We document a guest contribution on the recent mobilisation of health workers in Dorset against the Trust’s attempt to outsource their work. We have documented a struggle against outsourcing at Prospect Park hospital before. It is great to see that a strong strike vote can force both Trust management and government representatives to put outsourcing on hold. As workers have to use whatever means at our disposal to defend our wages and conditions.
In terms of the relation between workers and the unions, we think that workers have to develop independent forms of struggle. Recent experiences from hospital struggles in Dachau, Berlin, Freiburg or other towns in Germany, which are generally presented as a success of the ‘organising model’, show the problematic results if workers rely too heavily on union organisers.
Workers in Dorset have secured a significant victory. NHS trusts in Dorset wanted to privatise their jobs, but Dorset NHS staff said No! with a strong vote for strike action. The next day the government effectively stopped the privatisation of their jobs. The threat of strike action also prevented a planned nationwide rollout of subcontracting NHS hospital roles across England.
In late September, Unison balloted its members and the results revealed a striking 74% turnout among Dorset workers, with 94% voting in favour of industrial action. This is an exceptional level of participation, especially given the postal voting system designed to hinder union efforts by making it harder for workers to cast their ballots. The strong response highlights the deep concerns workers hold about the future of their jobs and working conditions.
While this campaign took place locally, its impact resonates far beyond Dorset, sending a clear message against the outsourcing of NHS services across the whole of England. Any trust that might have been considering subcontracting will be worried that their staff will do a Dorset and vote to strike.
Privatisation
This campaign carried significant strategic weight nationally. NHS England had been encouraging hospital trusts to consider setting up subcontracting companies—sometimes referred to as “subcos”—reviving attempts from a similar wave of privatisations back in 2018. If this plan had been implemented nationwide, tens or even hundreds of thousands of NHS staff could have been shifted from direct NHS employment into private firms. These companies would have costly management structures that add financial burdens, and privatisation often leads to cuts in staff pay, benefits, sick pay, and pensions. Pension entitlements, in particular, are a significant cost for private companies to trim since NHS workers contribute a notable portion of their salary into a robust pension fund—an advantage rarely seen in the private sector. With such high stakes, the success of the Dorset campaign effectively stopped subcontracting proposals nationwide. Had Dorset lost, it would have encouraged similar privatisation efforts across England.
Experience from other areas where subcontracting and privatisation have already occurred shows a recurring negative trend: staff lose NHS-level terms and conditions. A 2018 wave of privatisations generated strong opposition nationwide, particularly in the West Country. Workers at hospitals such as Southmead in Bristol strongly resisted, while efforts in Gloucester failed to stop privatisation. Typically, privatisation results in a patchwork of contracts—some employees retain NHS terms including pensions and sick pay, while others are placed on contracts lacking these protections and often receive lower pay without guaranteed raises. This creates inequality, undermining staff morale and unity.
In Dorset, management promised that current and new staff would retain Agenda for Change terms and conditions for 25 years, supported by a “triple lock” agreement between the trusts and the subcontractor company. However, this promise was viewed skeptically by workers, who saw the agreement as unenforceable and liable to be altered or disregarded by management at any time. This further heightened fears that privatisation would ultimately degrade working conditions over time, despite official assurances.
So, how did the Dorset campaign succeed?
Management had designed the process to push the privatisation plan through quickly, minimizing opportunities for challenge. However, union laws require time-consuming procedures to organise a legal strike, including discussions and votes among members. At the campaign’s start, union membership in Dorset trusts was low, and there had been no recent industrial action. Many workers saw unions, especially Unison, as more of a service provider than a force able to mobilise and win campaigns.
The campaign overcame these challenges through consistent, visible presence in hospitals, political action, and broad community engagement. This intensive effort demanded substantial resources—from national, regional, and local union teams—all committed to opposing privatisation in Dorset.
Crucially, the campaign built grassroots worker ownership, which is essential for any large-scale union effort. Inspired by organising tactics developed by Jane McAlevey and the Rosa Luxemburg Foundation’s “Organised for Power,” Unison has adapted this framework into its “Organised to Win” methodology. This starts with the detailed mapping of all departments and workers in Dorset hospitals, identifying supporters, and potential supporters. Such mapping allowed organisers to target resources and conversations effectively.
Migrant workers were a vital and clearly recognised part of the Dorset campaign, playing an essential role in its success. Their involvement helped prevent management from exploiting divisions within the workforce, which might have been much easier if international workers had been excluded or sidelined. These workers not only contributed through organising but also acted as powerful voices within their own communities, communicating the importance of the campaign to their diasporas and rallying broader support.
Targeting the undecided
Winning a campaign also means persuading those who are undecided or hesitant to take action. Undecided workers can be won over with careful engagement and clear, honest dialogue. Reaching a majority is critical to success.
The Dorset campaign was marked by large, energized meetings and events such as “March on the Boss,” and an assertive stance toward management’s plans. Unlike many recent UK worker struggles, which have been cautious, Dorset workers actively confronted management and rallied in numbers. Physical votes held at these meetings attracted large groups of workers chanting “No Subco!” Personal testimonies shared at these gatherings brought the issue close to home, giving the campaign a strong emotional and personal foundation.
Listening to workers
A key tactic was the use of scripted conversations, borrowed from US union organising techniques. This ensured all activists communicated consistent key messages, boosting the campaign’s coherence and strength. These conversations had defined purposes depending on the stage—early discussions focused on mapping and leadership identification, while later talks encouraged participation in protests or strike votes.
Workers often suppress anger about workplace injustices day-to-day, so these conversations aim to surface that frustration and provide hope through collective action. Explaining how organising can make a tangible difference encourages workers to join the union, vote in ballots, and strike.
More information and training is available here Organizing for Power – Rosa-Luxemburg-Stiftung
Othering the Union
Management repeatedly attempted to isolate the union as an outside disruptor, but the campaign stressed that the union is composed of the workers themselves. Building a committee of active workplace representatives who negotiated directly with management empowered Dorset workers, fostering confidence and democracy.
Faced with well-organised, determined Dorset opposition, the government reversed its privatisation policy within 24 hours of the strike ballot result being announced. This quick turnaround is notable because the Labour government leadership is not known for opposing privatisation. Dorset workers had done more than win locally—they had thwarted a national privatisation programme. Had similar actions spread across England, they could have radicalised the public sector workforce, strengthened activist leadership, and posed a serious challenge to ongoing attacks on workers’ terms and conditions. The government’s rapid retreat reflects the strength of organised worker resistance and its potential to grow.
This victory highlights how democratically organised campaigns can protect public sector jobs. NHS workers can push back against privatisation and win. The government are increasing under pressure, and the NHS is increasing short of staff. This is a good time for workers to organise.
