weeks.

Elena works as a hostess for a multinational company. Her English is not good so she feels very lucky to have a job with a big private company in a London hospital. She gets paid every four weeks but the money changes and she is very confused. It seems like her pay has been going down.

Last month she thinks her money was down by £200 and the month before she thinks she might have lost £54 but luckily she managed to get some basic groceries from a charity for £3.50. The “nice supervisor” told Elena her pay is fine. The supervisor likes Elena and he gives her some overtime hours but she is feeling tired.

Elena’s friend is “very clever” and sometimes she helps her to get into her payslip online on the phone. Her friend told Elena that her money is wrong. The other manager has told Elena to fill in a form if she thinks her pay is low but Elena is too embarrassed to say that she can’t do it because she doesn’t understand the pay or the form properly. Today is payday and Elena feels slightly sick as she approaches the shop to charge her electricity metre key.

Facilities management companies never give good reasons why they short-pay their employees on such a huge scale and with such alarming regularity. The way outsourced hospital workers are treated goes right to the heart of why privatisation is wrong.

You would almost be forgiven for thinking these companies deliberately mess up people’s wages — but the reality is just as bad because these companies just don’t care and every pound in unclaimed pay makes the contract even cheaper to run.

Incredibly, in spite of the fact that part-time work, casual work and pay exploitation is common practice, most of the big NHS facilities management companies are well on the road to being celebrated as “living wage employers.”

The concept of the real living wage is meaningless unless it is underpinned by a genuine commitment to pay workers for the hours they have worked and allocate them enough permanent contracted hours so that they can make ends meet.

It’s high time to recognise that the private companies in the NHS won’t ever achieve the real living wage standard because the will to pay full wages owed simply isn’t there and incompetence and inefficiency is the order of the day when it comes to the pay of the so-called “hourly rate colleagues.”

The struggle to end privatisation must happen at all levels — from the shop floor right up to government itself. Ending privatisation is Labour Party policy, yes, but unfortunately it is not communicated in a clear and consistent way.

Every last one of us, whether inside or outside the NHS, can find a route to put the pressure on to end outsourcing. It is important that everyone, including MPs, support NHS workers who have the courage to take collective action via their trade unions. Union-led campaigns do attract public support if managed properly and they tend to have a significant impact within the NHS itself.

Collective trade union activity has enabled NHS workers to win pay increases and make gains on health and safety during the pandemic. The GMB has organised its members to resist cuts in hours and to stand up to bullying.

Reps and members across our hospitals are standing their ground in the face of victimisation for their union activity because they have had enough of being ground down and they are ready and willing to fight back. When organised trade union members rise up as one, with the full backing of their trade unions and communities they can and do stop cuts, restructuring and attempts at further privatisation in the NHS.

The abuse and exploitation of outsourced workers is inextricably linked to deteriorating standards in our hospitals. It’s well within our reach to build campaigns that win even bigger gains in the NHS and secure the ultimate prize of bringing all NHS outsourced workers back in house for good.

It is only a matter of time before everyone including all NHS workers, patients, NHS community campaigners and others become a fully united and unstoppable force against those whose sole motive is to extract profit out of our NHS at the expense of human beings. It’s high time that we all came together to build enormous pressure behind a clear and unequivocal demand to end the surge of outsourcing in our hospitals for once and for all.

Helen O’Connor is the GMB NHS union organiser for the Southern Region — @HelenOConnorNHS.

All names have been changed at the request of those interviewed.