Founded in 1916, the Royal College of Nursing (RCN) can lay claim to be the world’s largest trade union centered on nurses. With 435,000 members in the United Kingdom — from registered nurses and midwives to health-care assistants and nursing students — today it’s wielding its strike prerogative for the first time in its 103-year history. It’s made this choice in far from ideal circumstances — and yet with the National Health Service (NHS) under pressure, the decision for defensive action comes not a moment too soon.
On November 7, after a ballot lasting four weeks, nurses in Northern Ireland voted in favor of industrial action set to commence on December 3. After four months of abortive negotiations with Northern Ireland’s devolved Department of Health, the consensus was nigh on unanimous. Some 96 percent of those who took part voted in favor of industrial action; 92 percent voted for a strike.
But why take action now, right on the cusp of a period when the health service faces its busiest time of the year? It’s a textbook case of critical mass in action. Indeed, for the Department of Health, the writing isn’t so much on the wall as it is scrawled across every bedless ward and overstretched waiting room throughout Northern Ireland.
With the health service operating under a 12 percent staff shortfall, the three thousand unfilled nursing posts have put an unworkable strain on health-care professionals across the board. This shortage has only aggravated preexisting issues like spiraling waiting lists (nearly 300,000 people — approximately one-sixth of the population — are on a waiting list for a first appointment with a consultant), emergency room waiting times (the number of people waiting more than twelve hours at emergency rooms has doubled since last year), and bed shortages (the average number of beds dropped by 250 over the last five years — 4.1 percent of the total). And that’s only grazing the surface.
The evincible right to pay parity has propelled many strikes since the dawn of modern nursing in the early 1900s — and we have already seen such strikes in Chicago and the Republic of Ireland in 2019. Beyond the more entrenched issues mentioned above, nurses in Northern Ireland also have a clear-cut case over pay: after all, they’re the lowest paid in the UK. While a registered nurse in Scotland at the bottom of band 5 earns £24,670 a year, and those in the same position in England and Wales take home £24,214, nurses in Northern Ireland earn £22,795. RCN has itself highlighted the negative repercussions of such inequality — it insists that pay “is a central factor in the recruitment and retention of nurses and has therefore directly helped to create the current nurse staffing crisis in Northern Ireland.”
Bearing the Brunt
Recognizing the need to address this problem, RCN isn’t alone in taking direct action. On November 11, health staff and social workers in Northern Ireland represented by UNISON — the UK’s largest union, representing around 25,000 workers in Northern Ireland’s NHS — also voted overwhelmingly for industrial action. With millions being misspent on short-term agency staff (the equivalent of putting a Band-Aid on a bullet wound) the union has stressed that nurses are no longer prepared to accept the lowest pay levels, greatest number of frontline vacancies, and highest waiting lists in the United Kingdom.
UNISON Northern Ireland regional secretary Patricia McKeown said:
Health workers don’t take industrial action lightly, but they’ve been pushed to the brink. Responsibility for averting this situation lies with the Department of Health, the head of the Northern Ireland civil service, and the Department of Finance. They must access the funding necessary to resolve the pay problem and start addressing safe staffing levels as a matter of extreme urgency.
To grasp why the strikes are not just unprecedented, but important to every patient and health-care professional in Northern Ireland, we only need to look at the current political impasse, which has worsened. Indeed, come January, Northern Ireland will have been three years without a functioning devolved government, after its main parties (Sinn Féin and the Democratic Unionist Party) spurned hard-won power-sharing over differences relating to abortion rights, same-sex marriage, and other issues. Without a sitting government — and thus an actively concerned health minister whom they can formally negotiate with — Northern Irish nurses have found themselves shouting into the void. Spearheading sweeping changes in any system can seem ambitious at the best of times. But attempting to speak up and be heard amid a wider political vacuum? That’s a different kind of commendable.
Of course, nurses put their patients first and foremost, and their action reflects this fundamental altruism. Ahead of industrial action — including a full walkout on December 18 — they are refusing to carry out work-related tasks that are not patient-specific. Working unpaid hours, admin tasks, and completing paperwork other than individual patient records are among the eleven jobs that they will refuse to do ahead of the strikes. As with strikes and protests over health care in France, New York, and elsewhere this year, these professionals are making a very clear statement: safe staffing and fair staff contracts are indivisible from the wider need for stable and sustainable patient care.
Nurses and patients are quite literally in it together. RCN’s Pat Cullen spelled it out:
The 3,000 nursing vacancies that currently exist are having a detrimental impact upon patient care and adding enormous pressure to the existing nursing workforce, who are doing everything they can to care for patients. Nurses are no longer willing to see patients being denied the health-care services to which they are entitled.
The barely functional Department of Health claims to be “focused on finding a way forward” in finalizing a formal pay offer for 2019/20 (“This will be the best offer possible within the budget available,” they said). But the proposed strikes — which are scheduled from early December through March — look certain to go ahead.
Bearing the brunt not only of the fallout of Brexit uncertainty, but the literal falling out between Northern Ireland’s main political parties, nurses can no longer simply warn of the impact of staffing shortages and inequality. It’s time to take action. Despite the short-term increased risk to patient safety over the coming weeks, the sheer strength of the consensus among medical staff mirrors a much broader reality of collective selflessness. After years of bubbling under the surface, this direct action is neither knee-jerk nor ill-considered. It’s timely and essential, and it deserves unequivocal support.