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The Ward Round: What strikes mean for NHS managers

Published on: 10 Nov 2022

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

The arrangements to cope with strike action that NHS trusts have been preparing under “Operation Arctic Willow” could be needed sooner rather than later after the Royal College of Nursing confirmed this week nursing staff have voted for unprecedented industrial action.

Strike votes were very close in many places, but industrial action is now likely to take place at 130 organisations before the end of the year.

The RCN is the first union to make a move, with the other large players including Unison, Unite, GMB and the British Medical Association either still balloting or yet to begin the process. The other major unions have however voiced robust support for the action, with Sara Gorton, head of health at Unison, declaring the RCN’s results a “loud wake-up call”.

NHS Providers meanwhile urged government to sit down with union leaders and find a solution “as soon as possible”. “Prolonged action is something everyone wants to avoid,” NHSP interim CEO Saffron Cordery warned.

Sympathy for strikers and safety concerns

It is still early days and trusts’ leaders have said they are still getting their heads around the prospect of a strike and working through the potential impact. Kirsten Major, chief executive of Shelford Group trust Sheffield Teaching Hospitals, said ensuring patient safety would be “the paramount consideration”, a view echoed by many.

Another chief executive in the North West, who wished to remain anonymous, said the strikes would “compound the risks of the hardest winter we have ever faced” and added they were in no doubt other professional groups would follow suit.

“We can argue the moral and ethical reasons not to strike but staff are at the end of their tether and feel they’ve already gone above and beyond with a slap in the face via their pay packets as reward,” they added.

Other have echoed a worry about the “obvious risk” to elective care recovery this winter.

Health and Social Care secretary Steve Barclay said he was disappointed at the decision of nurses to strike and said it will result in delayed treatment for patients. But Alison Leary, chair of healthcare and workforce modelling at London South Bank University, said that if the NHS wants “safe, skilled care and [to] retain skilled labour, we have to pay”.

”The fact nursing has tolerated poor pay and conditions for years doesn’t mean [it] always will,” she added.

Which trusts voted for strike and which did not

In our analysis we have tried to unpick why – perhaps surprisingly – nearly all the trusts in the south west indicated they would strike, as well as a number of prestigious teaching trusts in London and specialist trusts, which always perform well in the NHS Staff Survey. Counterintuitively staff at the “worst” trusts to work at have not balloted to strike.

An interesting point raised by an HSJ commenter below the story - the south west has been experiencing severe ambulance delay issues with no respite in sight. They argue, it’s no surprise staff are fed up.

Another theory is trusts with a more engaged culture, visible staff leaders and perhaps more substantive staff, are more likely to galvanise and vote in a union ballot. But this is hard to definitively prove.

Of course, not all staff who vote to strike will necessarily do so and employers might still be able to persuade them otherwise. But considering this industrial action hinges on pay, which is down to the Prime Minister and the Chancellor, leaders are not hopeful the tide can be turned

Local workforce integration gains highlighted

Meanwhile, the Health and Social Care committee session this week heard from Sir David Nicholson, former NHS chief executive and chair of two trusts in the Black Country, among other witnesses to discuss integration within the NHS.

Sir David spoke candidly about the problems faced by the region in the past when competing for staff.

He said his local trusts’ turnover “about ten per cent of our staff a year and most of them are moving to other places in the Black Country”. He described how some staff were offered “inducements” by other trusts, whereas others moved for “justified” reasons.

However, he described how a provider collaborative had been developed in the Black Country which had been “brining clinicians together from all of the various organisations … to mutually support each other”.

The trusts were thinking increasingly about “common approaches” in how they employ their staff in what he said represented a “great opportunity”.

“That would never have happened ten or five years ago… that has big potential for the population as a whole,” he added.

This work ties into NHS England’s desire for a “one workforce” model across local health system and for trusts to become “anchor institutions” within their local communities. Easy for some but much harder for those who haven’t worked together historically.

I’m increasingly noticing examples of systems working together and pooling their workforce, particularly for groups of staff in desperate shortage, such as midwives.

But even if the NHS manages to stamp out internal competition, it may be that increasingly attractive terms and conditions in the private sector (healthcare or otherwise) are too attractive for staff to refuse.