Skip to main content

More nursing strikes planned as unions split on pay deal

Published on: 14 Apr 2023

The Royal College of Nursing has announced fresh strikes after its members voted to reject the government’s pay deal, while Unison healthcare staff voted in favour.

Unison and the RCN are the two largest NHS Agenda for Change unions.

The RCN this afternoon said its ballot ”reached 61 per cent of eligible members”, and 54 per cent voted to reject it, versus 46 per cent to accept. The union’s leadership had endorsed the deal, which emerged from pay talks between government and all Agenda for Change unions last month.

However, responding to members’ vote, it today announced “a round-the-clock 48-hour strike without derogations from 8pm on 30 April to 8pm on 2 May”, meaning “for the first time, the RCN strike will also involve nursing staff working in emergency departments, intensive care units, cancer care and other services that were previously exempt”.

The period covers the May bank holiday Monday and the following Tuesday, which is likely to be more disruptive, and may coincide with rumoured further junior doctor strikes. It will take place in all English trusts where the RCN has a strike mandate (about half — see map below).

However, the RCN has also said it will shortly reballot its members to seek a mandate for six more months of strikes. It will hold a single national vote — rather than trust by trust — meaning it will either succeed, or fail, across all of them.

The move to new strike action, before all Agenda for Change union ballots have been completed, was severely criticised by NHS Employers as “premature and disproportionate”.

The RCN’s current strike mandate expires in early May, at which point it would need to hold a fresh vote to continue action.


Unison today announced that its ballot of 288,000 staff — including ambulance staff and lower paid staff such as healthcare assistants — had seen 74 per cent vote to accept the offer, and 26 per cent to reject. Turnout was 53%, with 152,329 votes cast.

Some union officials have said the AfC unions agreed to decide collectively whether to accept the deal, using a weighted formula to combine the results of all their ballots. But the RCN has announced further action regardless.

Unison head of health Sara Gorton, who is chair of the NHS staff side group, indicated that other AfC unions would make a final decision later this month. She said: “Clearly health workers would have wanted more, but this was the best that could be achieved through negotiation…

“Other unions are still consulting so the full picture won’t emerge until the end of the month.”

NHS Employers chief executive Danny Mortimer said: ”There is a mixed picture emerging… We all need to see what the final view is across these trade unions as a whole.

“Whist there is now a period of uncertainty due to the differing responses I would urge all parties to await the completion of the process for all unions this month before deciding what their response should be.

“The calling of further strike action at this stage in the 50 per cent of English trusts where there is a strike mandate for the RCN would therefore be premature and disproportionate.”

The main components of the pay deal which was proposed were: a 5 per cent pay increase for 2023-24; a one-off award of 2 per cent of 2022-23 salary; and a one-off “NHS backlog bonus”, which varies by pay band. The deal does not cover doctors, who are on separate pay frameworks. 

Strike action by all unions took place through the winter but was paused in late February early March when pay talks began.