We distributed this article with our hospital magazine Vital Signs no.5 – we need help financing the print costs, please donate here!

After a below inflation ‘increase’ of 3.6% for 2025/26, the government has announced that things will look even bleaker next year, with an increase of 2.5% for 2026/27. There has still been no clear signal from the RCN whether there will be a strike for higher wages in 2025 or not. We are bored of waiting and want to use the time to reflect on the most recent pay strike in order to learn some lessons.

The holding pattern

The pay rounds in the NHS follow a similar pattern, a pattern that weakens our collective strength to struggle for better pay and conditions:

• Each year in April the government announces a ridiculously low pay increase, e.g. this year it was 2.8%, while it was clear that inflation would be higher than that.
• The trade unions grumble a bit, but don’t coordinate any cohesive action together. At our Trusts in Bristol we have more than half a dozen unions, but they compete with each other, rather than join forces.
• The government improves the offer slightly, e.g. this year it was 3.6%, which is still pretty much a real wage cut. The trade unions take ages to consult their members. They are largely absent from the day-to-day situation in the hospitals and only send out a few emails, reminding people to vote whether to accept or reject the pay increase.
• By August NHS workers are paid a small chunk in money as a back dated payment from April, which is meant to make people think: “Well, now that I have this bit of money, why should I bother to vote against it. There is no open process to prepare for a pay strike, so why should I bother to get engaged?” 
• As a result, only some unions manage to mobilise enough members to vote for taking action. This means that any potential strike is already in a weak position. 

The only way we can interrupt this pattern is by creating a common strike platform that reacts to the government pay offer immediately, not months later.

Lessons from the last round of strikes

Now that some unions might call workers out to strike we should look back at the last round of strikes in January 2023. This was the first time in three decades that nurses went on strike in the UK. We took part in pickets at Southmead hospital and spoke to colleagues in various NHS Trusts in the UK in order to learn from their experiences. 

The national level

• Once it became clear that only members of the RCN would go on strike at Southmead hospital, management and union reps of the joint union committee met initially in talks that treated the upcoming industrial action as a ‘serious incident’, similar to grave accidents, and started discussing possible derogations (minimum staffing levels during the strike) and exemptions. 
• In contrast, there was no collective meeting of all unions on how to support the RCN strike and no communication towards the members and workers. The only emails that were sent by Unison and GMB to their own members made clear that, as both unions failed to meet the legal threshold, members could not participate in the RCN strike. 
• Trust management sent emails that they respect the right to strike, but at the same time increased payments for bank workers between mid-December and mid-January 2023 by 30% for nurses and 15% for the rest, incentivising people to take on extra shifts. This clearly aimed at weakening the impact of the strike. 
• In the meantime, the government added some sticks to these carrots. On the 7th of December 2022, they first threatened to legally ban strikes in the health sector. On the 10th of December 2022 they then spoke publicly about using army personnel to replace striking workers. This turned out to be a paper-tiger early on, as the number of potential soldiers was very low (around 600 army drivers and 150 logistical staff compared to a total of 16,000 plus ambulance paramedics who were balloted to strike) as they often lacked the necessary qualifications and knowledge.
• In England the RCN leadership decided to limit the first round of strikes to 44 Trusts out of the 102 that met the legal threshold for strike action (out of 215 eligible in England). This caused frustration amongst those members that had voted in favour of industrial action. 

The strikes at Southmead hospital

• In tandem with this, the top-level of the RCN and the NHS hierarchy decided the so-called ‘derogation’, the exemption of certain departments from the strike and/or the imposition of minimum staffing levels on certain wards. This was done without input from members or hospital workers.
• Local RCN reps and committees then decided about particular minimum staffing levels during the strike. The way this was negotiated between a few RCN reps and management left a lot of scope for confusion and most workers felt pretty manipulated by or disengaged from the process. This issue is at the heart of the question of who is in control of the strike. Workers on each ward know best what their current patients need in terms of minimum health and safety and would be able to coordinate how many workers can participate in the strike. 
• There were many individual texts and emails from ward managers to people who they suspected would go on strike – allegedly in order to be able to ‘plan for the strike days’. In some wards, managers ‘allowed’ workers to go on strike, often for a limited amount of hours. It seemed the strike was controlled by managers. In a few cases nurses decided collectively on a ward level how many and how long to attend the strike picket – that’s a good start!
• Even if this was not intended by the RCN, the way that the derogation process was handled, left the control of the strike largely in the hands of the trust hierarchy. This can be done differently, as strikes in Germany have shown. There the striking colleagues on the picket-line itself kept in touch with workers on the wards and decided together, if more people were needed on the wards or not.
• The impact of the strike differed sharply from ward to ward. At Southmead, some workers reported that they actually had higher staffing levels on the strike day than normally, in particular in the emergency department. On other wards, colleagues said that matrons and managers had to do bed care and bring patients to the toilet – which can clearly be stated as a positive result of the industrial action in terms of educational value (“it’s good if they get their hands dirty every now and then”). 

Proposals

If there is another round of strikes, we need to start with the following steps to avoid repeating the mistakes of the last round:

• Let’s use the picket-lines to discuss strike tactics, not just to wave flags or blow into whistles. 
• Let’s organise common rallies of workers at the BRI and Southmead.
• Let’s talk with colleagues, first and foremost with health workers who have not been part of the strike, such as porters, cleaners or HCAs, how we can strengthen the strike and make our voices heard.
• We need open meetings to reflect collectively on our experiences and circulate reports of struggles in different areas and efficient tactics.

For a strong and united struggle, led by those who fight it!