NHS Workers Are Saying No, Now It’s Time for Unions to Step Up

In the staff room at my hospital, feelings of abandonment, hopelessness and scepticism, which became commonplace as the government muddled through the pandemic, have given way to anger. After months of a health crisis in which colleagues have risked their lives, sacrificed all normality, and seen their co-workers become seriously ill or even die, the government’s omission of nurses and other health workers from its touted ‘public sector pay rise’ came as a cruel joke.

A few weeks ago the government announced a pay increase for 900,000 public sector workers including teachers, police officers and senior doctors. Having hoped to pass it off as recognition for the role public sector workers have played since the start of the pandemic, the Conservatives’ offer of a pay rise of up to 3% depending on job role was viewed sceptically after a decade of pay freezes and rising living costs.

Indeed, the meagreness of the ‘rise’ was quickly overshadowed when it was revealed that the large majority of NHS workers, myself included, would not be receiving any increase in pay. The excuse we are being given is that we already had a pay rise in 2018. Like the increase we have just been omitted from, however, it was a pay rise in name only: an increase below inflation, which, after years of pay freezes, still left the average registered nurse with a 20% real terms pay loss.

During the first peak of Covid-19, tens of thousands of NHS staff began turning to social media as a space to talk through their anger at the government and the daily failures which they had to experience first-hand as a consequence. Now, with the slap in the face of the pay announcement and an easing of social distancing, the need to translate our grievances into action has become obvious.

Back at the start of July, the 14 NHS unions had already challenged the government to turn applause into tangible recognition by bringing planned pay negotiations – currently set to begin in September with a view to implementation in 2021 – forward immediately. Nurses United, a grassroots campaign of rank-and-file workers that has emerged online this year, quickly seized the moment and after an initial demonstration went on to support over 40 demonstrations across the UK on 8 August, organised by NHS workers in a quickly formed Facebook group containing over 70,000 members, and coalescing behind a demand for a 15% pay rise for all NHS staff.

The demonstrations brought out large numbers of NHS workers, with a widespread desire to continue to build the campaign and, at least symbolically, escalate the demand for better pay. At the same time, there exists uncertainty about how to achieve this, and in particular about the role the trade unions ought to be playing in relation to a campaign group like Nurses United. After a chant of “What do we want? 15%! How do we get it? Strike!” at the London demonstration, a younger colleague near to me asked her co-workers: “But why not? Why can’t we strike?”

Aside from the pernicious but common belief that “NHS staff don’t go on strike” because of the nature of their work, many workers participating in the demonstrations – particularly younger workers – are familiar with taking political actions such as marching or signing a petition, but there’s a growing recognition that these forms of protest won’t be enough to win. At the same time, however, one senses that many workers are grappling with the fact that the day of action on 8 August was organised by a campaigning group of nurses rather than any of the trade unions.

Online, many conversations among health workers have now gravitated towards a discussion of different unions’ positions and their various merits, with people weighing up which unions are really ‘on the side of staff’ or strong enough to lead members into industrial action. In a context of relatively low historical engagement, it’s clear no union has a pristine record in the eyes of health workers, though there is at least a growing recognition that what can be gained through particular unions will come down to the question of what rank-and-file members put in. Meanwhile, although the NHS unions at least seem to be in public agreement that pay needs to be increased and talks need to be brought forward, existing early indications suggest disagreement between Unison and the Royal College of Nursing about what pay claim to advance, with neither touting the 15% workers just demonstrated for.

Unfortunately, the issues facing NHS staff and strategy for advancing their demands have been obscure for a long time. Both workers and the public have been encouraged to see issues of pay and conditions in terms of discrete staff groups – doctors and nurses, medical staff and non-medical staff – rather than as a thoroughly interlinked workforce. Although the idea pervades that the government agrees pay with each group separately, the truth is nurses, health care assistants, radiographers, porters, cleaners, admin staff and the vast majority of workers employed by the NHS share a single pay agreement merely divided into different bands. It follows that to build a successful grassroots campaign, organisers will need to engage with workers from across all NHS staff groups and the unions that represent them.

Trade unions have some work to do here, not least if they wish to play a role in establishing the kind of cross-role unity that will be needed to win this fight. So far, grassroots demands are in advance of the unions and it will be up to shop stewards and activists alike to ensure different parts of the movement are working together. After all, it remains the fact that trade unions have a strong impact on NHS workers’ pay; the last pay agreement – overwhelmingly criticised at Saturday’s demonstration in London – was only agreed when members of the majority of unions accepted it in a ballot, with the highest turnout of any ballot being just 30%, in the case of Unison.

Despite these tensions, we have to believe NHS workers can win a 15% pay rise, not least because polls have evidenced broad public support across the UK, and recently we’ve seen nurses securing increases in countries like France and New Zealand. But the government appears unwilling to bring pay discussion forward, instead preferring to hold off from opening negotiations until at least September, suggesting a deal wouldn’t be put to workers until 2021. This would give the government time to get their narrative on public spending in order, but one suspects a further advantage in the mind of the government would be that the strength of NHS workers’ political engagement would wane again to the levels we saw at the time of the last pay deal.

It is therefore crucial that grassroots activists, organisations like Nurses United, and the left in general, keep the demand for 15% central to the conversation around NHS pay. Rank-and-file trade unionists should be upholding this demand while providing the workers mobilised by these protests with the tools they need to understand and escalate their struggle, while the trade union leaderships need to demonstrate their recognition of the widespread anger of NHS staff by reflecting it in their plans for pay negotiations, which need to be shared more transparently with the membership.

This fight comes at a potentially pivotal moment for the labour movement, with Unison set to elect a new general secretary in September, Len McCluskey tipped to be stepping down from his leadership of Unite early, and a recession which has only just arrived. Success will rely on unions learning to be more combative, taking a leaf from grassroots unions like United Voices of the World, and on NHS workers rekindling the kind of solidarity which has been lacking for too long.

Jack MacBean is a radiography assistant and trade unionist working at a hospital in south-east England.

This article was amended on 13 August 2020 to clarify that the nationwide demonstrations held on 8 August were organised by NHS workers belonging to the ‘NHS Workers Say NO! to Public Sector Pay Inequality’ Facebook group.