Tens of thousands of nurses and ambulance workers joined Britain’s largest-ever health sector strike on Monday – the latest walkout to cause disruption at the National Health Service. Public support for striking staff remains high, but negotiations with the government over pay increases have reached a stalemate.
This week is set to be the most disruptive in the 75-year history of Britain’s National Health Service (NHS), according to National Medical Director Stephen Powis.
The start of the week was set to be especially fraught as nurses and ambulance staff staged strikes on the same day, leaving the health service tens of thousands of workers short. Nurses will continue striking on Tuesday, followed by physiotherapists on Thursday and another round of strikes for ambulance staff on Friday.
This week’s industrial action is the latest in a series of historic walkouts among Britain’s health workers that have grown in scale over the past three months – an extraordinary scenario in a country that views its universal healthcare system almost as more of a national religion than a public service.
“Nurses are seen as the angels of the health system, and it's unprecedented for them to actually strike,” said Tony Hockley, senior visiting fellow in the Department of Social Policy at the London School of Economics. “They’ve threatened a few times over the years but it's never happened before.”
Top of nurses’ demands is a pay increase to counter Britain’s soaring inflation rate, which as of December 2022 was at 9.2 percent – the worst it has been in four decades.
Working conditions are also in the spotlight. “NHS Staff do not reach the decision to vote to strike lightly,” said NHS Workers Say No, a grassroots campaign group, in a statement. “We have had enough of our patients receiving unsafe care in an understaffed and underfunded service.”
‘Pay, recruitment and retention’
Amid a cost-of-living crisis, soaring prices have hit health workers especially hard. Nurses in the UK are among the worst paid in Europe, according to OECD data. The average salary for a nurse of between £33,000 - £35,000 (€37,000 - €39,000) has lagged behind pay growth in the public and private sector, and failed to match inflation for the past 10 years.
In early 2022, 14 percent of nurses were found to be relying on food banks run by charities that support the NHS.
Low pay is exacerbating poor working conditions. “Pay, recruitment and retention are the biggest issues,” said Hockley. “The main driver of poor working conditions is staff vacancies but nurses are finding it hard financially to stay in the NHS. It’s losing experienced staff because they're going to work in supermarkets.”
Some 25,000 nurses have left the profession over just the last year, according to the Royal College of Nurses, and the shortfall of nursing professionals could reach almost 40,000 in 2023.
“They are saying that the NHS is in a serious crisis,” said Dr Jennifer Crane, lecturer in health geography at University of Bristol. “And that to strike is to show care because staff are flagging that their departments are too short-staffed to look after patients.”
‘A special case’
When strikes began in December 2022, the Royal College of Nurses initially asked for a pay rise of 5 percent above inflation and has since said it could meet the government "half way”. The trade union wrote to UK Prime Minister Rishi Sunak on Saturday asking him to bring the nursing strike "to a swift close" by making "meaningful" pay offers.
Meanwhile, Sunak said in a TalkTV interview last week that he would "love to give the nurses a massive pay rise" but said the government faced tough choices and that it was funding the NHS in other areas, such as by providing medical equipment and ambulances.
So far, weeks of pay negotiations between workers’ unions and the government have been fruitless. The government has argued that pay increases would be unaffordable and would cause prices to rise even further – and, in turn, increase interest rates and mortgages.
The health worker walkouts are part of a wave of industrial action sweeping Britain. Since last summer, around 500,000 public and private sector workers have staged strikes disrupting schools, universities, transport networks and the civil service.
This has contributed to the deadlock with health staff. “The government is very concerned that it will get an inflationary pay cycle in the public sector generally,” said Hockley. “Even though there might be a special case in the NHS, where there are huge vacancy problems, it’s worried about having a special case that then spills over to every other public sector.”
Saving the NHS
In April an annual public sector pay review is likely to result in pay rises across a variety of services, although there is no guarantee how much health workers may receive. Pay increases in 2022 were criticised by unions for being far below what was needed to “save the NHS”.
For now, the government in England is “resolute” about putting off pay increases until spring, “and it seems adamant to stick to that if, politically, it can weather it”, Hockley said.
But pressure is mounting. NHS bosses on Monday urged the government to reopen talks with striking staff and stop the disruption caused by walkouts.
Nurses, in particular, have strong public backing. A poll by the Observer newspaper in January found support for striking nurses was at almost 60% – the highest support for any group of striking workers, and a fall of just four points since December.
“Even if people see their own healthcare disrupted in the strikes, many people have a deep love for the NHS as an ideal and are likely to believe NHS staff when they say that [they need] to fight for change,” said Crane.
Throughout Britain, ministers are also starting to take a divided approach. Health unions in Scotland paused strikes this week after the Scottish government agreed to start annual pay reviews early, among other measures.
In Wales, many health worker strikes were averted on Monday after Health Minister Eluned Morgan offered eight health unions an extra 3 percent on top of the additional £1,400 (€1,570) already promised.
Nursing unions in England said on Monday they would stop the strikes if Sunak made them the same offer. Otherwise, they are determined to continue.
“They are adamant that they can't go on providing unsafe care,” Hockley said.
