Home » News/Views » Health unions make progress

Health unions make progress

9 March 2023

Nurses on strike December 2022, Bradford Royal Infirmary, West Yorkshire. Photo Workers.

Despite government bluster, health service workers are now making progress in their pay dispute. On Thursday 2 March the health unions were invited by government to enter formal pay talks through NHS staff council.

In response trade unions representing ambulance and other NHS workers in England have agreed to suspend strike action, at least for the moment. The Royal College of Nursing (RCN) had already agreed to suspend strikes by nurses in return for talks.

Right direction

This invitation will require clarification. The government may think it can defuse action without addressing the causes of the dispute. But it is a step in the right direction which health workers can exploit.

Sara Gorton chair of the union group on the NHS staff council and Unison head of health said “Health unions will need to clarify the basis upon which talks can get underway through the NHS staff council. This includes understanding the status of the unilateral talks that have taken place with the Royal College of Nursing.”

Other unions have taken a similar critical approach in calling off planned action. GMB pointed out that the government announcement represented a big shift and this was due to the action taken so far. Unite sought assurances that the government was acting in good faith with regard to the scope of any settlement.

‘Government has acknowledged that the attempt to deal with one union would founder.’

The government has in effect acknowledged that their attempt to agree a deal with one union, namely RCN, would have foundered. How could they have agreed a deal only with the RCN when many nurses are in other unions? Unison for example has over 200,000 nursing members and students, including large numbers of registered mental health nurses.


And if the government intended to agree a deal with nurses, were they going to ignore other NHS workers? How could there be progress with only one union or one profession?

The union side of the NHS staff council is made up of representatives from the 14 trade unions reflecting the wide scope of NHS workers: British Association of Occupational Therapists, British Dietetic Association, British Orthoptic Society, Chartered Society of Physiotherapy, Royal College of Podiatry, Federation of Clinical Scientists, GMB, Managers in Partnership, Prison Officers Association, Royal College of Nursing, Royal College of Midwives, Society of Radiographers, Unison and Unite.

National pay

One of the major, if less celebrated, steps forward for the British working class in the last twenty years has been the construction of a national pay system for a national health service, our National Health Service. You can’t really have a national service with a fragmented pay system – it is what ‘national’ means.

This national pay system, introduced in 2004, was predicated on what became known as partnership working – reviled equally by both self-styled ‘left’ and ‘right’. But it reflects the fact that there really are only workers in the NHS; not a capitalist in sight.

‘Pay scales were constructed jointly with trade unions.’

The national pay scales were constructed to replace what were increasingly local, antiquated, and shambolic set ups. But importantly they were constructed, not imposed, jointly with trade unions – not with staff individually.

Those who fear or despise organised workers hate this pay system, known as Agenda for Change after its original working title. They have looked for any opportunity to smash it up. Smashing up the partnership working from which it arose would be even better in their eyes.


A lingering weakness remains alongside the positive step of creating a national pay system. This is the Pay Review Body (PRB), appointed by government. It is the antithesis of pay bargaining as it involves supplication to the PRB – in the form of an appropriately entitled ‘submission’ – by the trade unions.

The Treasury, in other words the government, sets the financial remit for the PRB. Yet the government pretends that the PRB is independent and that they have to abide by its outcomes. Other public sector workers, such as civil servants, have similar arrangements. They are a relic of past government attempts to curtail struggle – only surviving because workers have not yet abolished them.

‘Pay reviews are relics of past attempts to curtail struggle.’

Unsurprisingly governments ignore pay review outcomes when it suits them – or they demand job cuts in return. And whenever workers take effective action on pay there are calls to “reform” the system. That’s again the case with the NHS PRB, for example proposals by the Nuffield Trust. Even if well intentioned, these calls ignore the fundamental contradiction in pay review systems and their history of failure.

Only in the NHS have workers effectively countered review bodies and fragmented bargaining with a national pay structure. Backed by industrial action, this should make the review process redundant.

Even the RCN who were instrumental in setting up the PRB in the 1980s are beginning to show some understanding of its limitations. Many RCN picket lines saw placards condemning it. And the RCN’s general secretary referred to the health minister hiding behind the “fig leaf” of the PRB.


The government pitch to the PRB at the end of February was that they would fund only a 3.5 per cent award for 2023-24 because of its “fight against inflation”. It threatened that anything more would reduce public service provision and increase government borrowing.

This attempt to shift the blame for the nation’s financial position to NHS workers was met with derision and opposition from unions. They saw little point in engaging with the review process if the outcome was already fixed. And that’s why the government now entering into direct negotiations represents progress.

‘A possible outcome of the dispute is dismantling the PRB.’

One possible outcome of the current dispute is the dismantling of the PRB and its replacement by direct negotiations in the NHS staff council, in which all 14 NHS Unions are represented. This would be a significant achievement in its own right.


The Agenda for Change national bargaining structure has to an extent also proved resistant to the effects of devolution. Financial control of the NHS was devolved to Scotland and Wales in 1999, but the national bargaining structure is still the reference point for pay awards.

A divided NHS across Britain is, in the long term, not good for NHS workers or their patients, but there is one positive aspect. Recently the Scottish government has chosen to ignore PRB reports and negotiate directly. It’s done so again this year, as has Wales. And all the NHS unions have taken a coherent national approach to the separate sets of negotiations.