Here’s what the government can do to end the nurses’ strike

Nurses are set to strike for 48 hours later this month, after the Royal College of Nursing (RCN) rejected the government’s pay offer for NHS staff, while Unison, the largest health union, decided to accept it. Unite and GMB are still balloting their members. Meanwhile, junior doctors, represented by the British Medical Association, are continuing with industrial action.

What will the government do now?

In short, nothing. Conservative party chairman Greg Hands and health secretary Steve Barclay have said any government initiative will have to await the outcome of the Unite and GMB ballots, which close on 28 April, and the meeting of the NHS Staff Council on 2 May. The council has responsibility for the Agenda for Change pay system, and has representatives from both employers and trade unions. After that, ministers have these options:

What will happen with the GMB and Unite ballots?

The GMB has recommended acceptance, while Unite has made no recommendation. If members of both unions reject the pay offer. then the ongoing strikes will be more effective, and their negotiators emboldened. If one or both accept the deal, then the RCN and BMA action will be correspondingly less effective. The margins on the ballot results will also be indicative of membership mood.

What will the RCN do now?

In their own words: “We remain in dispute with the government regarding 2022-23 pay, strike action will take place round-the-clock from 8pm on 30 April to 8pm on 2 May. We will also conduct a new statutory ballot for industrial action regarding the 2022-23 and 2023-24 pay offers. We’ll announce the dates and specifics of this postal ballot in due course.” The RCN has also said there will now be no protection for emergency or cancer care in the next strike action, but members will guarantee cover for “mass casualty” incidents.

For how long will the junior doctors stay on strike?

Until the government agrees to negotiate with them. Ministers had given the impression they would not talk to the BMA until it dropped the 35 per cent pay claim and called off strike action, but this attitude now seems to have softened. One possibility is that the arbitration service Acas will be called in next month to provide space and support for talks to end the strikes.

Why does the government seem so stubborn?

Fundamentally, it’s because the whole question of NHS and other public sector pay was supposed to have been de-politicised many years ago by taking it out of collective bargaining and handing it over for independent determination by a series of sectoral pay review bodies, such as for the police, armed forces and so on. Ministers are reluctant to abandon this independent pay review system; they also want to leave things to NHS trust management teams and the unions locally.

However, unions say the government’s terms of reference and submissions to the pay review bodies, which comprise economists and other experts, are loaded and fail to account for adequate recruitment and retention of staff.

Is the public supportive of the strikes?

Broadly, yes. However, any concurrent action by nursing and support staff and by doctors may create some extreme dangers to health, and the public reaction to that is less certain. Such is the wider unpopularity of the government that ministers are liable to be blamed for things that aren’t even their fault; ongoing strikes add to a sense that the government is not in control of events.

What about Labour’s policy?

This is mostly unknown. Wes Streeting, shadow health secretary, complains with some justification that he isn’t in power and is in no position to settle the dispute, not least because neither the BMA nor the RCN are affiliated to Labour. On the other hand, Streeting has said he thinks the doctors’ 35 per cent figure to restore the purchasing power of their salaries is an unrealistic number with which to open bargaining. He has also expressed his concern about the RCN’s removing the usual derogations for emergency care.

What is the effect on waiting lists?

Whatever view is taken of the attitude of healthcare professionals, hundreds of thousands of operations and other procedures have had to be postponed, and many more will follow if strike action drags on through the year. This will inevitably hit patient welfare. For example, early diagnosis of cancer can help outcomes, but strike action will delay some tests; it will also mean performance targets will be missed and Rishi Sunak’s pledge to reduce waiting lists by the start of next year will also remain unfulfilled.

What should Sunak do?

He should calculate the minimum position required to settle the nursing dispute, and move to it as rapidly as possible; that might be on pay, recruitment, staffing levels or some combination of them all. In due course the same will be needed with the doctors at the BMA. The alternative is never-ending NHS disruption that will be mostly blamed on ministers and will destroy the government's slim chances of re-election next year.