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Striking to lose: problems facing the NHS industrial action

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Note: This article was written before the decision to call off local government strikes by UNISON, Unite and GMB.


 

The media is widely reporting the decision by NHS unions to stage the first strike over pay in 32 years. Contrary to the media reports, this action is not the result of widespread frustration over poor pay deals, but the fact that health unions finally decided to ballot their members for action after 32 years of accepting pay deals. NHS staff have had 4 years of a pay freeze, and the 1% pay offer withdrawn by the government was only the latest in a long line of injustices heaped on NHS workers, including privatisations, cuts and scapegoating for the failures of government policy.

What is different now is the context; the NHS unions are facing both anger from their memberships and a crisis of legitimacy. UNISON, UNITE and the Royal College of Nursing (RCN) have presided over the wholesale destruction of the NHS at the hands of the Tory government. While UNITE has been willing to act oppositionally, backing community campaigns and local demonstrations, the leaderships of UNISON and the RCN have been completely acquiescent to the governments agenda, the RCN even collaborating with the government over the Health and Social Care Bill.

With this legacy behind them the withdrawal of the government's pay offer forced the unions to ballot over pay in order to shore up their credibility, and maintain the appearance of opposition to the government after allowing their members to take a kicking for the last 4 years with no serious attempts at confronting the government's agenda.

In UNISON, every year the pay freeze motions at UNISON health conference calling for action against the freeze have been ruled out of order, kept off the agenda, or voted down following opposition from the union leadership. Its not that members decided themselves not to fight, its the fact that control of the democratic mechanisms for deciding when to take action - ballots - are controlled by the union hierarchy and only utilised when they want it to be.

The RCN has talked about balloting its members but has yet to do so, despite pressure from the membership. Its legacy is gaining nothing for its members from collaborating with the government over the Health and Social Care Bill, missing the opportunity to campaign for mandatory minimum staffing levels in the wake of the Francis Report, overseeing the rise of nurses' registration fees from £76 to £120 in the space of three years, while the registration body for nurses serves as little more than massively expensive and inefficient truncheon in the hands of government. This has resulted in its members being exhausted and burnt out on criminally understaffed wards, with 60% of them looking to leave the job.

The decision finally to ballot has revealed the weaknesses of union organisation in the NHS, and of the do-nothing strategy of the union leaderships.

A potemkin UNISON


UNISON's ballot, while widely reported as showing a two-thirds majority for action, revealed the structural weaknesses of the union organisation following decades of privatisation, and the lack of engagement of much of the membership. UNISON has roughly 427,000 members in the NHS, going on the number of ballots issued in last years HealthSector elections.

The number of NHS workers balloted for the strike was 300,000. Why the discrepancy? 120,000 of those UNISON members work in privatised parts of the NHS, and are not covered by the Pay Review Body decision, and thus not entitled to strike against it. This includes most NHS cleaning staff and a whole host of other ancillary services; patient transport, laundry services, kitchens, hospital security. They constitute the bulk of low paid workers in the NHS. Rather than issue pay claims for those workers and ballot them when those are rejected by their respective companies, a time consuming but completely possible action, UNISON decided to just ballot those covered by the pay review body.

This sends the message to the mass of low paid NHS workers that the union isn't willing to fight for them, it undermines the strength of any action taken and breaks down solidarity between low and high paid workers. If you're the union branches trying to argue that hospitals should stop all non-emergency work to allow more members to participate in strike action, being able to legitimately claim that transport, cleaning and catering are all affected helps that argument. The knowledge that these workers won't be taking action will embolden NHS management.

The turn out for the ballot was also dismal, 13.3% of those balloted, 40,104 of 300,000, voted. Of those who voted, 26,126 voted yes to strike action, and 33,481 yes to action short of a strike. This unfortunately is fairly standard for UNISON. In the pensions ballot in 2011, Unison balloted 750,000 local government workers and 350,000 health employees. The turnout then was 29%.

When UNISON Health rejected the pensions deal offered to UNISON after the strike, turnout was just 14.8% and 50.4% voted no.

UNISON also appears to play fast and loose with membership figures. This statement from UNISON claims 350,000 NHS members were balloted. This is directly contradicted by information elsewhere on the UNISON website and has not been explained. If its an attempt to bolster members confidence or bluff management, its an unprincipled approach, especially when information to counter the claim is available elsewhere on the union's website.

UNISON has declared that their members will only participate in a work-to-rule till the 18th of October, in contrast to UNITE who have declared theirs will run till the 9th November, when there are rumours of another “day of action”. So UNISON's members will only be able to work-to-rule for three days, then its back to work as normal.

This curtails the ability to maintain pressure on the employers, and harms reps' ability to organise an effective work-to-rule. Perhaps its also because UNISON see a deal being reached very quickly following the strike, and the leadership don't want the hassle of ending a work-to-rule, an act which could be unpopular with members if the deal isn't any good.

There is also the question over how much active participation can be expected from members when participation in the ballot is so low, and participation in the union structures is also tiny.

In last years National Executive Committee election, out of roughly 300 branches, just 69 submitted nominations for the elections. Turnout in the vote was 20,883, just 4.7% of the total membership.

This raises questions as to how active are the majority of Unison's branches, and how engaged are the membership. If there is to be the type of strike action we need to win even the 1% the government withdrew, we will need to take recurrent and sustained action. Without an engaged membership organising and taking a lead, this won't be possible.

The anti-trade union laws stipulating ballots-via-post and other onerous conditions are part of the problem, detaching decision making and control of disputes from branches and the workplace, leading to disengagement by the membership. Also UNISON's terrible internal bullying culture encourages disengagement lest activist members incur the wrath of officials who witchhunt and victimise them.

Facing all these problems, its questionable whether UNISON could pull off sustained, effective strike action. Massively disengaged membership, low levels of activism, division of membership between NHS and privatised services, are all  not easily solved, and there are few signs that UNISON is taking any steps to rectify them.

Minority unions

Both GMB and UNITE have members in the health service, but they are “minority” unions. Unite has roughly 100,000 members in the NHS, the GMB 22,000. Unite's ballot result was 62% in favour of strike action, 77% in favour of work to rule in England, with slightly higher results in Northern Ireland. They have not released the turnout. The GMB had a 78% vote in favour of strike action, and 91% in favour of action short of a strike. Turnout has not been released either. These are promising results, but given the possibility of settling and calling off strikes already being raised in Local Government, if UNISON decides to settle in health, its doubtful either union would stay out on their own.

The Royal College of Midwives also voted for the first time to take industrial action. It is positive that all the unions will be acting together, and hopefully some links between union activists on the ground can be built. We have been in this situation before though.

In 2011 all unions in the public sector went on strike for a day against pension reforms. Within three weeks UNISON's leadership had decided to accept the government's slightly improved offer, and called off the strikes. All other unions eventually pulled out as a consequence. When UNISON Health members were balloted to accept the deal months later, they rejected it by 50.4% on a 14.8% turnout. With a weak mandate, and a demoralised, disorganised membership unable to enforce the decision due to the months spent “consulting” along with the drawn out ballot process, UNISON's leadership declined to act on the rejection, and the pensions dispute was declared over.

Sold out, sold short

There is already the danger of our strike being sold short. A paltry pay offer has already been made by the government to Local Government workers. UNITE and GMB wanted to consult members on this non-offer but it was withdrawn by the employers as UNISON rejected the opportunity to consult members. I imagine there will be a similar offer made to NHS workers after the strikes. If turnout on the day is not strong, and members and branches are not pushing for more action, the unions could quite easily do what they did in the 2011 pensions dispute, accept a slightly better (or simply not as bad) offer, and call off action while members are consulted over whether they accept it. These consultative ballots take months to arrange and organise and the energy and organisation built up in the run up to the strike will be frittered away campaigning for a rejection.

Even where members do reject an offer, this is no guarantee the strike will be put back on. None of the democratic lay bodies of any of the unions have enough pro-strike members to push through a vote for more action against the will of the leadership. The only thing that will potentially keep action on the agenda is consistent campaigning activity at the base of the unions; members holding workplace meetings, organising an effective work-to-rule and maintaining pressure on the leadership to act by passing resolutions, writing to officials and keeping support for the strike going.

A short strike, a long campaign

The strike is limited to 4 hours, from 7am to 11am. The short time of the strike may encourage attendance as members don't need to lose a whole days pay, but anecdotal evidence from reps has some members saying they may not bother striking as 4 hours is not serious action. It doesn't represent the scale of their grievance with the government, and they don't expect it to win anything.

While all members should respect the democratic vote of the members and join the strike, the reality is with a demoralised and disengaged membership, appeals to principle are not enough. If we are to get members to respect the vote and not cross the picket, there needs to be action worth taking, a pay deal worth fighting for, and a strategy to win. Without these things members will not be convinced of the necessity of action and appeals to working class and trade union principles, when class consciousness is at a low, will not be enough to secure a good turn out.

We need proper strikes, Twenty four hours not four hours. Escalating action, one day, then two, then three over the next three months would put pressure on the government, and now is the time to do it in the run up to an election.

A decent pay claim, 11%, equivalent to what MPs gave themselves would give members something to fight for, and be easy to justify and popularise to the public. Any counter arguments that this is a time of austerity can be met with the mountains of evidence that there is plenty of money to cover pay in the NHS, if the market mechanisms, costly privatisations and extortionate PFI are dismantled, renationalised and cancelled respectively.

Our union leaders need to stop worrying about embarrassing the Labour Party and Ed Miliband, and start fighting for their members. The unions need to offer a positive vision of what the NHS could be if the government's policies were reversed and a democratically run, publicly owned, and well funded NHS was rebuilt, and make the fight for pay part of a fight for that vision of the NHS.

We don't control the machine

One serious problem we face is the inability of branches to call action, and corresponding disengagement of the membership from branch activity. The ability to ballot is held by the unions' regional and national structures, not by branches. This means branches are reduced to lobbying and pressurising these leadership bodies to allow them to vote for action, which is nigh on impossible given the lack of involvement from the majority of union members.

Union activists need a wide ranging discussion to develop a strategy to re-engage our members, revitalise branch organisation and give branches the ability to credibly pressure the union machine for action. This should be tied with a serious examination of how we democratise our unions, and campaign for the repeal of the anti-trade union laws. These laws force unions to adopt these onerous balloting methods and curtail the memberships' ability to exert control over the union and their own industrial action. Until they are repealed, or rank and file members find innovative ways to overcome them, they will be a serious obstacle to the sort of industrial action we need to win.

What can we do now?

While on the pickets tomorrow, arguing for further action, and getting support for resolutions through reps and branch meetings is a must. Make sure workplace meetings happen this week to plan and coordinate the work-to-rule for the next several weeks. If possible a weekly meeting should be called to see how members are implementing it in each department. This will allow people to raise difficulties, and identify any managers or departments which are resisting it or hassling members so they can be spoken to and the members supported.

Management have already been caught planning to undermine the strike even though it is only four hours long. They will be working to minimise the effectiveness of any work-to-rule, so we should be prepared.

In a previous article I detailed some imaginative ways the work-to-rule could be implemented to reduce pressure on staff, and develop organisation among members. Hopefully this will spark further discussion and responses. I believe we need to fully face the situation we are in, look at all the inadequacies of our union organisation and politics, in order better understand how to create a viable plan for getting ourselves out of it.

A number of single issue campaigns are developing which may be useful for engaging members and drawing them into activity in the longer term, and could form the basis of joint campaigning work between union branches around the country:

The 4:1 campaign works to highlight nurse understaffing in NHS services, and pressure the unions to campaign for mandatory minimum staffing levels, as is the agreed policy of UNISON and RCN.

Docs Not Cops is a coalition of health workers, migrants groups and other activists which is fighting the effects of the Immigration Act on the NHS, and oppose the racist charges it seeks to impose.


A cross union rank and file meeting has been called by a number of trade union activists in the public sector. It will take place on November 8th at the Indian YMCA, 41 Fitzroy St, London, UK W1T 6AQ and run from 12 noon to 5pm. This will be an opportunity for health trade unionists to meet and discuss the strike, the effectiveness of the work-to-rule, what our various leaderships are planning, and where we go from there.

See also: How can we save the NHS? which is available as a pamphlet. If you would like to order copies for your workplace, union branch or campaign group please contact This email address is being protected from spambots. You need JavaScript enabled to view it.