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For the first time its 106-year history, the Royal College of Nursing (RCN), the UK’s largest nursing union, has voted to take strike action. Nurses in the UK have been on strike before and achieved change, but the scale of this strike is extraordinary.
This dispute, like many forms of industrial action, centres on pay. The salaries of registered nurses and nursing support workers have fallen in real terms by almost 20% in the past ten years. But this dispute is about more than just pay.
The nursing workforce in the UK is under extreme pressure. Over the past few years, the UK has seen a loss of experienced nurses and a population with an increased need for nursing. People are living longer with more multiple conditions and frailty. This has meant workloads have increased and have now become unsustainable. Nurses are compromising on patient care and patient safety, and they find that intolerable.
Nurses are leaving the nursing register at a faster rate than ever before and the English health service has over 40,000 vacancies unfilled. To add more workers to the nursing workforce, employers and policymakers have chosen to take on more and more people without registered nurse qualifications to make up the numbers for the least amount of money. This group has many different job titles but is mainly a support workforce.
Although the support workforce is a valuable addition, it has become clear that in recent years this workforce is being used to substitute for registered nurses. This is not only exploitative, but it also means registered nurses are put under more pressure to supervise their work. Although the support workers deliver care, the registered nurse is still responsible. The evidence shows that it is registered nurses that make a difference to patient outcomes, such as survival – adding more support workers does not have the same effect.
Unlike many other industrial disputes, the media and government ministers are employing moral arguments around the nurses’ strike. These arguments range from questioning the morals of nurses who strike to asking if nurses are deserving of a pay rise. Moral arguments are irrelevant but probably based on the fact that nursing is a majority female profession that has relied on describing its worth in terms of its virtue rather than its expertise. Striking does not fit in with the image of women who serve the needs of others.
Nursing is a competitive labour market, its workers are highly skilled and in short supply globally. This means nurses can choose alternative employment both in the UK (in the private sector) and abroad.
As a workforce and patient safety researcher, I have seen only too clearly how the evidence for safe levels of staffing has not been recognised by governments and policymakers. In Scotland and Wales, there is now “safe staffing” legislation, but this applies only to hospitals in those countries. The evidence for safe staffing and contemporary workforce planning remains robustly ignored.
More expensive in the long run
Poor staffing means poor care – and poor care costs taxpayers more. There has been an increase in the cost of medical negligence in England which reached record levels in 2022 and outstrips the cost of any pay award. Add to this the cost of temporary workers of around £6 billion and the return of investment back into the UK economy (nurses are also taxpayers and consumers) increasing nursing pay doesn’t seem like a bad option.
I support the nurses’ strike if it means their work becomes more valued and hospitals and community services retain experienced nurses. As a taxpayer, a carer and potentially a patient, I can’t afford not to.
Alison Leary is a Fellow and member of the RCN
