Health workers strikes have been a key component of the pay revolt over the past few months, with massive support from the general public. Rob M, a UNISON, RCN and rs21 member, argues that health workers should reject the proposed deal – there is plenty more to be won!

NHS workers strike, 2023. Photo: Steve Eason

Last Friday (17 March), after three weeks of ‘intensive’ negotiations, NHS unions and the government announced a deal had finally been reached in the months-old pay dispute that has seen massive strikes by staff employed under Agenda for Change (AfC) in England, including nurses, ambulance workers and physiotherapists. NHS staff in Scotland accepted a pay deal earlier this month, but in Wales negotiations have re-opened after RCN members rejected an earlier offer, and NHS workers in Northern Ireland are still in dispute, with Unison members set to strike on 31 March and 3 April.

Despite the strong impression given in media reports, the dispute in England is not over, and nothing is agreed unless and until a majority of members accept the offer. All unions involved have agreed to put it to the members, with all but Unite recommending acceptance. It was widely reported that the government had made urging acceptance of any deal a precondition of negotiations, although leaders such as Pat Cullen of RCN now deny this was the case. 

After many months in which Health Secretary Steve Barclay flat out refused to talk about pay in the NHS, the climbdown was a partial victory for workers and for strike action, though not as big as the union leaders claim.

The deal itself is designed to confuse workers and the public at large, to make it seem more generous than it really is. Put simply, it amounts to a one-off payment averaging 6% of base salary, on top of the £1,400 flat-rate rise already imposed by management for this year; and for 2023/2024 a rise of 5% for all workers except the very lowest paid, who will receive around 10%. What is not mentioned is that, as things stand, from 1 April the lowest paid will be earning less than the legal minimum that the government cruelly terms the ‘National Living Wage’ (whilst openly admitting they don’t know anyone who could live on it). Even a 10% increase is below inflation, and leaves porters, housekeepers, healthcare assistants and others on lower wages than they would receive in supermarkets and warehouses, exacerbating a critical staffing shortage.

The government also has been at pains to point out the one-off payment is split into a 2% bonus and a gradated ‘Covid recovery payment, an obvious attempt not just to further muddy the waters, but to offer even less to other public sector workers by making the NHS out to be a ‘special case’.

As some people have already noticed, there’s a real sting in the proposal’s tail – because the one-off payment is not consolidated, most of us would be paid less in 2023/24 than for this current year! After 13 years of real-terms pay cuts it is nowhere near what we took action for. It’s ironic that Sara Gorton, Unison’s head of health and lead negotiator for the joint staff council, has repeatedly derided the 70p an hour rise awarded last year, whilst jubilantly recommending this year’s 80p as a major victory. Unison, the largest NHS union, catastrophically failed to achieve a strike mandate in all but a few non-ambulance Trusts. It was the grassroots rank and file organising of ambulance workers that won ballots in their trusts, with little help from the union machinery. 

Splitting the workforce?

Amongst the usual meaningless platitudes about working groups to look into improving conditions at some point in the future is an interesting promise, apparently secured by the RCN before other unions were allowed into talks, to create a separate pay structure for nursing staff only. Currently, all NHS staff in the UK, except dentists and doctors, are employed under the AfC pay structure, making them probably the largest single bargaining unit in Europe.

Unsurprisingly, the RCN leadership considers this a major selling point. As is evidenced by their horror at the very notion of coordinated action and the removal of other union banners and placards from picket lines, the bureaucrats clearly know that their own interests lie in remaining a strictly sectional professional body that occasionally dabbles in trade unionism. What is interesting is that they seem to believe they can convince rank and file members that it is also in their interests to separate themselves off from a million of their fellow workers. 

There are longstanding and legitimate grievances with AfC pay, banding and progression, and sadly the leadership may well be able to convince some nurses that going our own way is the answer. It will be the job of socialists and serious trade unionists to argue that our strength lies as always in our numbers and our unity.

The government is desperate to head off a wave of strikes that has begun to embolden NHS workers and to ignite class consciousness amongst the broader working class, who remain overwhelmingly supportive of industrial action. The union leaders will by and large do anything for a quiet life and, in lockstep with the government, are trying to quell an invigorated membership with a few much-needed crumbs now and the vague hope of better times to come if we keep our heads down and carry on. If they are successful, it will be a major blow to workers in the health service and across the country. 

We must take note of the junior doctor’s slogan ‘Pay Restoration Now’, educate our colleagues, organise to reject the paltry offer, re-ballot employers without mandates and demand a fully funded pay rise that restores wages to more in real terms than 2010. Rank and file groups such as NHS Workers Say No are gaining strength and organising to reject the deal and fight back against a Conservative government and conservative union leaders.

We have seen what our strikes so far have achieved, and many members are ready and willing to see what serious co-ordinated action could win. 

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