As junior doctors in the BMA prepare for three days of strike action this week, Rob M, a UNISON, RCN and rs21 activist, explains that the pay fight isn’t over across the health service.

RCN Strike Solidarity march and rally from UCLH, London 18th January 2023 – photo by Steve Eason

Following unprecedented strikes across the health service in England, the NHS Staff Council, representing workers from 12 trade unions, narrowly voted to accept the government’s updated pay offer in early May. All NHS workers in England except doctors and dentists (those employed under the ‘Agenda for Change’ contract) will now receive a one-off non-consolidated payment of around 6% of their salary for 2022-23 at the end of June. They will also receive a consolidated rise of 5% backdated to 1st April 23, with the lowest paid receiving more in order to keep their pay marginally above the legal minimum wage.

While this will no doubt come as a relief to the Tory government, who are clearly hoping to draw a line under the recent wave of strikes, in reality it’s only a temporary and partial reprieve for them, obscuring a more complex picture in which there remains hope for socialists.

When we look at the disparate results from the 12 unions and the context around them, a clear pattern emerges. For instance, in UNISON, the largest NHS union, 74% of members voted to accept the deal on a turnout of just over half. This followed UNISON’s failure to even meet the 50% turnout threshold for strike votes in all but a small minority of workplaces (mostly in the ambulance service).

By contrast, in Unite, where no official recommendation was given, 52% of members rejected the deal on a similar turnout. However, this number rose to 70% amongst ambulance staff, who had been brought out on strike by Unite several times in the preceding six months. Unsurprisingly, UNISON has not published a similar breakdown for its members in ambulance trusts who took strike action.

Following escalating strikes in over half of the employers, Royal College of Nursing (RCN) members rejected the improved pay offer in April, the only union where the membership voted against the official recommendation. This surprising result was in part due to years of grassroots organisation by groups such as Nurses United and NHS Workers Say No, independent cross-union groups with significant numbers of rank and file RCN members.

Clearly the more workers have been involved in the dispute, the less likely they were to accept the settlement. Where large numbers of workers struck, they had the confidence to demand more.

Continuing the fight

The RCN leadership was clearly shaken by the strength of feeling and organisation amongst the members. Having called in private investigators and the police to shut down a member-led petition calling for a vote of no confidence in the executive, they found their hand forced by a major shift in the balance of power. Immediately, further strike dates were announced for the May Day bank holiday weekend, sandwiched between the statutory two weeks’ notice and the end of the six-month strike mandate.

This wasn’t the best possible timing, as most non-urgent services would be closed, with others running on minimum staffing levels that would be covered by ‘life and limb derogations’, in which the union agrees to release members from striking to preserve life and prevent serious harm. However, for once it was out of legal necessity rather than the bureaucracy’s timidity. And to their credit, they realised partial and limited action was not sufficient, and called a continuous 48 hour strike without blanket derogations for whole services.

What happened next was a taste of what is to come if the Tories succeed in passing their Strikes (Minimum Service) Bill. Using anti-union laws already in place, the government took the RCN to court over striking on May 2, on the basis that the final hours fell outside the six-month mandate, having initially threatened to challenge the legality of the entire strike. RCN General Secretary Pat Cullen opted not to be drawn into an arcane legal argument about whether the announcement of ballot results is Day 1 or Day 0 of a mandate, and didn’t attend the court hearing. The union succeeded in taking action until midnight on May Day and protested outside the court, rousing members and the wider working class with the sight of the Tories taking nurses to court.

As a result of sustained grassroots pressure forcing unprecedented action, the RCN has gained over 40,000 members during the six month strike period, with many more joining since to vote in the current strike ballot that opened on 23 May and runs until 23rd June. The previous ballot was disaggregated by employer, with around half of trusts reaching the threshold to strike. This ensured there would be some action even if there wasn’t sufficient turnout overall. In the event, it seems the threshold would have been met previously, and the current ballot is across all NHS employers in England. This is a risk, but it appears the union believes it can be won and is taking it seriously, with a major drive to get out the vote and a recommendation to vote yes to strike.

Not fighting alone

Whilst the RCN, Unite and the Society of Radiographers are in a minority amongst Agenda for Change unions in continuing to strike and/or ballot for further action, the British Medical Association (BMA) remains in dispute over junior doctors’ pay, with a third 72 hour strike recently announced from the 14 June. Doctors are demanding pay restoration, real-terms wages having fallen by more than 25% over the last 15 years. They have repeatedly rejected a 5% offer that mirrors the one now being given to nurses and others. Whilst the issues of unsafe staffing affecting patient care, a health service in freefall collapse, pay erosion and record vacancies are the same, the disputes have too often run parallel to one another. With different contracts and pay review bodies, it has been all too easy for junior doctors and non-medical NHS staff to fight separately and without reference to one another.

However, it has been encouraging to see some breaking down of outdated professional boundaries, especially through NHS Workers Say No, with ambulance workers, nurses, physiotherapists and doctors visiting each other’s pickets, speaking at joint events and offering practical help with organising. This must go further if we are to succeed in clawing the NHS back from its present dire state and radically improving conditions for both patients and staff. It will require high-level matching of demands and co-ordinated action. At the present juncture, this may look impossible to many. However, a generation ago, the RCN was constitutionally opposed to strike action, one year ago there had never even been a national nurses strike, and only a few short weeks ago we were told 5% was the best we could get.

In Scotland and Wales, where pay negotiations are held directly with devolved governments, NHS workers have repeatedly been told each offer was the best and final one, only for rejection and the threat of strikes to produce better offers. In Scotland, health workers have narrowly accepted a deal which, whilst still inadequate and below inflation, will see frontline nurses earning around £5,000/year more than their English counterparts. In Wales RCN members have also rejected the latest offer, and the union has called a 48-hour strike for 6/7 June, and again on 12/13 July. The situation in Northern Ireland remains unclear, with the civil servant running the health service in the absence of Stormont announcing a couple of days ago that even the below-inflation pay award for England could not be afforded – health unions have yet to respond.

Inflation remains stubbornly high, with food price inflation just shy of 20%, levels most workers have not seen in their lifetimes. Whilst Sunak continues to promise halving inflation this year, it is clear to anyone struggling through the current crisis that life is increasingly unaffordable. Inflation, unlike superficially attractive lump sum payments, is consolidated. For millions of people, including NHS workers, the days of just putting the heating on when it gets cold, or doing a weekly foodshop without needing a credit card are over.

If the government’s Minimum Services Bill eventually passes in anything like its proposed form, it will make legal industrial action in the NHS even more difficult that the Herculean task it already is. It is important that unions continue to lobby MPs and support the TUC’s campaign to amend it or prevent its passage, and if necessary challenge it in the courts. However, the recent strike wave reminds us that our strongest weapon remains the collective withdrawal of our labour, a demonstration of power that reminds the ruling class that they need us but we don’t need them. If they succeed in making effective action illegal in the NHS and elsewhere, it will require mass law-breaking to re-assert our power as workers. This will never be initiated from above by the leaders of our unions. It will only ever be a possibility if we continue the hard work of organising on the ground in the here and now.

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