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Is a nurse strike on the horizon?

As the RCN begins the process of balloting its members on strike action for the first time in its history, Independent Nurse looks at how it has got here

Since the days of the coalition government which began more than a decade ago, the topic of pay has been an extremely contentious subject for nurses, policy makers and unions alike. The issue, that nurses are not paid enough, leading to pressures on the workforce, has been simmering during the COVID-19 pandemic. However, with the Government’s recent offer of a pay increase of at least £1400 for 2022-23, it has come to the boil again.

The Government says that the award will be a consolidated uplift to full-time equivalent salaries, enhanced for the top of bands 6 and all points of bands 7 so it is equal to a 4% uplift. According to the Government, last year, NHS staff received a 3% pay rise while the government temporarily paused pay rises for wider public sector workers with salaries over £24,000.

This means that, over the last 5 years, the non-medical workforce (including nurses and paramedics) has on average received a cumulative pay rise of over 18% and consultants have received a cumulative pay rise of around 15%.The average nurse’s salary has increased from £32,385 in 2018 to 2019 to £37,000 in 2022 to 2023 following this latest pay rise.

‘This government hugely values and appreciates the dedication and contribution of NHS staff which is why we will give over one million NHS workers a pay rise of £1,400 this year, on top of the 3% they received last year when pay rises were temporarily paused in the wider public sector,’ said new Health and Social Care Secretary Stephen Barclay.

‘We asked the independent pay review bodies for their recommendations and I am pleased to accept them in full.’

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However, despite warm words from the Government, the offer has been sharply criticised by nursing unions, who say the rise is meaningless in the face of skyrocketing inflation. The pay award will be backdated to 1 April, and, according to the RCN, represents a real-terms pay cut given that RPI inflation is currently at 11.7%. The reaction has been uncompromising with the RCN balloting on strike action for nurses for the first time in its history.

‘This is a grave misstep by ministers. With this low award, the Government is misjudging the mood of nursing staff and the public too. There are tens of thousands of unfilled nursing jobs and today ministers have taken the NHS even further from safe patient care. Living costs are rising and yet they have enforced another real-terms pay cut on nursing staff. It will push more nurses and nursing support workers out of the profession,’ said RCN General Secretary and Chief Executive Pat Cullen.

‘Our members will vote and tell us what they want to do next. We are grateful for the growing public support, including over strike action. The award must be fully funded with additional money. There can be no question of money being taken out of existing NHS budgets.’

The Government contend that a high wage rise would prompt further inflation, leaving nurses worse off in the long run. ‘We want a fair deal for staff,’ added Mr Barclay.

‘Very high inflation-driven settlements would have a worse impact on pay packets in the long run than proportionate and balanced increases now, and it is welcome that the pay review bodies agree with this approach.’

The pay offer is not solely being criticised by nursing organisations. Think tanks such as the Health Foundation point out that the pay rise has not been costed and will further stretch the NHS budget. According to the foundation, offer to staff increases the NHS pay bill by almost 5% in 2022/23 with pay rises weighted more heavily towards the lower paid. However, there is no new money proposed to fund this, leading to speculation that other services will be impacted.

‘The Government can’t keep piling unfunded commitments into the NHS and leave it to those on the frontline to pick up the pieces – the NHS deserves better,’ said Anita Charlesworth, Director of Research and the REAL Centre at the Health Foundation.

‘NHS trusts are presented with a near impossible task for which they are set up to fail. The Government has already demanded that they make big efficiency savings. Meanwhile, services are facing unprecedented pressures, with waiting times at record levels, ongoing COVID pressures, chronic staff shortages and a social care system on its knees. Something has got to give.’

Strike action

The anger over the pay offer, as well as historic grievances against how the Government have treated NHS staff, particularly in the wake of the pandemic, has led to the possibility of a nursing strike.

Industrial action by public sector workers has already been a high profile topic, due to wide spread rail strikes initiated by unions in the transport sector. Now, nurses may follow.

In an emergency session, elected members of RCN Council voted to ballot members on Agenda for Change contracts in England on whether they want to take industrial action. The RCN say that this will not be a consultative ballot where we test the strength of feeling of members. It will be a statutory ballot which, if enough members take part and vote for action, could lead directly to members taking strike action or action short of strike.

‘Our members are being failed by the Government and we will not stand for it. Today’s pay announcement makes it harder, not easier, for them to cope with the rising cost of living,’ said Chair of RCN Council Carol Popplestone.

‘It won’t do anything to recruit or retain the nursing staff our NHS desperately needs. It doesn’t recognise the skill and responsibility of the job we do. It won’t keep patients safe. Your elected Council will listen as much as lead in the months to come. We need to hear from you all – how this decision makes you feel and what you want to do as a result.’

The last time UK nurses went on strike was in 1988. Throughout the crisis there was acrimonious debate between the Royal College of Nursing, which opposed the strike, and the trade unions, which organized it. On the day of action, strike action was widespread but inconsistent. In the end, the nurses made some gains, but most of their concerns were ignored. Since then the RCN has dropped its opposition for strike action, and nurses may present a more united front.

New research suggests that the public would be supportive of nurses striking. A YouGov Survey found that a majority – 60% – would support nurses going on strike. A high number – 71% – also said they’d ‘sympathise’ with a strike by nurses, including 42% who would have ‘a lot’ of sympathy for them.

‘We will be balloting our members working for the NHS in England over pay and public support is already growing. They know that nursing staff are patients’ greatest advocates, and this support runs both ways. They are joining us in saying enough is enough,’ said Ms Cullen.

‘The Government is refusing to recognise the skill and responsibility of the job. And they are pushing people out of the profession. A lifetime of service must never mean a lifetime of poverty. This real-terms pay cut for our members is a national disgrace.’

The impact of nurse strikes on patient healthcare is unclear, due to a lack of data in the UK. A study of nurse strikes in New York State from 1984 to 2004 found that in-hospital mortality increased by 19.4 percent and hospital readmissions increased by 6.5 percent for patients admitted during a strike. Among their sample of 38,228 such patients, an estimated 138 more individuals died than would have without a strike, and 344 more patients were readmitted to the hospital than if there had been no strike.

In response to the threat of strike action across the public sector, the Government has vote to approved regulations to use agency staff to cover striking workers, a move criticised by unions, citing safety concerns. The regulations allow employers across all sectors to use agency staff to replace striking workers, and to increase the level of damages a court can award in the case of unlawful strike action.

‘The Government is prepared do anything to stop strikes, except encourage dialogue and sensible industrial relations. Sending agency staff into disputes to break strikes will only fan the flames and make it harder for employers and unions to reach agreement,’ said UNISON general secretary Christina McAnea.

‘Ministers have been spooked by the sympathy people are showing for workers fighting for fair wages. The Government’s cynical solution is to ride a coach and horses through employment law, risking the safety of staff and the public by parachuting in agency workers.’

The issue even played a little cameo in the ongoing Tory leadership contest when the frontrunner to replace Boris Johnson as Prime Minister Liz Truss suggested that nurses outside of the South East could receive a pay cut if she was elected, a policy that was very swiftly backtracked on.

While Ms Truss’ idol Margaret Thatcher may have built her legend on her intransigence in industrial disputes, it seems that this problem may require a more nuanced approach. Watch this space.