On 15 and 20  December, 100,000 nurses in England, Wales and Northern Ireland (United Kingdom) went on strike and with two more days of strike action planned for later in January in England. This is the first time in the 106-year history of the UK’s biggest nursing union, the RCN (Royal College of Nursing), has done this. Simply put: 44 out of 219 NHS trusts (hospital groups) in England, six out of seven health boards in Wales and all six trusts in Northern Ireland were affected – including Gloucestershire Hospitals NHS Foundation Trust, where I practice clinically in Emergency Medicine.

In July 2022, the UK government accepted pay recommendations in full from the independent NHS pay review bodies. This meant, that for more than one million NHS workers, including nurses, paramedics and midwives, an offer of a pay rise of £1,400, which equated to a pay rise in the lowest earners of 9.3%. For senior nurses, they were offered a pay rise of 4%. It was stated that this increase recognised the contributions from NHS staff while balancing the need to protect the taxpayers, manage public spending and not drive inflation.

Unfortunately, inflation has continued to increase due to a variety of reasons, including the on-going conflict in Ukraine and of course the continuing effects of Brexit. That with a combination of a seven-year public sector pay cap which ended in 2017, meant that nurses real-term pay fell by 20% according to the RCN.

This has now led to the RCN requesting a pay rise of 5% above inflation, the equivalent of a pay rise of 17.9%. It has been turned down by the UK government on the basis that it is unaffordable. This has led to the strike action.

National derogations agreed and agreed again

The RCN has agreed several derogations, initially for acute services—covering critical care, chemotherapy and dialysis. However, ongoing negotiations with the NHS CNOs, this has now been extended to include mental health, palliative care and other urgent interventions, such as insulin administration in the community.

Life-preserving treatment must be provided, however more routine care will be disrupted. This includes planned operations such as hip and knee replacements, community nursing services and health visiting. Hospital appointments will also be affected because for those areas affected, the level of service will equate to that of cover on the Christmas day or night period.

Hospital doctors, General Practitioners (family doctors), community pharmacies and dentists were not affected, and citizens could access these services as normal.

It’s no secret that healthcare organisations across the United Kingdom are strained and this is playing a significant role in the decision to strike. It is important that as demand for services grows, we all evolve along with it. In these times, when organisations are trying to meet the needs of their caregivers and patients, it is clear that this issue is one that demands full attention until a resolution is found.