We will try and interview a few fellow health workers before, during and after the NHS strike – if you want to share your experiences, please write to us. You can download our strike newsletter here, for your local pickets and staff rooms…
Could you start by introducing yourself and saying a bit about where you work?
Hi, I’m a registered mental health nurse in the UK, I work in South East England in an NHS community mental health and addictions service.
What kind of impact has the cost of living crisis had on your work on a day to day level?
It’s been felt in terms of the impact on people’s health, stress levels and morale, and how it’s affecting everyday circumstances – differences and inequalities feel more dialled up.
Within the work itself there’s been reduced capacity to respond, more vacancies, more intensive workloads; more standardisation, less options, longer waits for things. It feels like we’re apologising for things more often.
Just on the level of your workplace, how have you and your colleagues responded?
People are supporting each other emotionally and practically at the office and in group chats. Sharing coupons and info around discounts and freebies, breakfast clubs; more talk about ways of reducing bills. Making do with less, changing habits – cooking with microwaves instead of ovens, not going out, spending more time at the office to save on home heating/electricity … Taking on extra shifts with crisis teams, looking for jobs with higher rates of pay, more people talking about leaving nursing indefinitely.
How are you and your co-workers feeling about the upcoming RCN strikes?
All the nurses I’ve spoken with have been supportive of the strikes, if torn about walking out on patients and co-workers.
Nurses in the local hospital trusts are striking, so there’s some buzz about that.
The ballot result for where I work came in just short of the legal threshold for striking, so I’m not sure pay and conditions have been enough of a collective point of conflict here, as yet. It was great to see some mental health trusts amongst the list of those striking, and would be good to learn more of their stories and what helped to get the ballots over.
What was the balloting process like?
The ballots were by postal vote back in October. In the run up there was sustained campaign activity both publicly and through official union communications – email bulletins and briefings, text message canvassing, pop-up demos and stalls in hospitals; lots of press coverage, ads on YouTube!
Strategy has all been centralised by RCN nurses, filtered down in terms of leadership to union branches who’ve overseen local tactics. There’s been lots of training offered – from general organising and canvassing to volunteering at the pickets.
In the trust where I work nurses set up WhatsApp groups to campaign between workplaces, agreeing plans for distribution of materials. There’s been things like ward walks and pop up demos, flyering and information sessions.
At the same time, uptake hasn’t felt so widespread, and I wonder if this can be explained in part by the make-up of community mental health services, where nurses tend to work in low numbers alongside other occupational groups, and maybe miss a collective sense of professional identity you might find in other settings? There’s been a more recognisable campaigning presence at the hospitals, where nurses tend to be more concentrated together. Locally, it’s been these trusts where nurses got the ballots over.
What do you think about how the RCN have been handling it so far?
I was conflicted last March when we pulled out of the collective position on pay. It felt like we missed an opportunity to stand in public with other NHS workers with a pay demand that lifted everybody’s pay and conditions, not just nurses. I wonder if we’re deepening divisions between nurses and other workers as a result of this.
Just on the level of what has been done, the efforts and coordinations this year feel massively developed from previous. The campaign has run since 2020, but the ballot returns this year feel like a culmination of a lot of work and momentum.
At the same time, organisation and delivery of the campaign feels like it’s mirrored the way nursing work tends to be allocated and divided up within the NHS, with top down leadership determining the running and feel of the campaign. Senior nurses in NHS teams/services might also be occupying leadership positions in union branches, which can influence the kinds of relationships it’s possible to have with the campaign. It’s been difficult to take initiative without having to run this back through official union channels. For example, I ordered campaign materials for the office which didn’t arrive, and when I chased these I learned that attending official training in advance of campaigning was really the main process for getting involved. In such a large union it makes sense that some consistency is probably needed, but in context, it can be deflating to have to campaign by rote towards outcomes handed down from above, because so much NHS work gets organised this way! It’s taken being able to get past some of these organisational hurdles to find a connection with the campaign that feels more shared and participatory.
What are you expecting from the dispute?
I’m expecting decision makers will want to minimise NHS disruptions during the cold weather period, so there’s potential leverage there. It’s difficult to know and comment without being involved in the strike coordinations.
I’d imagine strike days are being well planned for in advance, by both nurses and service managers. Interestingly, some striking nurses are also likely to be occupying senior nursing, and managerial positions within NHS trusts, which could be a useful, if competing set of commitments to take into the dispute.
One of the general challenges facing nurses will be finding ways to honour their commitment to patient safety, whilst effectively bringing impact through the strikes. Problems for service systems on those days could end up getting attributed to striking nurses, ramping up divisions, and tension for those on pickets who are taking on more responsibilities through their decision to strike. It’s worth remembering that a regular day in an NHS hospital or service just now is likely to be disrupted, resource depleted and slowed, and this is something nurses are wanting to draw attention to, rather than escalate.
I’m also expecting many nurses to be striking for the first time. It’s been great to have patient groups getting involved. I think there’ll also be strong support from local NHS campaigning groups.
What are the main divisions among nurses? How do you think they’ll play out in the strike? Do you have any thoughts about how they could be addressed?
Some of the formal divisions in nursing are in the allocation of work, different rates of pay, contractual terms and benefits, working conditions and the kinds of work being done. Lower banded or lower paid nurses tend to take up the more intensive, clinically risky and sustained aspects of patient facing work, and this is also the kind of nursing work more likely to be casualised and/or outsourced. Specialist and senior nurses, nurse managers and consultants get paid more and take on more aspects of clinical governance, and are more likely to be working with more substantive employment terms and benefits. These aren’t always clear cut distinctions though, and elements of both care delivery and management will cut across almost all nursing jobs, but this feels roughly where some of the main divisions in nursing labour appear. There are other kinds of social divisions to factor in too, inequalities in how UK nursing work is allocated along lines of race and place, class and gender have been well documented, during the pandemic especially.
When thinking about divisions amongst nurses it’s difficult not to extend this to include the divisions made possible bynursing too. Nurses are divided, whilst dependent on one another, but they’re also heavily reliant on other occupational groups for their work process – healthcare assistants, support workers and carers have inherited aspects of care work that nursing – through professionalisation, has been able to hand off, such as the more embodied aspects of direct patient facing care …
Political and ethical/value differences in how nurses situate themselves towards NHS work are also relevant to the strikes. Nurses opposing, or abstaining from striking are doing so to protect an already straining NHS during a period of high demand, and relatedly, there’s nurses prioritising their professional duties of care to patients and the public over and above the call to fight for conditions needed for care to go well.
In terms of how these divisions might influence or play out with the dispute, maybe it could be generative to ask how our campaigning relates itself to these divisions? If nurses win on restorative pay, what changes and what stays the same? How can we ensure we aren’t going back to work any more divided than we presently are?
Have you been following the disputes led by other unions (the BMA and Unison)? Is there much of a link between their mobilisation and the nurses?
Yes, both the RCN and JDC/BMA disputes feel like they’ve got restorative demands in common.
As for links between different unionised nurses on a day to day level, it’s not something I’ve been involved with where I work, and again this is mainly due to the make-up of the team I’m based in. I’m in touch with some UNISON nurses in other parts of the service, and we’ve discussed the different campaigns and ballots, but in fairly non-directed, observational ways – following the news and official updates, rather than actively organising anything together.
At some of the early demos I went to for the fair pay campaign there was a felt presence of both RCN and UNISON nurses, and in spite of the break RCN made in March, cross-union links look to have held up between nurses and other health/care workers who’ve been active in broader NHS anti-privatisation and protection campaigns. At the Trade Union Congress (TUC) this Summer, RCN nurses turned out to walk with other health-care workers, in spite of being unaffiliated and with no official backing.
Whether and how these kinds of links and bonds can be strengthened, developed and taken back into workplaces is maybe another question.
What direction would you like to see the strikes take?
It would be great if things could develop to a point where they can become more generalised, where we can relate the campaign to health and social care work more broadly. I’m not sure at this point what form this could take, or how to go about it, but it feels like some nurses at least are longing for the dispute to reconnect with the bigger picture. It’s been painful to read the UNISON ballot result because I think some RCN nurses were hoping there’d be scope for coordinated strikes with fellow UNISON workers this winter. If we aren’t together on a collective demand, we could still come together and support our respective ones. I’d like to see things develop, and support more developments in that direction.
And finally, how is the current situation affecting you and your co-workers confidence at work on an everyday level?
It’s been energising to take part in the campaign for restorative pay, to support the challenge to the pay review, against the kind of power relation between nurses and the government it expresses; but honestly I haven’t experienced too much of a shift in confidence just yet, and this probably reflects the scope of the campaign, and my level of involvement.