Clapped as heroes but
now enduring a pay cut

For the first time in more than 100 years, nurses across the UK have voted to strike over pay and patient safety concerns.

The Royal College Of Nursing’s (RCN) statutory ballot saw nursing staff at 176 NHS organisations vote in favour of industrial action – including hospitals in Sheffield, Leeds, Manchester and Liverpool.

It is anticipated that the first walkout could take place before Christmas, with the mandate to organise strikes running until early May 2023.

Strike action would affect routine services such as planned operations, district nursing and mental health support – but not emergency care, with the RCN following a “life-preserving care” model to maintain safe staffing levels.

Pay is at the heart of the action – research from London Economics, commissioned by the RCN, found that between 2011 and 2021, median weekly pay had decreased by 6 per cent in real terms. 

To address the issue, the RCN is asking for a pay rise amount of 5 per cent above the Retail Price Index measure of inflation.

But the health secretary Steve Barclay has stated that strike action is “in nobody’s best interest” and the proposed pay rise “is simply neither reasonable nor affordable”.

On 17 November, the nursing union called on Barclay to open “formal, detailed negotiations” in the next five days or it would announce its first strike dates and locations for December. 

When the government did not commit to negotiations, Pat Cullen, RCN general secretary and chief executive, said that although meetings with the health secretary had been “cordial”, the union would shortly announce dates for December strikes.

We talk to four nurses about how hard their job is in an NHS under strain and why they want to take action while remaining committed to safeguarding patients.

‘By the end of 2020 I was in total burnout’

Lee, a nurse based in Manchester

“My shifts would feel so intense at times. I would sometimes get to the end of a shift and just feel like the day has been a blur.”

Qualifying in 2019, it wasn’t long before Lee was thrust onto the “relentless” and “overwhelming” world of the Covid-19 wards.

“I internalised a lot of what I saw and carried it with me for a while,” the 39 year old says. “I think this was a coping mechanism.”

Diagnosed with PTSD earlier this year, it was the experience of the pandemic that pushed him towards voting in favour of strike action. His shifts would often run over their allotted 12 hours, he’d frequently find himself without time to eat or have a break and the toll on his mental health was significant.

“By the end of 2020 I was in total burnout and had experienced some traumatic moments. I needed to step away from the wards.

“For me [strike action] is about how we as a collective profession were praised throughout the pandemic but now the pandemic has eased and life is getting tough again with the increased cost of living.

“They forget the nurses, and make out that we are well paid. The sad thing is, I never went into nursing for the money, and certainly didn’t foresee a global health emergency – but it is the profession that I chose and love.”

Having spent many years working in the military, Lee was inspired to become a nurse after he witnessed first hand the care that his grandad received while in hospital.

“I remember sitting with my grandad in a hospital ward and seeing all these wonderful nurses and support workers and thinking to myself I would love to do something as rewarding as that. It really left an impression on me.”

He loves his job and the chance it gives him to “show care and compassion” – but without proper investment, he says, the NHS will stagnate.

“I think the NHS has worked tirelessly. They are thoroughly deserving of an increase in pay.

“In terms of the strikes, the cost of living is obviously a huge factor for me and I believe this is a big reason for others. I also firmly believe that the only way you are going to grow the NHS and improve conditions is investing in nurses through better wages and working conditions.

“I would remind critics of the essential and amazing staff that went to work in a global health crisis at a time when there was no vaccine, at a time where the situation was changing daily. We were clapped as heroes, yet now we are effectively taking a real terms pay cut due to inflationary pressures.

“I personally believe that austerity is not inevitable. I believe that we all deserve a properly funded and staffed NHS, I believe this is something that the public deserve and expect. If we continue to haemorrhage staff in the NHS as we are at present, I believe this will make a difficult situation even worse in the long run.”

‘It’s unfair because it’s unsafe’

Holly Johnston, an oncology nurse based in Sheffield

Holly Johnston describes staffing at her work as a “constant battle”.

“People are leaving and they’re going to go work for jobs with less responsibility and often with more pay,” she says. “They’re getting burnt out really quickly and we’re not replacing the experience.”

As a result, Johnston says, newly qualified nurses are being put in charge of wards before they’re ready.

“They’re stepping up and doing the best they can,” says the 39 year old. “But it’s unfair because it’s unsafe in a lot of ways. You often don’t have all the competencies and capabilities that somebody that’s been there a long time might have.

“I’m not saying that if you’re young you don’t have those skills but it puts people under stress a lot quicker and you end up burning out and leaving.”

In cancer care, she sees the impact of those staff shortages and intense pressures to keep up – waiting lists are still being worked through post-pandemic, the patient to nurse ratio has increased, people are receiving late diagnoses, there’s a lack of beds and speciality staff are being moved to other short-staffed areas.

Having worked in nursing for just over 18 years, she’s seen the work change over the years – once an attractive job with “good terms and conditions”, she now sees her colleagues “struggle to make ends meet”.

“Everyone is picking up agency shifts, and I just think it’s fundamentally wrong that you don’t have enough to live off on your normal hours.”

Having come out of the pandemic with long Covid – something she says is affecting a number of her colleagues – Johnston has had to reduce her hours to better cope with the demands of the job.

“People have not had a break since the pandemic and it’s just relentless. So in terms of morale, the people that are still there are angry or they just leave. People feel really undervalued and just annoyed at how they’re being treated.

“We’ve had clapping and been held as heroes during the pandemic but as soon as you try and better your own pay and terms and conditions you become the enemy. So we’ve seen a lot of attacks in the press and from government about nurses and NHS workers, which is obviously upsetting to a lot of people.”

Striking, she explained, is “a last resort” – but unless pay is prioritised, nurses will continue to leave and the recruitment battle will wage on.

“People don’t make this decision lightly. And it’s more unsafe if we don’t strike. People are dying now. We need a fully staffed workforce to work through the waiting lists.

“We need to invest in the staff so that we can look after everybody else properly. We don’t want to get to the point of striking but the government has repeatedly ignored calls from the NHS that this needs sorting. Hopefully if they got round the table and made a deal with the unions then it wouldn’t get to that point at all.”

Fellow NHS workers turning to food banks

Carmel O’Boyle is a nurse based in Liverpool and chair of the RCN’s North West regional board

“It’s been a horrendous decision.”

Carmel O’Boyle didn’t want to have to vote to strike – neither did her colleagues.

“We’ve all sat and shed tears and I’ve cried with colleagues who have always said please don’t make me go on strike,” she say. “And those same colleagues are saying I’m going to have to vote yes now because there’s nothing else I can do. I can’t see how we can make the government listen to us and we can’t carry on like this.”

A nurse for five years and a healthcare assistant for some 20 before that, it’s a job that she loves.

But, says the 42 year old, the reality is that the workforce is under huge pressures, the industry is struggling to recruit and retain staff, and nurses simply “can’t afford” to work in the NHS.

“I think the NHS has been run on goodwill and cups of tea for a long time. And it’s kind of the will of healthcare workers if you like – we want to make sure our patients are safe and we want to make sure everyone is okay, and it’s that kind of attitude that we just want to do the best for everyone.”

It’s not that the goodwill has run out – but she sees fellow NHS workers turning to food banks, struggling to balance their work and home lives, working overtime for extra cash and to help understaffed teams, worrying about if they’re going to be able to make their mortgage payments or pay their bills.

“You can’t pour from an empty cup. Your nurses are exhausted and they just can’t give more than they’re already giving.

“We desperately need more staff and one of our issues is that our nurses are paying to train and then coming into a profession that hasn’t got an appropriate wage at the end of it. We are losing some of those students to graduate supermarket schemes who are snapping up people with fantastic transferable skills and paying them more for less stress.”

Often described as a vocation, O’Boyle says it’s a “privilege” to do her job – but that she shouldn’t be punished for doing something she loves.

“Whether it’s vocational or not, we are trained, skilled, educated professionals and that needs recognising by the government.

“I think there’s an antiquated idea of a nurse that stands at the end of the bed waiting for the doctor to tell them what to do and makes beautiful hospital corners. That’s lovely but not where the profession is now.

“The profession has moved on massively but our pay scales haven’t. With 12 years-plus of Tory government, austerity and recessions, pay has never kept up with inflation.”

She is keen to stress that if strike action does take place, there will be measures in place to look after patients.

“Yes, there will be disruption and there will be delays. But life preserving care will continue – and, of course, this can be stopped at any time with the government engaging with us. Nobody wants to go on strike so if they just have a conversation with us, we won’t.”

‘Patient amounts have more than doubled’

Katy, bank nurse based in Leeds

Last year, Katy resigned from her substantive post.

“I really did love my job when I first started,” she says. “But one of the big issues now is you can’t do the job properly.

“The first year I qualified, I worked on a ward and you would have six or seven patients to yourself and with a healthcare assistant you would be responsible for those patients.

“Those patient amounts have more than doubled in some areas. In that area I used to work in, it’s now 12 or 13 patients.”

The impact of that workload, she says, is that you cannot complete tasks on time – and in nursing, a task can be as crucial as getting somebody the antibiotics or insulin they urgently need.

“When you’re short staffed and you can’t complete all the things that need doing, you leave late because you’ve left your writing until the very end of the shift. You’re asking for the time back and it doesn’t always get added on. It’s disheartening.

“You get home and you wonder what are the things that I’ve missed? It never leaves you.”

It was working on Covid wards that really took a toll on Katy’s mental health – not enough PPE, out of date PPE, breaks that were either delayed or never came, all the while dealing with the trauma of a global pandemic.

Eventually she ended up taking time off sick, returning for a short period and then handing in her notice.

“The plan was that I could choose what days I was working, how much I wanted to work and generally give myself a bit more time to myself,” she says, explaining why she took a bank position.

And although the work now feels more on her terms and she’s better able to protect her mental health, she’s still returning to an understaffed workplace. Frequently she will be asked to work on a ward that she’s unfamiliar with, just to make up the numbers.

“I got into nursing to do the job properly – to deliver the care that we’re supposed to deliver, to make people better, to give end of life care, to treat people. I can’t deliver that care to the best of my ability now because of the short staffing.

“I just think that when there’s more than 40,000 people missing from your workplace, then the care that people are going to get is not going to be the best. It’s probably not going to be good at all.

“People leave and we’re not filling the gaps. One of the biggest issues is that the people that are leaving are the very experienced staff, the ones that have been there the longest, the invaluable staff that can educate and teach the new generation of nurses – and they’re irreplaceable.”