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South West and specialist trusts saw biggest strike vote

Published on: 10 Nov 2022

Nursing strike action is planned at nearly all trusts in the South West this winter – compared to less than a third in London, following Royal College of Nursing ballot results, HSJ analysis shows.

In order to hold a strike at a trust, under the “disaggregated” ballot rules, at least half of eligible voters must do so, and at least 40 per cent of the total eligible pool must vote in favour of action, as well as a majority of those who do vote.

The RCN today said it had passed these thresholds at 130 NHS organisations, including 104 provider trusts in England – about half the total trusts – and was therefore planning action at those providers. 

But there are notable trends within this total.

In the South West, action is planned at 19 out of 20 trusts (only Yeovil hospital is not), and in the North West, 63 per cent are planning action. But in London only nine out of 26 trusts (26 per cent) are planning action, and in the Midlands it is 39 per cent (see chart left).

Within the capital, RCN members voted for action at a number of the largest, prestigious teaching hospital trusts acute trusts – including Imperial, King’s, and Guy’s and St Thomas’, and St George’s – whereas those at smaller district general hospital trusts mostly did not.

Several sources said the main barrier for the union was reaching turnout thresholds in each trust, which relies on active branches and local leaders. The RCN was said to be close to reaching the required threshold in a lot of trusts.

One trust director in London told HSJ: “[It] looks like DGHs didn’t get the turnout. Specialists may have a younger workforce who are more immediately affected by the cost of living.” The source, whose nurses are planning action, said managing services through the strikes would be “a complete nightmare”.

A senior source at a trust which did not hit the thresholds for action said: “We are really surprised. We were gearing up for strike action, thought the nurses had a strong case and thought they would vote in favour.

“We’ve been preparing for how we keep the show on the road with strike action going on and being as supportive as possible while ensuring services continue. In some ways we are breathing a sigh of relief, although we hope that [the ‘no’ result] does not mean [there is] not a fair settlement for the nurses.”

Others point to higher staff turnover at trusts in London, particularly compared to movement between more distant providers in rural areas, which makes it harder for unions to keep up to date records for balloting. 

A trust leader in the South West, speaking about its high share of trusts opting for action, noted that the cost of living crisis may have the “impact same as [in] London”, but staff are paid no London weighting. The person added that the “leadership roles of the RCN” are also crucial, and there are “some [union] big hitters in South West who are very visible, approachable and held in high regard”.

Major trusts where members did not reach thresholds for action include Barts, Mid and South Essex, and University Hospitals Leicester trusts, as well as Manchester University and the Royal Free foundation trusts.

The RCN was recommending action over pay and safety conditions. It is the first time the RCN had held a statutory ballot of its members on industrial action across all four home countries in its 106-year history.

Specialists back strike

In terms of trust type, all but three specialist trusts – Liverpool Women’s, Moorfields and the Royal National Orthopaedic Hospital – had staff who voted in favour. The split was more even among community and mental health organisations (see chart right).

These variations may also be partly explained by more long-term and engaged nurse staffing in specialist trusts compared to general acute and mental health.

Beyond provider trusts, just under half of integrated care systems – 20 from 42 overall – saw staff vote in favour, of which many were in the south of England and the Midlands.

Among arm’s length bodies, NHS England’s Yorkshire and the Humber teams voted for action, as did Health Education England nurses in the North West.

The RCN is calling for a pay rise of 5 per cent above inflation, measured by the retail price index.

In response to the ballot results, health and social care secretary Steve Barclay said on Twitter: “It is disappointing some RCN members voted for industrial action.

“We accepted the recommendations of the independent NHS Pay Review Body in full and have given over one million NHS workers a pay rise of at least £1,400 this year on top of a 3 per cent rise last year.

He added that unions’ demands for a 17.6 per cent pay settlement “are around three times what millions of people outside the public sector will typically receive and simply aren’t reasonable or affordable”.

NHSE recently asked systems to prepare for strike action by taking part in “multi-day” exercises to help stress test the service’s preparation ahead of winter.