December 2022 through to January 2023 will go down in history as an unprecedented winter of discontent in the UK. Following closely on the heels of December actions which saw strikes by train drivers, bus drivers, ambulance paramedics, school teachers, university lecturers, post office workers and others, nurses at hospitals across England and Wales have come out on strike for the first time in their history. As with most public sector workers, they are striking for higher pay to compensate for galloping, double-digit inflation that has severely eroded their standard of living.
Nurses in Scotland are also threatening strike action if the Scottish government does not improve its offer of 7.5%. After being accepted by other NHS (National Health Service) unions, the deal was put to the RCN (Royal College of Nursing) which decided to ballot its members to either accept or reject the offer. Despite the absence of a clear stance by the RCN leadership, the offer was overwhelmingly rejected by 82% of those who participated in the December ballot. Since then the Scottish government has resumed negotiations with the offer of an accelerated timetable for a 2023-24 pay deal. They have also committed to making an additional, one-off payment equivalent to 3 months' salary at the new rate.
The UK government, on the other hand, has refused to enter into negotiations, resorting instead to the tiresome mantra of adhering to the deal offered by the so-called "independent" NHS Pay Review Body. The remit for this, and other public sector pay review bodies, is established by the government. It specifically includes "the funds available to the Health Departments as set out in the Government’s Departmental Expenditure Limits” and “the Government’s inflation target” as part of its terms of reference.
Unsurprisingly, this organization offered a meager £1,400 pay rise, amounting approximately to a 4.8% rise in the 2022/23 payroll. Inflation in the UK has been running at double that for the past 3 months. The RCN in England is seeking a pay award that goes 5% above inflation. This would go some way to compensate for the real terms pay cut suffered by all public sector workers since the 2008 financial crisis.
It was clear from my discussion with nurses on the picket line, that the pay claim was just one aspect of dealing with the deepening crisis within the NHS as a whole. With wages remaining stagnant, the NHS labour force has hemorrhaged, leaving it with major deficits in the number of nurses, midwives, doctors, mental health, and other care workers. As a result of this, many nurses, who are contracted to work a 37.5 hour working week, end up working up to 60 hours and sometimes more. This in turn is leading to extremely long waiting times for elective surgery as well as simple diagnostic appointments.
Fuelling this unprecedented crisis in the NHS, is an historical neglect of primary care, which is deteriorating even further as working people find it increasingly difficult to get any sort of appointment with their GP (local doctor). As a result, many are choosing to go directly to the A&E (accident and emergency) departments of hospitals to secure any sort of diagnosis and treatment. Combined with a parallel underfunding of social care for the elderly and disabled, this feeds the severe congestion within hospitals where patients are left lying in the corridors or being held in growing ambulance queues.
Recent figures from NHS England for November 2022 , showed that more than 54,500 patients waited over 12 hours in emergency departments after clinicians decided they needed a hospital bed. That was the highest number ever, representing a three-fold increase from just over a year previously. At the same time, the report revealed that the mean average response time for “category one” calls — defined as life-threatening emergencies — was 10 minutes 57 seconds, the longest since 2017. For those in non-threatening categories, the waiting times can be several hours.
The crisis in the NHS places an enormous burden on all its workers, including doctors themselves who are leaving the sector in droves. This is an especially terrifying situation for working people who need urgent treatment and cannot afford the luxury of going private. The disparity in this two-tier system was revealed in a recent article in The Guardian newspaper:
"NHS trusts with record waiting lists are promoting “quick and easy” private healthcare services at their own hospitals, offering patients the chance to jump year-long queues.....
A woman whose elderly mother was treated by the trust in October claims she was told she could bypass long waiting lists if she paid: 'My 86-year-old mum will have to wait two years on the NHS or can see the same surgeon in the same hospital and be treated in two weeks for £1,200'."
The same report claimed that 'hospitals are offering hip replacements for £10,000, cataract surgery for £2,200 and hernia repairs for £2,500. MRI scans are offered for between £300 and £400.'
As frontline workers bearing the brunt of the NHS crisis, nurses themselves are facing the same conditions as other sections of the working class. According to a recent statement from the RCN, “growing numbers of nursing staff [are] using food banks, taking on additional jobs, and accruing personal debt”.
This forms part of a spiralling use of foodbanks, with record numbers of people in work now having to use them on a regular basis. According to the Trussell Trust charity, food banks are being driven to "breaking point" with almost 1.3 million emergency parcels given to people in a six-month period in 2022, representing a twofold increase over pre-pandemic usage for the same period of time.
Under these conditions, nurses and other public sector workers are turning to their unions in order to use them as organisations that fight for their interests. On the picket lines, you can see how nurses are discovering a broader solidarity and unity of purpose, which the RCN tops are finding difficult to contain or suppress. Even in Scotland where UNITE and UNISON accepted the government's pay offer, there was considerable opposition amongst the ranks with more than a third of members voting against it.
Despite pleading for a shoddy compromise, the union bureaucracy's wiggle room is very limited. The millionaire members of the Wesminster cabinet, headed by hedge fund multi-millionaire Rishi Sunak, remain intransigent opponents of the pay rise so desperately needed and deserved by nurses and others. While nurses and other frontline health workers make daily sacrifices for their patients, Westminster seems quite content to let the situation fester.
In face of this intransigence, it cannot be expected that nurses will either escalate or continue their strike action indefinitely. However, if all the public sector unions were to coordinate their actions on the same days and call for simultaneous mass demonstrations, this would at least put greater pressure on the government to settle on terms that are favourable to the workers.
Winning a sizeable pay increase from such massive displays of resistance and solidarity would be a huge step forward. In the year ahead, there is no sign of the capitalist crisis abating. As the subsidy on energy bills expires, working people will be faced with even starker choices between eating or heating. The crisis in the NHS will continue to deteriorate, with millions of working people being affected. Even if the current disputes are settled with offers closer to the current inflation rate, workers' living standards will remain at an all-time low.
The fact that tens of thousands of nurses have come out on strike for the first time in history, is testimony to the high stakes involved. Workers have had enough of footing the bill for the bosses' crisis and are looking for longer-term solutions. As the struggles continue, this will inevitably deepen and sharpen the debate over the need for a government that genuinely represents working people.