Nurses’ rejection of pay offer leaves UK government strategy in disarray

Nurses’ shock rejection of an improved pay offer intended to appease them has left the UK government’s strategy for dealing with a damaging wave of public sector strikes in England in tatters. 

Ministers had hoped the deal thrashed out with NHS unions — and accepted on Friday by members of Unison — would pave the way for similar settlements with doctors and teachers, whose unions are holding out for bigger pay awards than Number 10 is willing to concede.

Only on Thursday, chancellor Jeremy Hunt was urging these unions to emulate the Royal College of Nursing, which initially pressed for a 19 per cent pay rise, before negotiating and recommending a much lower offer. But the RCN proved unable to sell that deal to its members. 

The government now faces renewed strike action by nurses and teachers, on top of continuing action by junior doctors whose latest four-day walkout placed intense strain on emergency care and led to thousands of appointments being cancelled.

Matthew Taylor, chief executive of the NHS Confederation, warned that this could make it “almost impossible” to meet Prime Minister Rishi Sunak’s goal of cutting NHS waiting lists. 

So far, there is no sign of any rapprochement between the government and the British Medical Association: ministers insist there is no basis to open talks unless the union abandons its position that a 35 per cent uplift is needed to restore the value of junior doctors’ pay

Nor has there been any move towards fresh talks with teaching unions, whose members last month rejected an offer of a one-off bonus of £1,000 for 2022-23, with a consolidated pay rise of 4.5 per cent for 2023-24.

The government has said the offer is final, but the National Education Union has set dates for fresh strikes on April 27 and May 2 to push for more, as other unions prepare to ballot members with a view to taking their own action. 

Several disputes over civil service pay also look set to worsen, with three unions threatening strikes on Friday in response to government plans for a 2023-24 pay award less generous than those rejected by nurses and teachers.

The toll that strikes are already taking on the public sector was laid bare this week in official data, which showed that stoppages in schools and many government departments and agencies in February checked growth in an otherwise resilient economy.

Service sector output was dragged down by a 1.7 per cent contraction in education and a decline of 1.1 per cent in public administration. In the three months to February, health sector activity was 3.1 per cent lower than in the previous three months.

Hunt told journalists in Washington this week that while this short-term impact was “incredibly regrettable”, there would be a “much longer and more damaging growth impact” if the government gave way to demands for pay awards that fuelled persistently high inflation. 

The bigger issue, though, is that even if the government finds a way to break the deadlock over pay with unions, it will still face a slow-burn staffing crisis across the public sector workforce.

Research published by the Department for Education this week showed that a quarter of teachers in England were considering leaving the state school sector within the next year. Workload was the biggest driver — with full-time teachers clocking up an average of 52 hours per week — but more than six in 10 were unhappy with the pay they received for the work they did. 

NHS vacancy rates have stabilised in recent months, following a sustained drive to recruit nurses and other health workers from overseas, but they remain well above recent averages.

Despite this, a long-term plan for the NHS workforce prepared by the service’s leaders is yet to be published, with the Treasury believed to have concerns about the long-term funding commitment required.

Lucina Rolewicz, a researcher at the Nuffield Trust, said the NHS’ growing reliance on overseas recruitment held risks. In some areas, such as mental health nursing, UK-specific qualifications were required, she noted. In addition, staff who were internationally mobile were more likely to leave and practise elsewhere after a few years in the UK.

“We’re competing in a very competitive global market for medical staff,” she said. 

Meanwhile, researchers at the Institute for Government, a think-tank, calculate that as many as one in four doctors aged between 25 and 34 left the NHS in the 12 months to December 2022.

This could reflect a growing trend for medics to take a temporary break from training after completing their foundation programme, whether to practise overseas or to work in other sectors, but it carries a risk that a growing proportion will leave medicine for good, or settle in countries such as Australia or Canada that offer higher pay and a better work-life balance. 

Nick Davies, a programme director at the IfG, said the impact of NHS strikes had so far been counted in terms of cancelled appointments, but “the harder and more important thing to quantify in the long term is what this does to retention”. 

He argued that the government’s approach to strikes — conceding as little as possible, as late as possible — had exacerbated chronic problems with staff recruitment, retention and morale that were central to the poor performance of public services. 

“Services depend on these staff . . . Ultimately, if they are unable to withdraw their labour or get a reasonable deal . . . they’ll leave the profession or not join it in the first place.”