Issue no. 1 – Minimum wages for maximum stress

Since the pay dispute in 2022/2023, there have been a number of local strikes across the country within the NHS. These may not have gained as much attention as the big national strikes, but it is important to look at them to analyse what is at stake here and whether there is anything that we can learn from them. What is interesting about the strikes that have been happening in the last year or so is that they mostly involve workers in lower bands that were broadly left of the big national disputes.

Now, Band 2 is a whole penny more than minimum wage per hour. You’ve got co-workers who have been working for the NHS for 30 years who are suddenly being paid the bare minimum that the NHS can get away with. We haven’t seen much in the way of a response yet, but when we do, we need to look at the struggles that have happened in the NHS recently, the strengths as well as the weaknesses to work out a strategy to win.

HCA re-banding

Most of the smaller strikes that we’ve seen recently involve HCAs pushing for re-banding to Band 3 with backpay to cover work that they were doing before these disputes. Mostly covered by Unison, these disputes have taken the tactic of short strikes and urging individual trusts to match what other trusts around the country have already done. In NBT for instance, HCAs were re-banded and awarded the lump sum backpay in January 2023 without having to go on strike, after a short campaign. Where trusts are holding out, we are seeing bitter disputes. Wirrall has seen the longest strike in NHS history, with Band 2 HCAs going on strike for 23 days at the beginning of the year, following 43 days in the second half of 2023. The Trust that manages the hospital have point blank refused to follow the trend of the rest of the NHS and NHS England have not stepped in to resolve the dispute. In fact, the national body managing NHS employers has advised that keeping HCAs (or Clinical Support Workers, as they’re called up there) on Band 2 is in line with the Agenda for Change.

It’s difficult to work out why Wirral are so reluctant to follow suit with the majority of Trusts, especially when the campaign that led to these strikes took place in three other trusts that have all settled with the union. What this does show, though, is that despite the perception that the NHS is a massive bureaucratic entity where the government has the final say, there is still an immediate class struggle to be had at the level of individual trusts with local bosses. This creates opportunities, where workers in one Trust can set terms for the rest of the NHS. This looks like it’s what happened with UNISON’s campaign to re-band HCAs, where workers pushed both the Trust and the union to implement the change, and there was a chain reaction from there. Beyond the initial campaign though, the push has been entirely managed by Unison through official channels and it doesn’t look like there have been many links made between workers at different trusts. We need to develop these connections if we are going to win in the future.

Instead of confronting the problem of understaffing seriously, what tends to be happening is that workers in lower paid positions are now just doing work that used to be done by higher band workers. We see it in HCAs doing nurses’ work, nurses doing doctors’ work etc. As the NHS strains at the seams, instead of resolving the real issues of understaffing and work intensification, NHS leaders insist that workers in various roles should just work more, selling it as ‘career opportunities’. However, that will never translate to increased pay without a fight.

Pay enhancements and bonuses

Pay enhancements being offered unevenly is another issue that we have seen a number of local strikes over in the past year. The most interesting one was the Maternity Care Assistant strike at Southmead that also included receptionists and housekeepers. The Trust was offering considerable pay enhancements to midwives but refusing to extend the same bonus offers to the lower paid workers, using the argument that they were not “first class staff” and could be easily replaced. The workers who went on strike made the argument that the work of the supposedly first class staff could not happen without the cooperation of the lower paid staff. Although the strike was well organised within the team, it doesn’t seem as though they were able to make much contact with other workers across the trust who were also not offered the pay enhancements, which could have bolstered the strike and opened up other opportunities for a stronger strike.

Selective awarding of bonuses has also caused other strikes across the NHS. Cleaners at a hospital in Dudley were excluded from the Covid related bonus pay because they were employed by Mitie, instead of directly by the NHS. There was a similar strike in South London, where workers were on contracts with no sick pay and didn’t receive any of the Covid bonuses despite working like the rest of us through the pandemic.

In these cases, what’s clear is how divisions in the workforce are used by managers, trust leaders, etc. to carve up our potential unity and our capacity to help each other in our struggles. A lot of these strikes won small concessions, but imagine how much more powerful they could have been if they were coordinated with each other. The unions don’t seem to have much interest in doing this, they like to keep everything as separate as possible. It’s up to us to make the connections, create forums for discussions about strategy and tactics like where we hold picket lines and which other workers we need to talk to. The work we do doesn’t happen without the complex cooperation of workers with different skills and knowledge. Our struggles need to reflect this and use it as our strength with nurses and doctors standing alongside cleaners and housekeepers and vice versa. Without this, they’ll keep beating us back one at a time.

Junior Doctors

The Junior Doctors’ dispute is the only national one still going on from the wave of pay campaigns a couple of years ago. Despite the more radical demand of pay restoration (35%) to 2010 levels, there hasn’t seemed to be much movement. The junior doctors were left isolated after various other groups of workers were sold sell-out deals. During the most recent strikes in February, the BMA union even told workers where they could and couldn’t have pickets, meaning there wasn’t any physical presence of the strike in Bristol.

The junior doctor strike still has a direct impact on the work in the hospital. For example, on a strike day often only half of the theatres for elective orthopaedic surgeries are in operation, because surgeons are sent to work on wards or in A&E. But this impact alone does not create bonds between workers, in this case between scrub nurses, health care support workers in theatres and striking junior doctors. The striking workers are not visible to other workers.

There have been issues with this strike from the start, with a lot of the messaging being focused around how junior doctors are worth so much more than other types of workers. This is a losing strategy, both for the particular dispute and for the working class more broadly. It’s our cooperation that gives us strength, and workers with more technical knowledge and positions such as junior doctors need to use their positions to bolster the struggles of other sections of the class, after all how could they do their jobs without an ary of support workers. The challenge will be for the junior doctors to open up discussions with other workers in hospitals, to work out where we can find common issues for struggle.


Only one strike has happened directly in response to the issue of understaffing. Despite understaffing being the massive elephant in the room in every dispute, only one strike in August 23 demanded a solution to the staffing crisis. Over 2,500 workers across 4 trusts in London went on strike, across various roles from nurses to pathologists to cleaners. Unfortunately this is an isolated case.

Any conversation with co-workers gives the impression that understaffing is the main concern for most of us in the NHS, and it is an issue that creates a natural unity across all bands and job roles. If we are going to push for a health service that is fit for purpose, we need to be having discussions in every hospital with workers in different jobs, bands and unions to plan our struggles, and we need to learn from the limitations of the strikes over the past few years. Bosses have used the divisions that already exist to carve up our strikes and take away their bite. Unions have caved under pressure, offering sell-out deal after sell-out deal, and there hasn’t been an effective counter-balance which could hold everything together. Labour don’t look like they’ll be much better than the Tories when they’re in government. We need to use our position of strength as essential workers to put forward a plan for the NHS and enforce it through collective action, not just stick to individual moaning about how bad things are!

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