Is the NHS gearing up for a new winter of discontent?

As the Royal College of Nursing considers whether to accept the latest pay recommendation, Sean O’Grady asks if its members are about to join the doctors on the picket line

More bad news for the government’s attempts to reduce waiting times in the NHS and end the incessant strikes that have troubled the service for some years. The Royal College of Nursing (RCN) is holding a consultative ballot on the independent pay review board’s recommended pay rise of 3.6 per cent.

It obviously comes during the five-day resident doctors’ strike, and there are also signs of unrest developing elsewhere in the NHS. Some difficult times lie ahead...

When are the nurses going on strike?

Not soon. The present RCN vote is “consultative” or “indicative”, and is aimed at strengthening their bargaining hand – there’s no commitment to withdraw labour.

Union sources suggest there will be an overwhelming rejection of the offer, which is already barely sufficient to keep up with inflation – but this may, to some extent, be a bargaining ploy as they enter into negotiations. Even so, the chances are they’d go on strike again after a “real” strike ballot, as they did so often in 2022 and 2023. It might happen towards the end of the year.

Is it too soon to use the phrase ‘winter of discontent’?

Sort of. Nonetheless, it is perfectly possible to conceive of the nurses and doctors being on strike simultaneously towards the end of the year. The GMB union is making similar noises about industrial action. They represent many domestic and auxiliary staff, plus ambulance crews (a service still in some crisis). It might well feel a lot like when Rishi Sunak was running the country – “chaos and confusion”.

What could stop the strikes?

More money, but that feels unlikely given the state of the public finances, and just how many people work in the NHS – the pay bill was around £82bn in 2023-24 for England and Wales, about a half of the NHS budget. So a 1 per cent uplift is the best part of £1bn.

A more important factor, though its impact is less direct, is public opinion. Support for strike action is certainly subsiding in the case of the doctors. Maybe Wes Streeting, faced with by far the greatest challenge of his political career, will somehow persuade them to help him reform and save the NHS – which would, after all, be in their own long-term interests.

What would be the effect on the NHS?

Severe – though eventually, when the strikes are settled, as they’ll have to be one day, the backlogs will eventually return to normal. The much more insidious damage will be to public confidence in the NHS as an institution.

If neither the Conservatives nor Labour can fix the NHS, the question may be asked, who can? For some it might feel as though more radical changes are needed, and that the NHS should be effectively privatised. Such changes would not necessarily be in the best interests of the BMA, RCN, or Unison members. The nurses should thus worry about destroying the thing they profess to love most – the health service itself.

What does the opposition say?

Nigel Farage wants a “French-style” insurance system – but that means hefty premiums for some, and presents a problem for those people who cannot afford them.

Questions would remain about how to fund the kinds of long-term treatment that the private sector refuses to cover – for dementia, cancer, degenerative diseases. Under such a regime, some doctors and nurses in some disciplines might prosper, but others would be worse off. It would be driven more by market forces.

The Conservative leader, Kemi Badenoch, wants to ban strikes by doctors: “Doctors hold lives in their hands. No one should lose critical healthcare because of strikes, but that’s what’s happening now. That’s why a Conservative government led by me would ban doctors’ strikes, just like we do [in respect of] the army and police.”

However, working to rule, and overtime bans, would not be outlawed, which could render the “ban” ineffective given how much the NHS depends on people working beyond their contracted hours. The Conservatives might also reinstate higher strike ballot thresholds or “minimum service” in hospitals and healthcare, now being abolished by Labour via the Employment Rights Bill. In short, some form of industrial action would remain an option.