NHS pay dispute from below – Online newsletter no.3 / 2021

Welcome to the third newsletter for a workers-led NHS pay dispute! The the internal consultations of the various unions about whether or not to engage in industrial dispute over the 3% pay decision by the government are drawing to a close. As health workers who take active part in the pay campaign we think that the most likely outcome is that the unions will announce that their members didn’t give them the mandate to mobilise for industrial action. This doesn’t mean that the dispute is over for us! The work-stress and low pay will continue and we will continue finding ways to confront this dismal situation.

* Both trust management and unions will say that they cannot do anything about pay and staffing levels, as these are allegedly ‘national issues’. This is not true. Trust management can find money to increase bank pay during certain periods, such as the summer holidays, or pay certain groups of workers more for ‘recruitment and retaining’ purposes. If your local union branch – or you as a collective of workers! – wanted you could engage in official industrial dispute over these pay issues on a trust level.

* There is a huge gulf between the low participation rate of workers in the union ballots and the mass of people who leave the job because they had enough! People are angry, but the unions are too far removed from the day-to-day on hospital wards and in the community health centres. As some of the reports in this newsletter show, the individual trade unions rather engage in pretty pathetic separate pay campaign activities, such as remote drop-ins, than visible joint rallies!

Let’s not give up hope in either way: there might still be enough people willing to vote for industrial action – and if not it just means that we have to find new forms to fight for better conditions for workers and patients!

For people who, like us, have difficulties to get their head around how the whole pay increase issue works we have summarised the basics below.

We need to share our experiences, please send us your ideas and observations: healthworkersunited@protonmail.com


* Comments from Birmingham

When I discuss the pay campaign there is general agreement that yeah the “3%” is an insult and yeah you shouldn’t stand for it and yeah strike action seems pretty reasonable under the circumstances. Then comes what you have been expecting and dreading “Nurses can’t go on strike”. I ask why and get all the answers you’d expect:

“Nurses in the UK have never been on strike” – Not true. Nurses in Northern Ireland successfully went on strike in 2019/2020 over not getting a pay rise in line with the rest of the UK but they tells me they don’t count, it’s not really part of the UK. Well that might be true you think in an abstract sense but that’s another argument. However it does seem to reflect a way people feel, we can’t do it because we never have.

“What about patient safety, they’ll die if we do” – I point out that they’ll die if we don’t, more and more nurses will leave the profession and less new ones will join. We’ve already got a nursing crisis and this will only make it worse. Any way the Northern Irishes strike was able to be done safely and nurses around the world have managed many times.

“We’re the most trusted profession in the UK. We can’t ruin that.” – I ask what’s good trust if we’re not respected. They says we are. You say does 3% feel like respect?

This goes on for a while as they bring up stuff like the miners how they were crushed. In the end they agree 3% is not enough and something needs to be done, that they’ll be voting against accepting with the union but that to them strike action is just beyond the pale. I get the feeling that although it was the only one there making this case it is probably more representative of nurses in general.”

* Report from Bristol

I took part in a UNISON union drop-in for the pay campaign. The problem was that the union only emailed and texted individual members and that the drop-in took place in a pretty remote tent structure – many of the colleagues I asked didn’t know where it actually was. So it wasn’t really a surprise that only a dozen or so people turned up, out of 8,000 plus hospital workers.

I asked the branch secretary if the joint union committee, which comprises the half a dozen unions recognised on site, could have a joint rally, in order to attract more attention, also from workers who are not members of any union. He said that the unions decided to have separate actions, also because they have different pay demands. He added that the RCN action mobilised less than ten people. After the first two weeks of campaign only about 10 to 15% of UNISON members were said to have returned a vote, which is pretty bad.

In the meantime the trust management reacts to pressure from below and announced that they have over 30 new nurses starting in September and that they will hire a large number of HCAs in autumn. They asked each ward manager to spread the word, in order to re-assure burnt-out workers.

* What’s the NHS Pay Review?

We can agree that the pay increase that has been mandated is an insult to workers. But it’s helpful to understand the basis and background of the NHS pay review in order to consider how best to respond to it and struggle for a better deal.

The current pay increase isn’t a ‘pay offer’ and workers and unions are not part of ‘wage negotiations’. So this is a different situation to those for example in some private sector wage struggles we may be comparing this to.

The NHS Pay Review Body (NHSPRB) writes an annual report (you can see them here: https://www.gov.uk/government/organisations/nhs-pay-review-body). It is responsible for recommending pay increases for workers under Agenda for Change pay scales, and the last recommendations were made in 2018 to cover the next 3 years so are up for review this year.

In doing this the NHSPRB takes evidence and recommendations from stakeholders, both government and the unions as well as other organisations including this year campaign group Nurses United. This year, the government’s recommendation was a 1% pay rise. Other recommendations varied, e.g. Unison asked for £2,000 on every pay point, the RCN requested 12.5% for all Agenda for Change staff, and UNITE asked for the higher of £3,000 or 15%. Nurses United also requested 15%.

The NHSPRB then reviews all the evidence, including what the government has said about funding and the financial situation, the labour market situation, vacancies, staff moral and retention, and this year the impact of Covid. On the basis of this they make a recommendation taking all of these things into account, and are recommending a 3% pay increase.

So the unions are now starting to consult on this pay increase, but this is not about whether we accept the pay increase, which is being imposed on us rather than offered, but whether we want to challenge it. Most unions are recommending industrial action, but there seems to be a degree of inertia and a lack of action on the ground in terms of organising to make that happen. They are initially launching ‘indicative ballots’ before deciding whether to seek a vote for strike action. Indicative ballots are not a legal requirement. If the unions did then move to vote for industrial action, this can take place legally if 40% of balloted workers vote in favour of it and at least half of the membership votes.

This process and how it differs from other pay struggles raises some questions such as:

-What difference does having the mediation of the NHSPRB have on the relations between the employer and the workers/unions?

-Although pay review bodies arose out of historical conflicts (such as the wage disputes and strikes of the early 1980s), they now report annually and the proposed increases happen as a routine rather than resulting from workers’ struggle. Has this disconnected and disempowered workers from the sense that we need to struggle for pay and conditions?

-Does the lumping together of a wide range of professional groups and unions in this way dilute their power?

-Has the pandemic influenced NHS workers’ sense of struggle, or their power to do so? Can our response to the pay review be different this year?

* Global supply-crisis hits the NHS

The health sector is a global entity, even if it’s called ‘National Health Service. Our PPE all came from China and currently there is a global shortage of tube for blood transfusion. We are also connected directly to workers in many other sectors, e.g. at the moment there are no flu jabs available due to labour shortage in the transport sector. In our hospital we had no wet wipes for weeks – which makes work really hard!

We could see all this just as nuisances and problems. Or we could see that if we combine our strength with other workers, we could improve our own situation. People only notice the vital work of, for example, truck drivers when the pubs run out of beer, McDonalds out of milk-shakes or hospitals out of medical supply. Workers, whether in care or other sectors have been told for too long that they have to accept low wages, because they are portrayed as being replaceable. At the moment we see that this is not the case!

We also see many struggles of health workers in regions such as India, Philippines, Poland or Nigeria – and many of our colleagues in hospitals and community health centres come from these places! Again, we can see this connection as a problem: ‘Management can replace us with migrant nurses any time!’ Or as a potential: ’Thanks to our colleagues who came from abroad we can learn more about experiences of struggle for better conditions!’

* Strikes at the two biggest hospitals in Berlin

End of August the trade union Verdi has called nursing staff at the state-owned hospital groups Charité and Vivantes out on a three-day warning strike. It’s mainly about staffing-levels, but also about equal pay within the hospital, as many workers are outsourced to subsidiary companies. Currently, the 2,500 employees at these subsidiaries receive several hundred euros less than those doing the same work at Vivantes. The response among workers at all eight Vivantes hospitals and the three Charité campuses to the partial strike has been solid. Supporters constructed solidarity camps outside of the hospitals, organising workshops, cultural events and public actions. The strike has an impact, according to the Berliner Tagesspiegel, Charité has already cancelled 2,000 appointments.

Management at the two hospital groups have reacted with ruthless arrogance towards the strikers’ concerns. Vivantes said it would not accept a collective agreement because the nationwide shortage of skilled workers means a reduction in nurses’ workload would force the company to cut 360 to 750 beds. Consequently, the company would have to dismiss doctors and other non-nursing staff. “The result would be a reduction of 870 to 1,300 jobs and an additional deficit of 25 to 45 million euros,” management claimed. This is clear blackmail! Vivantes blames nursing staff for the reduction of beds and jobs because they refuse to be paid peanuts for too stressful work. Workers cannot rely on the union, though. During the last dispute workers from the subsidiary companies were sold out. In the meantime management at other hospitals throw money at the problem: rather than agreeing to better staffing levels they pay up to 50 Euros an hour for nurses who take on additional shifts, such as in the vaccination project.
On 6th of September 98% of union members at the two hospitals voted in favour of an indefinite strike.

* Coming up: Discussion with health workers in New Zealand

Health workers in New Zealand have engaged in a series of strikes recently, midwives refused to attend elective c-sections, which is quite a step to take! We plan to talk to friends from the local health workers’ network – if you are interested, drop us a line!


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