The ongoing wave of public sector strikes, some of which could continue into the autumn, has been motivated by two main factors. One – the most immediate – is the spike in inflation and the cost of living crisis triggered by the war in Ukraine. For workforces which had already endured a steady erosion of pay and living standards for over a decade, this amounted to a blow upon the bruise inflicted by austerity.
The longer-term grievance relates to the more general underfunding and implicit undervaluing of public services, which successive Conservative governments have starved of necessary resources. For NHS employees especially, this has too often turned what should be the pursuit of a vocation into a quotidian exercise in putting out fires. The chronic recruitment and retention crises in our hospitals are the consequence of this dire combination of declining pay and increasingly beleaguered, morale-sapping working conditions.
Grudgingly, belatedly, the government has sought to partially address the first factor in the new pay deal agreed on Tuesday with the NHS Staff Council, which represents 12 health unions. This limited outbreak of consensus is progress of a kind. It might have been achieved much earlier had the health secretary, Stephen Barclay, agreed from the outset to negotiate on salaries. Instead, as Rishi Sunak talked tough about anti-strike legislation, Mr Barclay hid behind the miserly pay recommendation of the independent NHS pay review body, delivered before inflation hit. Months were wasted, with patients paying the price.
In an ebullient mood, Mr Barclay confirmed on Tuesday that he will swiftly implement the two-year deal. By doing so, he will hope to divide and rule, isolating Unite, which intends to carry on striking, and the Royal College of Nursing, whose members also rejected his offer and will be balloted on further action. In the short term, this approach may succeed. The numbers suggest that a second strike mandate for the RCN could be difficult to achieve. But the government should beware of over-celebrating an essentially hollow victory.
The tactical resolution of a pay dispute does not equate to a strategic solution for an institution in existential crisis. The nurses’ decision to reject Mr Barclay’s deal, taken against the advice of Pat Cullen, the RCN’s general secretary, testifies to a depth of alienation that goes far deeper than issues of remuneration. At the weekend, Matthew Taylor, the chief executive of the NHS Confederation, spoke of a “loss of hope” among overstretched staff. Too many feel unable to provide the care they know is necessary for their patients.
Announcing the pay deal, Mr Barclay pledged to work further with unions “to ensure that the NHS is the best place to work for staff, patients and taxpayers”. Warm words. But that kind of sustainable settlement – and a restoration of trust between the government and NHS employees – can only come about through a viable workforce plan to equip the health system to cope with a growing and ageing population. According to a leaked blueprint produced by NHS England, this would mean, among other things, doubling the number of doctors trained and increasing the number of nurses trained each year by close to 80%. Put another way, it would require a level of investment that might scupper Jeremy Hunt’s plans for tax cuts before the next election. NHS staff will not hold their breath.
