Last Wednesday, many nurses from across primary and secondary care opted to strike over the government's proposed pension changes, along with countless other public sector workers. Many other nurses chose not to exercise their right to strike.
While industrial action may not have united the profession, the feeling of gloom inspired by the chancellor's Autumn Statement seemed pretty much universal.
The day before the strike, George Osborne fanned the flames of discontent when he announced that plans to raise the state pension age from 66 to 67 would be brought forward by eight years to 2026, to save £59 billion. He unveiled a 1% pay cap for public sector workers, while forecasting more than 700,000 public sector job losses by 2017. And he talked of his intention to underake a review of the TUPE regulations that protect staff transferred to contractors and others through outsourcing, ignoring strong evidence of a correlation between the quality of employment and the quality of services provided.
Meanwhile, ministers expect health professionals to get behind their unpopular NHS reforms and to expend time and energy, immersing themselves in local health commissioning. They are amazed when clinicians show reluctance to take on extra work; to shoulder greater responsibility; and to indicate overt support for changes that many feel will not improve patient care.
This should surprise no-one; however, to snub commissioning is not simply to snub the government's reforms but to lose a voice in the decision-making process and the opportunity to ensure that nurses' vital insights are taken on board. Industrial action can sometimes force ministers to take immediate action, but long-term influence can only be achieved by inside, strategic involvement at the heart of decision-making.