Industrial action can have many causes, but there are two responses available to governments – negotiation or confrontation. Which path ministers take depends on a calculation about public opinion. Sympathy with the strikers will encourage compromise; suspicion that their demands are excessive permits intransigence.
Frontline health workers are generally held in high esteem, and the Covid pandemic reinforced national affection for the NHS. That sentiment will extend to support for striking nurses in England, Wales and Northern Ireland, but compassion will compete with anxiety about patient care. Mindful of that balance, the government has adopted a stance of calibrated intransigence, signalling readiness to talk, but not about the main issue – pay.
The government’s offer, a flat rate increase of £1,400 for most health workers, amounts to a real terms cut, given double-digit inflation. The Royal College of Nursing says that its members have suffered a 20% fall in incomes since 2010. The union is asking for a 5% pay rise on top of inflation.
The Department of Health and Social Care says public sector pay restraint is unavoidable in times of straitened national finances, and that the health service has been treated with relative largesse. Those arguments would carry more authority if constraints on the Treasury weren’t a result of the government’s own colossal mismanagement of the economy, and if the public sector was not still suffering from the effects of the last dose of Conservative austerity.
There is little flex in budgets because Liz Truss’s wild fiscal experiments ruined Britain’s credibility on financial markets. And there is less capacity to make do with less in the NHS because its staff have endured stress and falling living standards for years.
Those grievances were set aside during the pandemic – a commitment recognised in ritual clapping on the nation’s doorsteps. But applause doesn’t pay bills, as the nurses’ banners say. Critics of the strike might try to cast industrial action as an abdication of the duty to care, but the greater threat to safety is corrosion of working conditions and staff stretched too thin. Patients suffer most when nurses are forced out of the profession and none can be recruited.
The same applies to ambulance workers, who have also voted to strike. These are workers with a vocation. They know better than their critics what is at stake when they withdraw their labour. That they feel compelled do it is a measure of desperation. It expresses fear of penury and also anger at the state of a health service where government reliance on the willingness of underpaid staff to go the extra mile has turned to cynical exploitation.
Whether the public sees it that way is hard to predict, not least because the mood around strikes and the government reaction will be shaped by disputes in other sectors. A winter of discontent will test the patience of people whose services are withdrawn. It will also compound the growing sense of national stagnation under a government that is weak and directionless.
Either way, the prime minister should not imagine that he can ride out the coming storm or deflect blame for disruptions and stoppages. There is room for debate over the methods by which health workers express their grievances, but little question over where the responsibility lies for a crisis that has been building for 12 years of Conservative government.