How likely are NHS workers to strike this winter?

The Royal College of Nursing (RCN) recently announced that it will begin balloting its members in England and Wales over potential strike action.

The college is urging hundreds of thousands of its members to support a complete withdrawal of labour, with the ballot opening on Thursday 15 September for four weeks.

If its members support strike action, it will be the first ever strike by RCN members in England or Wales. The College went on strike for the first time in its history in Northern Ireland in 2019.

Unite the union is also consulting more than 100,000 of its health members across the NHS in both England and Wales about whether they would support industrial action. The union is recommending its members vote yes to industrial action.

The BMA has said it will similarly ballot its junior doctors in England for industrial action at the end of September unless the government commits to a fair pay award.

But why are NHS workers threatening to strike? And what will happen if there is a full or partial withdrawal of labour across the health service this winter?

Why are NHS workers planning on going on strike?

Last month, the government accepted all the recommendations made by the independent NHS pay review bodies. Over one million NHS staff are due to receive an annual pay increase of at least £1,400, with the lowest earners seeing a 9.3% increase in their basic pay compared to last year.

The average basic pay for nurses will increase from around £35,600 to around £37,000 per annum, while the basic pay for newly qualified nurses will increase by 5.5%, from £25,655 last year to £27,055 this year.

However, the RCN say that this pay increase leaves an experienced nurse over £1,000 worse off in real terms and are calling for a fully funded pay rise of 5% above inflation, which currently sits at 11.8%.

It described the recent pay award as “a national disgrace” and says ministers’ refusal to listen to nursing has left it with no choice but to consider industrial action.

It believes industrial strike action always should be a last resort, but the current NHS staffing crisis is causing unacceptable risk to patients and staff.

The College has also increased its industrial action strike fund to £50 million, up from £35 million. This package will help to provide financial support towards lost earnings should industrial action go ahead.

The British Medical Association (BMA) has expressed solidarity with the RCN and will support their nursing colleagues should they choose to strike.

Professor Philip Banfield, BMA council chair, said: “As the RCN themselves say, industrial action is a last resort for healthcare workers, and therefore this ballot is a clear warning to the Government that staff have had enough of not being listened to or valued.

“Doctors will offer their support and their solidarity to nursing colleagues who feel this is their only option to get this government to focus on the serious investment the NHS and its workforce so desperately need.”

The BMA also described the 4.5% pay uplift for doctors and dentists as “derisory and divisive” and said the government’s decision to exclude junior doctors from this pay increase was nothing short of a “betrayal” and showed the “blatant disregard” politicians had for doctors in training in England.

In light of this, the Association has warned that junior doctors have “no choice but to press ahead with preparations for a ballot”. This will begin at the end of September, unless the government commits to full restoration of junior doctors’ pay to levels equivalent to 2008/9.

What will happen if NHS workers choose to strike?

While it is not yet clear whether NHS workers will strike and to what extent, a poll of around 1,000 British adults found that 50% would support an NHS strike, while only 30% would oppose.

Carol Popplestone, chair of council at the Royal College of Nursing, said: “The public understands how important pay and working conditions are to a healthy NHS.

“The fact half of the public would support industrial action within it is proof of that. They know health and social care are on their knees.”

The last NHS strike over pay was in 2014, which saw thousands of health workers, including nurses, midwives and ambulance staff from seven trade unions, perform a walkout.

This was then followed by four days of work-to-rule, with staff refusing to do overtime without pay and insisting on taking their breaks.

Unions and NHS bosses met ahead of the strikes to ensure essential services were maintained and disruption was minimised. This ensured that emergency care was covered, with the military and police stepping in to help ambulance services where necessary.

Healthcare workers were also seen to be leaving the picket lines to help patients who needed immediate attention.

If NHS workers choose to strike, it is likely it will look rather different in comparison to the recent strikes performed by train drivers and refuse collectors. The aim of these strikes is to cause disruption, but for NHS workers, it is about sending a clear message to the government without causing harm.

For example, in 2014, the Royal College of Midwives supported strike action, but agreed to keep maternity units running so that no harm would come to prospective mothers and their children.

A mass exodus of workers

Whether the strikes go ahead or not, health leaders have warned that another cut in real-terms pay, coupled with staff shortages and burnout caused by the Covid pandemic could prompt a mass exodus of workers.

A recent report published by the health and social care select committee found that England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives. In social care, there are around 105,000 vacancies.

A fair pay award is crucial to tackling this staffing crisis and ensuring the health and care sector are able to recruit and retain staff. It is vital that care workers are adequately remunerated too, as the two systems are interdependent and each needs to be adequately funded to reduce pressure on the other.

As Mr Banfield says: “The Government needs to wake up and realise the true cost of keeping the expertise of doctors rather than driving them away from the NHS.”

Unite general secretary Sharon Graham said: “This ballot is a chance for our members to have their say, and whatever they decide, they will have the full backing of their union, Unite.”

The RCN’s England and Wales ballot will close on Thursday 13 October. In England, Unite’s ballot will close on Sunday 11 September while in Wales, it will close on Friday 15 September. The dates for the BMA’s ballot are yet to be confirmed.