Nurses and other health workers in England, Wales, Scotland and northern Ireland are presently engaging in consultative and official ballots on strike action. This is in response to the serious situation facing nurses and health workers, the shortages of staff [1], and the systematic lowering of their pay and conditions by so-called "pay-offers" [2] of around 4 to 5% by the governments of the UK. This is all under the direction of the Westminster government and its Pay Review Body. All of these so-called rises are way lower than inflation, which is currently between 9 to 13% and come on the back of years of below-inflation pay increases for NHS staff. Whilst the "pay offer" claims that low-paid staff will get a higher percentage rise, the offer does not apply to the majority of low-paid staff, who are not covered by the "agenda for change" pay system. These staff are working in hospitals and clinics whilst employed by outsourced private companies, or "arm's length" companies within NHS Trusts.

Pat Cullen, RCN General Secretary, said: "There's never been a more urgent time to fight for fair pay and patient safety. From severe staff shortages to a decade of underpayment, we can't continue like this. Nursing staff will stop at nothing to protect their patients. Staff shortages are putting patient safety at risk and the failure of governments across the UK to listen has left us with no choice but to advocate for strike action." The RCN ballot will run across the UK from September 15 until October 13.

Unison has also launched a Pledge Yes for the NHS campaign in a consultative ballot to "Take the first step towards industrial action", which is running over a number of weeks, before a strike ballot from October 27 to November 25. Explaining the pledge, Unison points on their website: "There are over 100,000 NHS vacancies including one in ten nursing posts vacant. You know the stress of understaffing, and the NHS is in the greatest workforce crisis in its history. Patients are put at risk when overstretched staff are forced to leave so they can feed their family."

Unite has already balloted health workers with a strike action ballot that closes on September 11. Unite general secretary Sharon Graham said: "This offer is nothing other than a massive national pay cut for NHS staff. After everything they have been through with the Covid pandemic and the service this workforce gives this country day in, day out, this is a kick in the teeth from the government and an insult to staff and patients alike. This ballot is a chance for our members to have their say, and whatever they decide, they will have the full backing of their union, Unite."

Also, in July the BMJ reported that hundreds of doctors marched from the Department of Health and Social Care offices to Downing Street to protest about their pay and call for industrial action. The demonstration brought together leaders from the British Medical Association (BMA), the Doctors' Association UK, and the newly formed Doctors Vote campaign, Junior doctors and medical students expressed their anger and frustration at the government's decision to leave juniors out of the 4.5% pay uplift announced for other eligible doctors. The association has calculated that the estimated take-home pay for the average junior doctor in England has declined by 22% in real terms between 2008-09 and 2020-21, and these losses are accelerating now with inflation continuing to rise.

Further, a report from the health select committee in July [3] concluded that the NHS and the social care system are facing their greatest workforce crises in their history, with around 100,000 vacancies being advertised in each at the end of last year. "The Workforce: recruitment, training and retention report outlines the scale of the workforce crisis: new research suggests the NHS in England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives; evidence on workforce projections say an extra 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade; hospital waiting lists reached a record high of nearly 6.5 million in April. The report finds the Government to have shown a marked reluctance to act decisively. The refusal to do proper workforce planning risked plans to tackle the Covid backlog - a key target for the NHS."

Over recent times the successive Health Secretaries at most talked about the pandemic causing lack of funding, beds and staff. They refused to recognise that their own and previous governments over many years have caused this crisis in the NHS by ongoing reduction in investment in the comprehensive public health and care system. This they have done in favour of costly investment in fragmenting and contracting out of many services and buildings (PFI) to private companies at huge cost, including the whole elderly care home sector privatised and employing very low paid staff. Added to this, successive governments have driven NHS Trusts and GP services in a corporate direction, encouraging the closure of more and more beds and have refused to meet the actual needs of the NHS for training of clinical and nursing staff and fully providing the most up to date equipment and premises.

This latest pay offer is a further case in point. The then Health Secretary Stephen Barclay directed an offer that does not even recognise the Health Committee's view that "pay is a crucial factor recruitment and retention", but has been deliberately imposing lower than inflation pay increases once again. He claimed when he announced it that "very high inflation-driven settlements would have a worse impact on pay packets in the long run than proportionate and balanced increases now, and it is welcome that the pay review bodies agree with this approach". How is this the case? How is it that meeting the needs of health workers pay in full and redressing the years of downgrading of their pay is an "inflation driven settlement", yet lowering their income once again will not have a "worse impact" and how is this a "balanced increase now"?

This whole conception is that the funding of health care and of staff pay is to be presented as a driver of inflation and a burden on the economy. Nothing could be further from the truth. Even the offer itself is to be funded from existing NHS budgets, which shows that it is a scam that will be used by health authorities to justify further NHS cuts and blame it on health workers' pay. There is no conception that the reality is that health workers contribute to the whole wealth of society so that people who live in it can function as fully as possible and create and produce the human and natural resources for all. Health workers do not cause inflation - that has more to do with the financial oligarchy and the rich who take more out of the economy than they put in. Health workers are the human resources that can implement the right of all to health care if they are given the resources to do it fully in society. Also, if they are given the power to decide along with the people they serve they can work to resolve the crucial questions that are causing the crisis in the NHS, such as the need for more staff and more NHS beds, ending privatisation and so on. Health workers are central to a human-centred health care system and their well-being is crucial to the future of the health care system.

Health workers are yet another section of the working class that have said that enough is enough and are building their resistance to yet another below-inflation pay rise that is an attack on their well-being and the well-being of society.

Notes
1. According to reports, one in 10 NHS jobs lie vacant. The number of unfilled NHS jobs hit a new high of 132,000 in June according to new data, prompting health service chiefs to issue serious warnings to ministers of an "all-engulfing NHS crisis". The vacancy rate now stands at 9.7 per cent, records show, with 46,828 nursing posts currently unfilled and 10,582 doctor roles remaining empty.
2. The "pay offer", in England and Wales is a complicated and divisive formula made by the Pay Review Body and accepted by the government that pits staff pay increases against NHS budgets. NHS staff will get at least a 4.5% "pay rise", with the lowest earners receiving up to a 9.3% increase backdated to April. Eligible dentists and doctors will also receive a 4.5% "pay rise". However, the UK government plans to "re-prioritise" the funding of this pay rise from existing NHS budgets so any rise will be and excuse to cut investment in services. The Welsh government accepted these recommendations but, as we publish, the government of northern Ireland has not decided. The Scottish government offered a 5% "pay rise" to NHS Scotland.
3. Workforce: recruitment, training and retention in health and social care: Health and Social Care Committee, July 25 2022
The report goes on to say, "Maternity services are flagged as being under serious pressure with more than 500 midwives leaving in a single year. A year ago the Committee's maternity safety inquiry concluded almost 2,000 more midwives were needed and almost 500 more obstetricians. The Secretary of State failed to give a deadline by when a shortfall in midwife numbers would be addressed. Pay is a crucial factor in recruitment and retention in social care. Government analysis estimated more than 17,000 jobs in care paid below the minimum wage."
https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/115/report.html
https://committees.parliament.uk/committee/81/health-and-social-care-committee/news/172310/persistent-understaffing-of-nhs-a-serious-risk-to-patient-safety-warn-mps/

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