Britain’s NHS has never seen industrial action on this scale

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OnMay 2nd health-care trade unions in England finally signed off on a government pay deal. More than 1m workers in the National Health Service (NHS) will receive pay increases of 5% this year—with an additional one-off bonus added on for the previous year. But hopes for an end to the industrial action that has convulsed the health service in the past six months may be dashed. Two of the 14 unions to vote on the deal are still holding out for something better. The settlement does not include NHS doctors. Whatever happens, the strikes have caused over half a million patient appointments to be rescheduled.

That made this wave of industrial action one of the worst in British history. The scale of them would have shocked Margaret Thatcher, the prime minister most associated with union clashes. In 1988 nurses from NUPE, a now-defunct union, organized a two-day strike for better pay. Thatcher accused them of increasing waiting lists and damaging patients. For all the finger-pointing, the Department of Health estimated that on the first day only 2% of all nurses went on strike. Only 200 of 9,000 scheduled operations had to be cancelled.

A quarter of a century on, things are much more severe. The waiting list returned then was below 1m; today it tops 7m (see chart). One of the unions to reject the government’s deal is the Royal College of Nursing (RCN), the main nurses’ union, which in its 106-year-old history had never gone on strike until last year. On May 1st its members concluded a 28-hour walk-out which affected half of English hospitals, mental-health and community services, and obliged nurses to leave the bedsides of their cancer patients. (It would have lasted 48 hours, save for a court ruling that the union’s strike mandate had expired.)

the RCN has vowed to escalate the strikes if it secures the backing of its 280,000 members in a new ballot. Last time around the votes were held on an NHS-trust-by-trust basis. This time, strikes would hit the entirety of the NHSand if there were no resolution with the government, it could last until next winter.

RCN members may yet vote against further action. But their union is not the only one mulling more strikes. On May 2nd junior doctors from the British Medical Association (BMA) were due to meet Steve Barclay, the health secretary, to put to him their own demands for a 35% pay rise to compensate for years of falling real wages. The talks follow the longest-ever strike by junior doctors last month. At the same time, the two other principals BMA occupations, consultants and general practitioners, are also threatening their own industrial action. “The current government has turned a lot of professionals into strikers,” says Dave Lyddon of Keele University.

For the NHS the events of the past few months will have long-lasting consequences. The Department of Health and Social Care has announced that some of the pay deals will be paid for through the “reprioritisation” of existing funds, as well as some additional government funding. That may mean less wiggle room for squeezed trusts, who are already struggling to balance their budgets.

Although a pay bump may help to retain some staff, the contracted negotiations between the government and the unions may also leave a sour taste. “It’s been unnecessarily confrontational,” says Stuart Hoddinott of the Institute for Government, a think-tank. The unprecedented scale of the strikes means that taboos have been broken. When a decision to strike next appears, it will be easier to walk out.

For the government, too, there will be ramifications. Hundreds of thousands of patients have had their hernia operations, knee replacements and the like rescheduled because of strikes. In January Rishi Sunak, the prime minister, urged the public to “hold me to account” if the waiting lists did not fall. That goal looks precarious.