The nurses' strike: caught between saving lives and making a living

For the first time in its history, the UK's largest nursing union is balloting for a national strike. The Royal College of Nursing (RCN) boasts over 300,000 members. But nurses are far from the only NHS workers edging towards unprecedented measures to secure the healthcare system the resources it desperately ahead of an especially grim winter. 

“For years, NHS staff have been overlooked,” Carol*, a senior community nurse in the NHS tells The Lead. “A decade ago, we were told it was to do with austerity and we were all in this together, but all these years later we see MPs taking above inflation pay increases every year and we're so much worse off. That’s why I will be voting to strike.”

Carol (who asked we don't use her real name) and the many healthcare workers represented by all the major unions across the UK who are voting in both indicative and formal ballots on whether or not they want to take strike action. Currently, NHS nurses are underpaid and overworked, often working 12-hour shifts as well as overtime with an average salary of £35,000. Nurses are given a mileage allowance of 20p per mile after the first 3,500 miles – less than the average price of fuel in the UK – and, until recently were given £60 a month ‘wear and tear’ allowance, although this has now been cut. With fuel and living prices soaring, many nurses say they are “paying to work” due to having to fork out for petrol, diesel and parking costs, causing many to consider leaving the profession. 

The financial hardship nurses are facing is severe. 14 percent of nurses have been forced to use food banks to survive, according to a survey of 2,500 nurses conducted by the the Cavell Nurses Trust in June this year. A further 41 percent reported that they had less than £500 in savings to get them through a financial emergency. Almost half (47 percent) have considered leaving their jobs.

Members of Unison, Unite the Union, GMB, the RCN, the Royal College of Midwives (RCM), the Chartered Society of Physiotherapy and the Society of Radiographers had a below-inflation pay deal of either £1,400 or 4 percent imposed on them by the government in summer, a move which has been called a “kick in the teeth” by Unite’s general secretary Sharon Graham and, rightly, a “real-terms pay cut” by Unison. 

With inflation now at 12.3 percent, the RCM says over two-thirds of the pay rise will go on energy bills, while the rest will get eaten up by tax. Carol, a Unison member, says the majority of the money will likely go on pension increases. Carol is already feeling the effects, living paycheque to paycheque, with, at the time of her interview, only £38 to last her the week until payday. “I'm a senior nurse with a degree,” she says, “This is absolutely not acceptable.” 

With reports of NHS trusts setting up food banks and ‘marketplaces’ offering donated school uniforms and office wear to struggling staff members, it’s clear that the current pay rate for healthcare workers is unsustainable. Many workers have been taking on extra shifts in order to afford gas and electricity, with one poll by Nursing Notes finding that 56 percent expected to work more than a week (37.5 hours) extra per month to be able to make ends meet. This is exactly why Carol feels so strongly about voting to strike. But for others, it’s not so clear-cut. 

What happens to patients? 

Louise, a 36-year-old community nurse from Scotland and RCN member who also prefers not to be named, believes that the NHS should “absolutely” go on strike. But from a moral point of view, she’s not sure she can vote Yes: “My head is telling me one thing and my heart is telling me another,” she tells us. She says that while no one gets into nursing “for the money,” the pay isn’t reflective of the needs of most workers. “I have colleagues who have to have other sources of income, they have second jobs, they do agency shifts, they do bank shifts to supplement their income. Some are having to use food banks, it’s disgusting.”

But, given the tangible importance of her work, Louise admits she’s on the fence. “I work in the community, so I go to patients' houses,” Louise says. “So although I agree with striking, I feel that my patients would get let down by me going on strike.” She says there are some patients who need to be seen twice a day, everyday, adding that if something were to happen to a patient during a strike, healthcare workers would be “demonised” by the press and politicians. It’s an understandable concern; despite vast swathes of the UK population standing on their doorsteps every Thursday during the first Covid lockdown to ‘clap for key workers’ and praise the NHS, the workers themselves were offered little more than a one percent pay rise post-lockdown. At the time, Conservative peer Lord James Bethell defended the decision, saying that nurses are “well paid for the job,” adding that many people “look upon professional jobs within the NHS with some envy”.

“We're the ones who are there to pick up all the pieces,” Louise says. “That's why I find it very hard to actually strike.” This sentiment is widely held throughout the NHS, with workers telling The Lead that they and many of their colleagues have always struggled with the moral dilemma of whether or not to strike, especially where patient safety is concerned. In a poll of 229 Scottish nurses taken in August this year, 67 percent said they would support industrial action, up to and including strike action. But nurses have reported a “shift in appetite” for strike action in the health service, and a snap poll of 50 nurses taken in July, every single nurse said they wanted to strike.

While it’s only natural for workers to worry, research has shown that strike action among healthcare workers rarely harms patients. A study published this summer found that strike action had no impact on in-hospital patient mortality. Another US study from 2015 found that patients “do not come to serious harm during industrial action provided that provisions are made for emergency care.” GMB’s national officer, Rachel Harrison, tells The Lead that if NHS workers took industrial action, “minimum safe staffing levels and cover would be provided,” but adds, “those levels and standards are not even being met now.”

A crisis of staffing

With a shortage of 12,000 doctors and 50,000 nurses and midwives, the NHS is facing its worst ever staffing crisis, a problem sorely exacerbated by low pay and poor conditions. “We are now in a situation where we can't recruit very often because of the fuel allowance - who wants to pay to work?” says Carol, who, just two weeks ago, had to run a district nursing team with only four staff members. “If we do recruit, they leave because we're so busy and they realise their fuel and wear and tear aren’t covered.” 

Not only is the NHS struggling to recruit, but healthcare professionals are leaving in droves – and Louise says, if something doesn’t change, “you'll have a workforce that's inexperienced, because the only people that will work are those new to the job, and many of your longer term staff will have left.” She believes healthcare workers may leave the profession entirely: “they may even go and work in supermarkets or other places where you can earn the same amount of money, and not have to deal with half of the grief that we get.”

For many, striking seems like the only option for the good of both the service and its patients – especially since the new health minister failed to properly address the issue of pay and recruitment in her Our Plan for Patients announcement last week. In her announcement, Therese Coffey said she would put a “laser-like focus on the needs of patients”, by slashing wait times and bolstering health and social care with a focus on recruiting more volunteers and encouraging retired staff back to work. However, UNISON general secretary Christina McAnea says that offloading onto volunteers is “not the solution,” calling on the government to “stop holding down the pay” of key workers. 

“Only with decent wages will both sectors be able to hang on to experienced employees and attract the new colleagues so crucial to get waits and delays down,” she says. “In every part of the NHS and care, severe staff shortages mean people are going without treatment and support for too long.”

Stuart, a paramedic, says he joined the NHS almost 10 years ago because he wanted to help people. “Going on strike for many years has seemed like it would put people at risk,” he tells us. “However, with the chronic underfunding and staff shortages, I don't think a strike would make things any worse than they currently are.” He says the current circumstances are making it near impossible for him to do his job properly. Although his job is prehospital care, Stuart has been acting as “more of a porter than a paramedic,” spending the majority of his shifts waiting to offload patients at hospitals. 

This, he says, is the main reason he and his colleagues have “changed their stance” to being pro-strike: “Not just for pay, but for the shambles the service has been led to.” Carol agrees, adding that with or without a strike, patient safety will remain “at risk,” but if nothing happens, so will the health – both physical and mental – of healthcare workers, further endangering patient safety. “The government can't continually expect the good will of the staff to keep the services going,” she says. “It's not safe or practical.”

Harrison, of GMB, adds that this campaign and potential strike is about “more than just a pay rise,” - she says retention is at the heart of it. “If pay and conditions are not seriously improved in the NHS, staff will continue to leave,” she says. “The Government is ignoring all the warnings, which as we enter the winter pressure seasons is irresponsible and could be catastrophic.”

While Louise fears being demonised and blamed for any patient safety issues during a strike, the RCN’s director for England, Patricia Marquis, is quick to note that, for the most part, healthcare workers have the public’s support to strike, citing an April YouGov poll in which 60 percent of respondents said they either strongly or somewhat support nurses taking strike action. “Strike action is no one’s first choice – especially nursing staff,” she tells The Lead. “We joined the profession to treat people, to advocate for our patients and the care they deserve, and through this vote we are saying they deserve better.” 

For most healthcare workers – and all workers – the decision to strike is never one taken lightly, but the situation for many is becoming unliveable. 

“A strike is probably going to be the only way we are going to get something done,” says Louise. While she remains in two minds about which road to take, it’s clear that NHS workers are asking for little more than the bare minimum.“We're not asking for the world,” says Louise. “We're not expecting to be millionaires; we just want to be able to afford to feed our families.”