Rishi Sunak and his ministers may want to move on from the political turmoil of 2022, but the crises it left behind live on. And nowhere is this more present than in the escalating disputes with healthcare workers.
When Pat Cullen, the Royal College of Nursing leader, toured NHS trusts last summer, speaking to burnt-out and frustrated staff before they cast their ballots on whether to strike, she urged the government to engage. The problem was that there was no one around to negotiate with. The caretaker Johnson government was absent and disempowered; the Truss government that followed it would self-destruct in a matter of days.
When Sunak entered No 10 in the autumn, he and his chancellor, Jeremy Hunt, chose to stress the importance of stability. The central message was one of taking tough decisions in the national interest. But here, the government made a critical misstep.
Instead of supporting healthcare workers, who had done so much during the pandemic and were now having to deal with an enormous backlog, they saw the NHS industrial action as part of a wider set of industrial disputes rather than as a special case that required a different response. Health ministers were told that talks with unions could happen – but not about pay, the main thing the professions wanted to discuss.
Ministers were sent on media rounds to defend the government line that awarding nurses more money would create inflation, and that an independent pay review process meant that they couldn’t intervene. None of this stood up to any contact with political reality. When the Daily Express and the Guardian are aligned in criticising your approach, you need to come up with something new.
Being health secretary is one of the toughest jobs in government, and the relationship with NHS staff is critical. I worked for Matt Hancock when he was health secretary and I saw these challenges first-hand. The current health secretary, Steve Barclay, has correctly realised that if his time in office is to deliver any of the commitments to reducing waiting times – which are currently not only the longest on record, but also affect huge numbers of people, with 7.2 million waiting for non-urgent treatment – he needs a deal.
This explains Barclay’s softer tone last week, and his offer to work with the unions to convince the Treasury to move was a quietly significant step. In 2018, we did something similar and managed to de-escalate rising workforce concerns and threats of strikes by bringing the unions and royal colleges in to help shape our questions at the forthcoming spending review.
But while the health secretary might be the public face of the dispute, he is not the person who can end it. The real power lies, as ever, with the Treasury, which is digging in, demanding that any pay offer comes from within existing NHS budgets.
This, of course, will not wash. The idea that the government is going to cut funding from busy services to pay staff working in those same services is a non-starter both practically and politically. Of course there will be some NHS programmes that can be paused or stopped, and some savings that can be found. An exercise was run during the summer looking at just that. This identified a few million pounds of savings, but a successful pay offer is likely to be in the billions.
For Jeremy Hunt, this whole business must present something of a conflict. As health secretary, he was the public face of the last major industrial dispute in the NHS – that with junior doctors – and was sent out to bat without much protection by David Cameron and George Osborne. As chancellor, he finds himself able to make the progress he was prevented from making when he was health secretary. And in fairness to him, he did use his autumn statement to prioritise health and social care funding over the next two years, and committed to independent forecasts to develop a long-overdue workforce plan. Both of these had been previously resisted by his new department.
I remember the sheer number of false starts in trying to get action on workforce investment when I worked in the Department for Health. Ministers, and senior officials have long been lobbying the Treasury for the workforce funding that is needed. We could all see the crisis that was developing. But while some money was found for services, it was not found for staff. It is this infuriatingly shortsighted approach over the years that has led us to this standoff we now find ourselves in.
But as an election draws ever closer, there is a limit to how long the government can continue to let the disputes drag on – especially when the public are siding so strongly with the striking workers. This impacts policy going into the election too. You cannot hope to develop a long-term workforce plan when the professions you need to consult and build such a plan are striking. You cannot deliver on cutting ambulance waiting times when paramedics are on picket lines, and you cannot get waiting times down without working nurses. And these are all issues voters care about.
It is time for the government to accept they cannot win this dispute, but they can end it. They should make a new offer, work towards a compromise deal, end the NHS strikes, and move on.
• Richard Sloggett is a former special adviser to Matt Hancock
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