A Nurses-eye View From The Picket lines

On packed picket lines up and down the country, NHS nurses are once again taking action that until very recently would have seemed impossible, and finding massive support for doing so. As the government belligerently refuses to negotiate, colleagues from physiotherapists to doctors greet us warmly as they too prepare to down tools and join us. Passers-by continue to honk their horns in support. Members of the public brave the weather to bring much needed supplies of coffee and cake, to share a song, a laugh and their own stories of struggling to get by.

It cannot be overstated just how extraordinary all of this is. The Royal College of Nursing has never before called a nationwide strike in its 100 year history. Indeed, until the mid-1990s the RCN was constitutionally opposed to industrial action. Ambulance workers are taking part in the biggest strikes since Thatcher took on the paramedics in the dying days of her administration and lost.

How did we get to the point where NHS workers, traditionally less organised and more reluctant to take action than most, are participating in some of the largest and most disruptive strikes of the current mini-wave?

If we listen to the government and both its supporters and detractors in the media, the reasons ultimately boil down to two things: Covid and Putin. This is extremely convenient for the Tories, as they can by and large get away with claiming neither is really their fault–the catastrophic handling of the pandemic and aggressive NATO posturing notwithstanding. The argument is by now tediously familiar to everyone from GB News viewers to Guardian readers. Covid created a huge backlog in non-Covid healthcare and the subsequent return to normal economic activity increased demand and pushed up global prices. This, along with the invasion of Ukraine, has led to double-digit inflation, eating into budgets including that of the NHS.

However, the roots of the present situation are both older and deeper than this convenient, superficial analysis would have us believe.

I, like many nurses, still vividly recall working through winter crisis after winter crisis in the years before the pandemic, including 2017-18 when the International Red Cross declared a humanitarian emergency in a healthcare system that not that long ago could truly claim to be the envy of the world.

During the height of the Covid pandemic I first became familiar with the term ‘moral injury’. Used in this context it describes the psychological and eventually physical effects on healthcare workers of repeatedly being exposed to suffering and death that, despite their best efforts, they could do little about. Looking back this phenomenon has existed at least for my entire nursing career. A common refrain in break rooms and now on picket lines is that staff are exhausted, burnt out and demoralised because day after day and night after night they are simply unable to provide the levels of care that they aspire to.

As time goes on, as the effects of years of austerity manifest, as the NHS slips down international tables on every measure, the level of care that can be provided falls further, and the moral injury worsens. Meanwhile the government can claim, truthfully, that it is spending record amounts on health (in cash terms, not in real terms per capita, the only measure that means anything), and an avalanche of preventable and unnecessary human suffering has led, before the pandemic, to the first drop in life expectancy since the second world war.

Since the 80s, pay for 2.5 million public sector workers, including NHS staff, has considered to be based on recommendations from ‘independent’ Pay Review Bodies. Every year a panel of ‘experts’ appointed by the government and drawn from the world of senior management and HR consultancy, provides ministers with recommendations on pay. These are based on submissions from employers, trade unions and, crucially, a remit that includes the overall budget set by the government. On several occasions in recent years, and indeed in the case of other PRBs in 2022, the government has not accepted their recommendations, which have in any case never been binding.

And yet the government line, learnt by rote and repeated by everyone from the PM to whichever poor unfortunate Junior Minister for Paperclips has to face the cameras, remains the same: we cannot override the Pay Review Body. Never mind that they did it last year in the NHS, or this year in two other cases, a point that they are surely grateful never seems to be put to them. In one sense the government is entirely right to say that even restoring NHS pay to 2010 levels is unaffordable. In fact, the cost is earth-shattering. It would cost them an economic orthodoxy that lifts caps on bankers’ bonuses and fails to tax wealth whilst Victorian diseases of poverty rear their ugly heads and people freeze in their own homes. It would cost them their jobs and their power.

Because we have not seen this level of strike action in over 30 years, and because of distortions and outright lies across the whole political spectrum of the media, there is a lack of understanding about what these strikes entail. This is amplified in the NHS as the action is in many ways unprecedented. No colleague I have met has any experience of going on strike.

The public have been led to believe that well-paid people seeking enormous pay rises are going to walk out and let people die, and yet despite this constant barrage of misinformation most news outlets have struggled to find patients opposed to the strikes. There are hilarious and heart-warming clips of BBC interviewers desperately trying to get patients seriously inconvenienced by strikes to condemn workers and failing abysmally. I invite you to watch them if you are ever feeling despondent and need to be reminded that 99% of us are on the same side.

In theory, our strikes are not “all-out” and picket lines are not about trying to stop all colleagues from crossing. Local strike committees agree ‘life and limb’ cover with employers and release a certain number of union members from striking to provide these services. In practice, this means on inpatient wards, where I work, ‘safe staffing’ levels are agreed that are higher than what we have on non-strike days, an admission that patients are not usually safe. Often, staff who are opposed to the strike and not members of the union fill those numbers anyway, but the union will ‘derogate’ members (release them from striking) if needed.

On the picket line, I have spoken to paramedics who say 75% staffing levels have been agreed, with strikers ready and willing to be called back by the union in case of emergency. Locally, they had the best response times in months. While I was there a member of the public had a seizure on a bus next to the picket line and received the quickest and best staffed attention anyone has ever seen as twenty paramedics co-ordinated a response.

Outpatient and non-emergency care is inevitably delayed. This can be very serious, as people will have delayed diagnoses and increased anxiety, or wait longer for treatments that would alleviate pain. However, all of us as patients are experiencing this slow collapse of the system already, and much to the chagrin of the government and media, people know that the failings in their care are due to Tory negligence and that workers are fighting not just for fair pay, but for a better NHS. Our resolve is only strengthening as it becomes clearer that what is needed is investment beyond anything countenanced by the political class and a radical overhaul of health and social care to achieve a true cradle-to-grave public service.

In the atmosphere of shared power brought about by collective action many will begin to wonder what other impossible things they can make happen. How about union leaders more concerned with empowering their members to fight than defending their own sectoral privileges? A Labour Party worthy of the name? Industrial action that not only seeks to defend workers from attack but to actually advance their interests further? Action that brings workers facing similar struggles together and uses the strength in numbers they are starting to witness to actually win? Perhaps even to hear spoken aloud those two words that are still only mentioned in hushed tones on the fringes of TUC meetings: General Strike.

Already rank and file pressure has forced all 14 health unions to collectively refuse to engage with this year’s pay review board. The government’s latest anti-strike legislation is provoking a coordinated and escalating response. Indeed, in threatening to preclude the possibility of lawful action, it may yet lead many into open revolt. For the ruling class, what nurses and other NHS workers are fighting for is dangerous: a country in which you can expect to receive excellent and timely medical care whenever you need it, where social care needs are met, where transport is affordable and reliable, where Uber-isation does not replace a universal postal service, where heating and eating is a right and not a privilege.

Our demands most moderate are: we only want the earth.

Here at Organise magazine we actively encourage contributions from all folks struggling for a better world. Not just the circle of anarchist communists we already agree with. We like to print these with as little editing as possible, which does mean we don't always agree with all the political content, but recognise the value and usefulness and support most of it.