This is a fast-moving topic and information should be read as correct at the time of publication.

Why are NHS workers striking?

In July 2022, the Government announced a 2022/23 pay offer for NHS workers, which would be backdated to April 2022.

Trade unions representing some NHS workers rejected the offer. Unions noted the increase in pay amounted to a pay cut in real terms and argued that it was too low in the context of the rising cost of living.

Union members also said health workers want to improve patient safety, which is being compromised by inadequate staffing levels and staff burnout. They were also concerned that people will be reluctant to join the NHS or stay in their jobs without better pay, exacerbating existing staffing problems.

Trade unions asked their members to vote on whether to take strike action. Unions must meet the thresholds set out in law to secure a strike mandate.

What were NHS workers initially offered?

NHS staff are split into different groups when it comes to pay, terms and conditions. Most NHS staff, except doctors, dentists and senior managers, are paid on a scale called Agenda for Change (AfC). The AfC scale is made up of payment bands from 1 (lowest) to 9 (highest). Many newly qualified clinical professionals, such as nurses, start at band 5.

Independent pay review bodies representing the staff groups make recommendations to the Government on pay for NHS staff based on a review of evidence from employers, unions and the Department of Health and Social Care. The Government makes the final decision on whether to accept the recommendations.

In July 2022, based on the pay review bodies’ recommendations, the Government announced the following pay awards, backdated to April 2022:

  • Doctors and dentists received a 4.5% increase in their salaries.
  • Employees on the AfC scale received a £1,400 permanent increase to their full-time equivalent salary (not a one-off payment), backdated to 1 April 2022.
  • Staff at the top of band 6 of AfC, and those in band 7, received a further enhancement to ensure their pay increased by at least 4%.
  • For staff in bands 1 and 2, the increase of £1,400 was in addition to National Living Wage adjustments.

Strike action and negotiations

Nurses and midwives

Members of the Royal College of Nursing (RCN) in England took strike action in December 2022 and January and February 2023. A further 48-hour strike planned for March 2023 was suspended when the RCN and the Government entered into “a process of intensive talks” on 22 February 2023, later joined by the other health unions.

A further strike took place from 30 April to 1 May 2023 (see a list of NHS trusts affected) after members of the RCN rejected a revised pay offer from the Government (see below).

The strike was planned to take place over 48 hours. However, on 27 April, a High Court judge said the RCN’s six-month strike mandate would have lapsed by Tuesday 2 May, so the strike was required to end on Monday 1 May.

A ballot of members of the Royal College of Midwives in England following the July 2022 pay award did not achieve a strike mandate.

Allied health professionals

Some unions representing allied health professionals on AfC contracts voted to carry out industrial action in response to the 2022/23 pay award. Some unions, such as the Society of Radiographers did not proceed with a formal strike ballot.

Members of the British Dietetics Association (BDA) and the Chartered Society of Physiotherapy (CSP) in England voted in favour of industrial action and the CSP began rolling strike action in January 2023. Both unions suspended strikes planned for March 2023 as they joined pay talks.

The British Association of Occupational Therapists and Managers in Partnership are represented by Unison (see below).

Other health unions

Unison, Unite and GMB Union represent members working across the health sector on AfC contracts, including ambulance workers, nurses and technical staff.

Members of the unions took part in strikes affecting NHS trusts across England in December 2022 and January and February 2023. Some strikes planned for March 2023 were suspended when the unions and the Government entered pay talks.

Members of Unite went ahead with local strikes at ambulance trusts and hospitals in England as planned on 1 and 2 May 2023, with more strikes planned for June.

Doctors and dentists

In January 2023, junior doctors in the Hospital Doctor’s Union (HCSA) voted in favour of strike action in England. In February, junior doctors in the British Medical Association (BMA) in England also voted for strike action in a national ballot.

Members of the unions took part in a 72-hour national walk out on 13–15 March 2023, followed by a further 96-hour walk out on 11–15 April 2023.

Hospital trainee members of the British Dental Association also voted in favour of industrial action at a number of trusts in England, where they joined the junior doctor’s strikes.

A further strike by junior doctors is planned for 14–17 June.

Senior hospital doctors in the BMA indicated they are prepared to take strike action in a consultative ballot in February 2023. A ballot to decide whether to take action, due to take place in April, has been postponed to 15 May following “constructive talks” between the BMA and the Treasury.

Why aren’t all trusts affected by strikes?

Under the Trade Union Act 2016, for a strike ballot in “important public services” to be valid there must be a 50% minimum turnout and at least 40% of all eligible members must vote in favour.

Under Trade Union laws, unions can ballot members at individual workplaces or organise aggregated ballots of staff who have common terms and conditions. This means the thresholds can apply to trusts or nationally, depending on the ballot.

What was the new pay offer?

In March 2023, following industrial action, the Government made a revised pay offer to employees on the AfC scale in England for 2022/23 and 2023/24, consisting of:

  • A one-off, non-pensionable payment for 2022/23, on top of the 2022/23 pay award, including two elements:
  • a payment equal to 2% of salary for all staff
  • a tiered “backlog bonus” payment for all staff, depending on the tier (average value of 4%). Tiers are groups of AfC pay bands, for example tier 1 includes pay bands 1–4.
  • A pay-rise of 5% in 2023/24 for most staff and 10.4% for those at band 1 and 2 entry points.
  • A series of “non-pay measures to support the workforce”, including challenging recruitment and retention issues in nursing and reviewing the process for setting pay.
  • Unions representing junior doctors have been in negotiations with the Government. On 22 May the BMA said the Government made a final offer of 5% but this is “simply not a credible offer”.

    Which unions voted to accept the new offer?

    Unions representing staff on AfC contracts asked their members to vote on whether to accept the revised pay offer. Members of the following unions voted to accept the offer:

    The Federation of Clinical Scientists has not published the results of a pay consultation.

    Members of the following unions voted to reject the offer:

    What happens next?

    The NHS Staff Council has responsibility for the AfC pay system and includes representatives from NHS employers and trade unions.

    On 2 May a majority of representatives from AfC trade unions voted to accept the revised pay offer in a meeting of the NHS Staff Council. The voting is reportedly based on an electoral college system, whereby each union’s vote is weighted to reflect the size of its membership, but details of the process and how weightings are determined are not publicly available.

    Health Secretary Steve Barclay issued a statement saying he will implement the pay offer and NHS staff will receive their extra pay from June 2023. Information about eligibility for the pay deal, including for bank staff, can be found from an FAQ page by NHS Employers.

    The Royal College of Nursing is holding a ballot on industrial action in England, it will close on 23 June.

    Further strikes for June are planned by members of Unite.

    The Society of Radiographers has written to the Health Secretary requesting urgent talks, but will ballot for industrial action if a “positive response” is not received.

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