I have been a Unison rep at the hospital where I have worked for about five years. I chose to become a union rep to get to know and support fellow workers from various departments, which is sometimes not easy in a workplace of 10,000 people, with many departments being pretty much secluded entities, such as the hospital kitchen, the laboratories or the sterilising department. My main aim as a communist is to create direct links between workers, to encourage self-organisation, collective reflections and direct actions. The following notes show that trade union organisations often counteract these aims. Before I go into details, I briefly look at the main structural issues of trade unions in general. We can see that the problems that I faced at my local hospital workplace were not necessarily exceptions or aberrations, but are largely determined by the union structure itself.
*** The problems with unions in general
As legal organisations, trade unions are confined by the labour law of their respective countries. Once recognised, unions have little to no interest in questioning these laws, as doing so might jeopardise their organisational existence or their funds. This makes them mediators between workers and bosses and limits their interest in overcoming class society and exploitation. At the same time, those laws that recognise unions also constrict strikes and other forms of industrial action, to the point that they become ineffective and divisive. In the UK, and in many other countries, it is illegal to strike for ‘political demands’, e.g. against certain government reforms, even if these reforms affect the ‘economic’ life of workers. Also ‘solidarity strikes’ in support of other workers are illegal in the UK, which gives away the main power that workers have to act collectively to preserve their wider class interests. The labour law stipulates that strikes have to be announced in advance, which gives the employers time to prepare counter-measures. The votes in ballots are largely individualised, e.g. through postal votes, which undermines collective dynamics. Trade unions tend to organise and mobilise only particular professions, which undermine a united response of all workers in a particular industry. It is therefore no surprise that most large-scale and militant struggles that actually shift the ground happen outside the official relation between employers and trade unions.
Furthermore, unions, like other organisations, put their own organisational interest before the interest of workers. We often see unions competing with each other. In order to attract members, unions will always try to portray themselves as victorious and undermine a necessary self-critical reflection of the strengths and weaknesses of workers’ struggles. This prevents workers from learning from their own experiences or experiences of others, which is of fundamental importance. In order to defend the interest of the organisation, trade unions tend to establish an internal hierarchy, which limits the space of self-organisation – which is fundamental for the development of working class power and the vision of a social alternative.
Finally, as organisations that represent only partial interests of a particular group of workers and that are tied to national law, trade unions tend to defend national or sectoral interests, rather than create international solidarity amongst all workers. We can see this when trade unions welcome national investment into rearmament, or other harmful industries, as long as it creates jobs for ‘their members’.
*** The union structure in our NHS Trust
There are numerous trade unions recognised at our NHS trust. Some of them represent only certain professions, such as the BDA (British Dietetic Association), the BMA (British Medical Association), the CSP (Chartered Society of Physiotherapists), the FCS (Federation of Clinical Scientists), the RCM (Royal College of Midwives), the RCN (Royal College of Nurses) or the SOR (Society of Radiographers). Others are supposed to represent all job categories, like Unison, Unite or GMB. Unison is the biggest of the trade unions with around 1,900 members. I reckon around 20% of all staff are union members, which is a much higher degree of unionisation than in other sectors. There are 31 trade union reps in total, out of which 4 are on full-time release, primarily because they have roles within the Joint Union Committee (JUC).
The participation of members within the union is pretty dismal. Around 10 out of 1,900 Unison members show up to the annual general meeting, partly because they are bribed with sandwiches and canteen vouchers. The monthly branch meetings are attended by four or five Unison reps and are largely a formal affair. The JUC is the main link between trade unions and management and most things are only discussed and decided within the JUC and not by the actual union branches. There is an incentive to be in the JUC, as it allows for regular meetings with management, which can feel important and which releases you from daily work. The JUC is not particularly democratic, for example the current chair was not voted in by everyone, but installed by the leading reps. The same happened with the current Unison branch secretary. In both cases because allegedly there were no other people who wanted to do the job.
*** Individual corruption: the gravy train of trade unionism
The example of the former Unison branch secretary’s union career is telling and not very exceptional. He started working in the Trust as a porter on the lowest pay scale. He became a Unison branch secretary and later on the JUC secretary. In 2018, the union engaged in a legal battle on his behalf, concerning the fact that his overtime and night-shift bonuses were not taken into account when calculating his wages on full-time release. This was one of the few open disputes between the union and Trust management. By being the JUC secretary you have a lot of chances to pick up management skills, e.g. you sit on job evaluation or other board meetings. After six, seven years of being a full-time union representative, the branch secretary left employment for the Trust and took on a HR manager position in a semi-private health company, paid around three times as much as his original porter job. Even by doing official management courses, it would have been hard for a porter to pull this off – being a trade union representative is a career jumping-board like no other. The former chair of the JUC had a similar success story. She used to work as a midwife and then took on job evaluation training for union reps. She was then given a full-time position as a job evaluation project lead by management.
In spring 2025, the JUC and Trust management entered an official dispute. This dispute was not about the closure of the detox unit, the exclusion of bank staff from the national pay increase or any other issue that would be of interest to workers, but about the pay rate of JUC officers. The JUC members decided to enter an official dispute because they wanted trade union reps who normally work as porters, health care assistants or admin workers to be paid a senior admin wage while doing JUC duties. It was said that Trust management was able to enforce a lot of sneaky changes during this period of dispute, as they didn’t have to consult the JUC. The latest quote from the branch and regional hierarchy exemplifies the problem of the gravy train pretty well:
“Just wondering if you are sending anyone to the Unison Health Conference 2026 in April in Edinburgh. We have rooms at the DoubleTree by Hilton Edinburgh City Centre at £229.00 per room per night – if you would like to book please do not hesitate to contact us.”
Due to a lack of rank-and-file activists the union headquarters might feel obliged to attract people by offering certain perks, but that of course also attracts a certain kind of people. It is therefore not surprising that the local union reps are often more conservative and less militant than the middle range of paid union staff and organisers – or non-unionised common workers!
*** Dispute around the health care assistant apprenticeship scheme, winter 2021
The Trust employed around 530 apprentices on the minimum wage, probably cashing in money from the government at the same time. According to the apprenticeship regulations, 20% of the working time has to be ‘off the job training’. The practice of the Trust was to declare anything and everything ‘off the job’. If you had to work on a different ward, doing exactly the same things – making beds, emptying bed pans etc. – they asked apprentices to “put it down as off-the job, so that you can reach your 20% and finish the apprenticeship”.
A group of apprentices addressed the Unison branch, but the branch secretary was pretty luke-warm about taking up the issue, beyond “speaking to HR about it”. Later on it turned out that regional Unison prided itself on having many NHS Trusts signing up to their so-called ‘apprenticeship charter’, which gives Unison a seat at the table of managing the apprenticeship schemes. Officially our Trust adhered to that charter and the union didn’t want to rock the boat. So a group of 70 – 80 apprentices issued a collective grievance, putting up posters in the hospital, and signing people up to a joint WhatsApp group. The Unison branch secretary reacted as usual:
”However the posters have focused minds whilst I recognise the frustration I can’t endorse the use of those posters any longer”.
We didn’t care much, as the posters were not from Unison anyway. In the end, the Trust management got a private consulting firm involved to ‘investigate’ the dispute. Those of us who stuck with the grievance managed to get a back payment of one year of wage differential between the health care assistant and the apprenticeship wage.
*** The trade union role during the mobilisation for the pay strike 2023
The pay round in 2022/23 was important. The previous pay round happened during Covid when it was more difficult to organise assemblies or meetings. This was one of the reasons why hardly any of the trade unions managed to mobilise a sufficient number of members to vote in the ballot – at least 50% of members have to participate and I think only 27% of all Unison members voted. So a friend, who was a GMB rep at the time, and I proposed to the JUC that all unions should hold a joint pay rally in front of the hospital to make the campaign more visible and to give colleagues the chance to join in. This proposal was met with utter hostility and a variety of excuses. The JUC and Unison branch secretary said that it would be confusing for members, as each union had separate pay claims – this was actually a phony excuse, as the demands were not that different and could have been explained during the rally. Health and safety was also given as an excuse, as the rally would have taken place in the same spaces that patients and their visitors were accessing. They also said we didn’t have permission from the hospital security, despite not even having asked for it. Another excuse was that they wanted to focus their limited capacity on getting the correct contact details for their membership so that the votes were sent to the correct addresses. This was evidently not done given the subsequent extremely low turnout for the ballot.
Within the Unison branch the proposal was rejected. At the time, the majority of Unison reps were in lower and medium management positions. The following quotations from an email exchange demonstrates the level of degeneration of trade unionism in the UK. We have to bear in mind that Unison was still officially mobilising for a pay campaign! I wrote:
“I would like to put forward the following proposal: Given the rather dismal outcome of last year’s pay campaign for all unions in the NHS and the severe inflation that we can expect for 2022 we should start the pay campaign 2022 on a more visible and united footing. That’s why we should organise a joint-union rally at Southmead hospital for better pay and staffing levels as soon as possible.”
The first reaction:
“Hello, personal perspective, I don’t support the proposal. Many taxpayers are facing apay freeze and so comparatively the health service staff who have received a rise (albeit unsatisfactory). I’d be concerned about losing public support at this time when everyones pocket is squeezed, not to say there might not be another time shortly when the more visible approach to unionism would be well received. Gut feeling is it might not go down well just yet. UNISON offered staff their say in terms of a Pay Ballot – and a re-launch of the Ballot; both of which did not receive sufficient votes to proceed.”
Just to clarify, the last sentence of this comment referred to the previous year’s pay ballot – so instead of thinking that we need to do more than just sending out individual emails to people, this union rep takes last year’s bad result as the final democratic word.
The second reaction, from the branch chair:
“Dear All – This is not the first time this has been raised and I thought S. [branch secretary] and I had answered this. However, possibly the point was not made strong enough. This is definitely not the time and place to start a campaign of organising a rally for the pay campaign, all of our members have voted with their silence and the lack of engagement. We currently have a situation in this Trust whereby staff are going to lose their jobs due to their personal belief and convictions, due to the compulsory vaccinations. Uncomfortable conversations are going to be held with staff to understand their situations. At this present moment, our members will need to support at these meetings to get them through this hard time. I absolutely support better pay for staff, but a rally now is not going to gain us any support at all, and we will be on our own; which would be futile. (…) it is not about rallying and campaigning only, it is about keeping our members well informed and in employment.”
In the end, the proposal to have a pay assembly outside the hospital was only taken up by the GMB. While initially mobilising for a visible assembly, the plans got watered down considerably; the GMB organiser and branch secretary decided single-handedly and at the last minute that the rally should take place in front of the union office instead, which is far from the hospital entrance where all colleagues would have been able to see it and participate. It is unsurprising that the rally was badly attended and that the militant GMB rep left the branch in response to this top-down decision.
*** The trade union role during the pay strike 2023
The attitude of the Unison reps resulted in Unison once again missing the necessary threshold of member participation in the ballot. This meant that only the RCN (nurses union) went on strike in 2023 and ambulance workers represented by Unite and GMB. The problem with the ambulance strike was that the two unions did not coordinate their actions, which left the strike disjointed. The first thing the RCN did at Southmead was to call a meeting with management to decide about minimum staffing levels (derogation) during the strike. Management declared the strike a ‘major incident’, and the two, three RCN reps left the control over staffing levels in management’s and ward managers’ hands. This caused a lot of confusion amongst nurses about whether they were allowed to join the strike or not. The other unions did nothing to support the strike.On the contrary, they sent out emails advising their members to stay away from the picket lines. In the end, only nurses were on the picket line, while porters, cleaners, health care assistants and other low paid workers had to continue working. About the picket lines the leading RCN rep said:
“We’re having picket line supervision training, alongside derogations committee meetings 2 daily and then there will be lots of support from the RCN to regulate the picket line itself. We are clear that the [sic] we have to v [sic] careful around who joins the picket line itself. We are currently in discussions with the Trust and Police as to safety of pickets and public.”
Their reaction to the proposal to bring some music was also telling:
“We need to be aware of rules around peaceful pickets and personally would have real concerns around speakers or music being played.”
In the end we brought a small sound-system and of course all colleagues on the picket really loved it. We summarised the experience of the pay strike and put it out there for wider discussion.
*** Problem of porters working double-shifts
The position of colleagues who work in catering, cleaning, portering and other Band 2 or Band 3 jobs is desperate. In 2025, when the minimum wage was increased, millions of NHS workers, some of whom might have worked for the NHS for decades, slipped below the minimum wage and the NHS had to boost their wages to avoid engaging in illegal work practices.
I sometimes work porter shifts and I come across many colleagues who work double-shifts, meaning 16-hour days. I raised this issue in the JUC and proposed that even if we cannot challenge this practice legally, we should at least put public moral pressure on the Trust. While wages are set nationally, the individual Trusts can pay bonuses, for example for ‘staff retention’. Basically, there is scope to do something about low wages and long working hours. The reaction from the JUC chair was:
“Tricky one as some staff need to work the hours to make ends meet. If we put pressure on the Trust to stop it then that will effect the members financially.”
This is trade union common sense! Let them work 16-hours, so that they can make ends meet, let’s not rock the boat, otherwise we might lose members. The JUC refused to address the issue of colleagues working 16-hour shifts in the 21st century.
*** Sabotage of solidarity during the maternity care assistant strike September 2023
The maternity care assistants (MCAs) went on strike over an unfair incentive pay scheme within the maternity department. Management decided to pay registered midwives 100% extra for each hour of overtime, while the maternity care assistants were only paid 50%. The explanation given to the MCAs was that midwives were “first-class staff” and that it would not be an issue to replace MCAs. The majority of MCAs were members of the GMB trade union and the strike was limited to GMB members. As the maternity building is located a considerable distance away from the main hospital building and the strike picket was held even further away, most health care assistants in the hospital were not aware of the strike. As far as I saw there were no serious attempts made to inform the hundreds of health care assistants on other wards about the dispute. I was aware of the fact that Unison members amongst the MCAs continued working and suggested that we contact all of them to hear how they feel about the issue. I asked the branch secretary for the contact details of our members in maternity to conduct a survey, but I was refused the data, despite the fact that membership information is usually accessible to all reps. The branch secretary said that “this is not our dispute, we have nothing to do with it and there is no need for a survey”. We supported the strike informally by writing and spreading the news about it and by attending the picket lines. Unfortunately the strike ended without a result – at least no result was made public to GMB members. There was no visible attempt to draw conclusions from the strike so that other workers could learn from it.
*** Unison officers attitude towards overtime campaign in theatres, spring 2025
The issue that NHS Trusts use the zero-hour ‘bank system’ to avoid having to pay the statutory overtime bonus of 50% is commonplace. Our Trust management used the overtime in a very divisive manner, e.g. in theatres the bonus used to be 100%, it was then cut to the bank rate, which is more or less the same as your normal pay. At the same time, workers in pharmacy retained their overtime bonus, while on the wards it had never been paid at all. Unison runs an online campaign on their main website which tells members that they should insist on being paid the overtime bonus for any hour worked above 37.5 a week. When theatre management sent a mass email announcing that they would only pay the bank rate, I responded, referring to the statutory right of overtime payment. The Unison branch chair, who by chance is a manager in theatres, responded to my reply in an email to the entire department saying that “I should not confuse things”. In the meantime I spoke to the Unison branch secretary, who was in the process of leaving his job and to start as a HR manager, referring to the official Unison campaign. He acknowledged that I had a point and agreed to putting up posters that informed everyone about their right to overtime payment.
Together with theatre colleagues we collected 60 signatures and started a collective grievance. The Trust Head of Communication managed our grievance. We argued our case, e.g. that we are usually understaffed and that therefore the same situation existed like in the pharmacy department, where the overtime bonus was paid. As to be expected, the final outcome of the grievance was the usual fudge: “Staff has the right to request overtime, while management has the right to offer bank shifts, instead of overtime shifts.” Our informal group considered a bank-shift boycott across theatres, but at this point there was too little cohesion amongst the workforce. Two months later the new branch secretary, who had been installed without a branch vote, called me into the office about the “confusing posters”. Together with the branch chair – or rather theatre manager – she requested that I take down the posters. I showed her the email exchange with the previous branch secretary and the official Unison campaign website, from which most of the poster text was copied. It was obvious that she was not aware of the campaign and that she just listened to the advice of the branch chair. This big divide between ‘well-meaning’ national campaigns and the dismal local branch conditions is not unusual. A similar situation arose a few months later around the question of outsourcing theatres to private companies on weekends.
*** Unison officers position towards job cuts and closure of the Acer detox unit, spring 2025
In spring 2025, the two NHS Trusts in Bristol announced 500 job cuts, the closure of the detox unit at Southmead hospital and job cuts at the sexual health clinic attached to Bristol Royal Infirmary. As Vital Signs we tried to get workers from both sides together to resist the cuts. I went to the Unison branch secretary to see whether the branch was going to do something about it. Her position was clear:
“We cannot do anything about the cuts, these are defined by the budget. All we can do is to support members with redeployment.”
Who needs bosses with trade union attitudes like these? As Vital Signs we tried to get together the workers from the sexual health clinic, the Acer unit and the disability activists, who were protesting about the cuts to the Personal Independence Payments at the time. This would have been a good occasion for a wider united front against cuts – a chance that was unfortunately missed. One of the main reasons for the fact that there was no open resistance against the cuts is the system of consultations and the individualising way in which management drags out these types of job restructuring, which tends to paralyse the unions.
*** Union rep attitude towards petition for bank workers, summer 2025
In summer 2025, management from both NHS Trusts announced that bank staff would be excluded from the national pay increase. There was no reaction whatsoever from the JUC, apart from a letter to management, asking for the reasons for the decision. Friends from Vital Signs together with bank workers started to walk the wards to collect signatures for a mass petition. Within a few days we managed to collect around 300 signatures from fellow workers of all job categories. The only person who refused to sign was a Unite rep. He said:
“I would support this in general, but these bank workers should join a union first. It is not good to do these things outside of the union.”
The fact that the unions didn’t do anything for the bank workers doesn’t mean that independent efforts are automatically successful. On a WhatsApp group of around 60 bank health care assistance there are a lot of complaints about the various levels of discrimination, e.g. the exclusion from the pay increase, but also the fact that bank workers only get the new uniforms after all permanent workers have received theirs. But when it comes to turning complaints into collective resistance, only 4 out of 60 people actually get involved.
*** Unison officers position to oppose army recruitment stalls at Southmead hospital
In late 2025 top management sent around an email to all employees about a successful series of workshops between Southmead hospital and army staff. They also highlighted the fact that the army could put up a recruitment stall inside the hospital. A few of us union reps urged the branch officials to send an official email to management, voicing our opposition to such a collaboration and requesting future consultations. The initial response was to claim that the NHS “is legally obliged to cooperate with the army”, which was relatively easy to refute, as these workshops and recruitment stalls are not something management is forced to engage with. The second response was that we actually should not oppose the collaboration between NHS and the army and that this is “a political issue”.
*** Migrant workers rally against visa changes and tightening of regulations
The changes to the visa sponsorship system and the indefinite leave to remain affects many of our international colleagues. It spreads fear and anger. In Manchester, many lower paid workers were threatened with deportation and also at Southmead hospital we came across distressed fellow workers. We proposed to organise a rally to voice our opposition to the changes in December 2025. The Unison office bearers reacted unsurprisingly:
“This is a national issue, the trust management has nothing to do with it. Mobilise members to the national demonstration”. – “I have not joined Unison to be in a rabble-rousing union, but to work together”.
By this time we had more reps on our side and we were in an official majority in the branch, but mentioning the fact that the rally would be good for member recruitment really made the difference. We were allowed to announce the rally as an official Unison rally. We invited all other trade unions at Southmead to participate in the rally, but we received no response. The main office bearers did not engage in any mobilising for the rally, e.g, by putting up posters, making banners or walking through the wards to inform people. Management imposed, as usual, that the rally could not take place in front of the hospital, but had to happen at a relatively remote round-about. The turn-out in December was unfortunately low.
*** General experience with representing members
Despite all these frustrating experiences, I can say that being a union rep also got me in touch with individual members who I would most likely not have met otherwise. I represent one member a month on average, primarily during performance, bullying or sickness absence meetings with management. These meetings are an absolute farce: management contributes to the current conditions of low pay and high turnover of staff or the alienation through bureaucracy and hierarchy at work, which then makes people sick or incapable of cooperating in an equal atmosphere with their co-workers. There is a lot of subtle bullying going on within teams, which are also mainly due to the general alienating conditions. After having contributed to these conditions, management then spends (highly paid) hour after hours in meetings to deal with individual cases of personal misery: mental health issues, shitty dynamics amongst colleagues and so on. As a union rep you are more of a social worker and you make sure that management follows their own rules. After the meetings I try to talk more with the affected members about the general working conditions and how these issues could be taken on in a more collective way. That’s basically the only positive aspect of being a union rep in the current moment.
*** What to do? Should we take over the branch? Should we start a new union?
I am sure not all union branches are as miserable as ours and I can understand the well-meaning advice: why don’t you get some more reps together and take over the branch? It is true, the boundaries could be pushed more. At the same time, why bolster a reformist, bureaucratic institution such as Unison? Why give this organisation of class mediation a radical sheen? And more importantly, why lose a fair amount of time and will to live by taking over all the formal and bureaucratic work that ‘taking over a branch’ would entail? And even ‘taking-over’ a branch doesn’t guarantee autonomy to act. We have seen dozens of cases where ‘militant’ local union branches were shut down by the union leadership. Do we want to fall into that trap? Or spend all our energy in trying to change the leadership, ignoring the general structural conditions that reproduce unions as mediating, hierarchical organisations?
From a revolutionary point of view it is actually a good situation that the mainstream unions are seen as largely irrelevant, because they don’t even take up the day-to-day defence of our conditions. This opens spaces for radical and independent efforts. In many ways the Vital Signs group, despite its minority character, is seen as the only voice in the hospital that speaks out about the daily struggle – while at the same time promoting workers’ self-organisation and stating openly that we need a revolutionary change of society.
Currently on the left in the UK, getting active in your union branch is presented as the prime, if not the sole way of re-kindling working class politics. I think this is pretty fatal, as it often leads to frustration and/or a certain de-politicisation – or perhaps more precisely to a separation between workplace activities and political organising in a separate sphere. For future debates we should first clarify and tease out what ‘working class politics within and beyond the workplace’ is from a revolutionary point of view and then, on that basis, discuss what role union branch activity can play.
Historically speaking most of the autonomous and revolutionary bodies of the working class didn’t emerge out of thin air or political sects, but as a rupture with official structures, driven by militants who often had been active in political organisations previously. In the future we have to steer between our historical political insights, e.g. that unions are systemically opposed to workers’ self-emancipation, and the actual conditions on the ground, meaning, the point where our fellow workers are at. The balance of power doesn’t always allow us to organise industrial actions outside of the union framework. This doesn’t mean that we should abstain from trade union-led action. We can participate in actions within union structures, but with the awareness and practical-political preparation that any collective disputes will have to surpass them in the medium-term.
