GMB organiser Helen O’Connor analyses the state of the NHS and the lessons to be learnt from the GMB ballot for trade unions organising health workers

As the NHS trade unions analyse GMB’s ballot results, which unfortunately didn’t meet the threshold for strike action, it’s important to draw lessons for the future, because attacks on the health service are not going away. Staff will continue to be affected by the ruthless drive to defund the NHS, carve it up, and farm it out the highest bidder.

The NHS is still a long way from being the poorest persons’ dumping ground that uninsured people get in America, but be in no doubt that the Tories will utilise this pandemic to drive their cuts and privatisation agenda, and attacks on pay, terms and conditions will be ramped up further. There is still much to defend and protect before we end up completely losing the free healthcare previous generations fought hard for.

The Health and Social Care bill, now due to become law, will give private companies greater powers to take over core care services. GMB Members, recognising that privatisation has an adverse impact on their own pay and conditions, have already taken successful strike action against being outsourced, and it won’t be long before this necessity will arise again.

There were factors that made winning this particular ballot very difficult. When the mood was high to struggle for a 15% pay rise, the conservatives deliberately delayed the 2021 NHS pay offer in order to kill momentum, and their strategy had some success. Delays in channelling anger into collective trade-union action poured further cold water over the prospect of successful strike action on NHS pay at this stage.

Barriers to victory

Although many NHS workers were bitterly disappointed to learn that the 3% pay rise was a pay cut, union visibility in workplaces, with the key factor being the lack of reps on the ground, was not sufficient to convert that disappointment into a desire to vote for strike action.

The overall lack of co-ordination across all of the NHS trade unions, who were split on the question of whether to go straight to a legal strike ballot, caused confusion amongst workers and served to further erode confidence.

All trade unions are up against the type of grinding anti-union legislation that makes achieving a successful strike ballot result difficult even in highly organised workplaces. However, health trade unions must avoid the danger of these laws becoming the main focus of our activity, because this would create a climate of uncertainty and hesitation that can have a negative impact on overall confidence to take part in the collective struggles that will become necessary in the coming period.

Failing to get over the line decisively in the NHS ballots has exposed weaknesses in both union structures and strategy that must be rectified through honest discussion and hard work, if we are to be ballot ready in the coming period. It is counterproductive to blame members for not voting in ballots. Campaigns need to be driven in workplaces, and messaging about the relevance of voting must be delivered via large networks of union representatives who have the trust and confidence of the NHS workforce.

However, it would still be a mistake for the political establishment to think that they can forever rely on the emotional blackmail they always use to keep NHS staff in work, because most unions have noted an upswing in member participation, as NHS staff slowly start to engage in collective trade-union activity.

Having only one isolated and overworked rep per NHS trust simply isn’t sustainable, and won’t enable us to organise properly. It is reps who have the hundreds of face-to-face discussions that persuade members to vote in ballots, and this will always be far more effective than the involvement of the regional officials.

Organising progress

Following the fantastic NHSPay15 campaign, we have gained an influx of good activists into the health trade unions. These new activists will need to prioritise organising their own workplaces, in order to gain the industrial experience necessary to lead future NHS strike ballots. They will require support, training, and further development in order to develop into workplace leaders and withstand some of the anti-union bullying that is still commonplace across the NHS.

And we will need to identify many more activists who are genuine spokespeople for their workplaces to organise the NHS properly. The activists will be found not just amongst the clinical staff, but also amongst the most oppressed layers of NHS staff. And these potential reps will encounter the biggest barriers to getting involved in the unions. They will be the workers on temporary contracts, the migrant workers, and young, working mothers. Building networks of these activists will be the key to winning future ballots in the NHS that give us a green light to take the type of co-ordinated industrial action that will really put pressure on the Tories.

Recruitment is important for strong campaigns, but a large membership level will also require seeking out many more competent and committed reps in every ward, unit and community team base to support and lead those members into action. So recruiting members is only half the task; the other half is to identify correctly the activists, and ensure that all members are engaged, active, and contributing to the success of their own trade union in every way they can.

Launching and winning future NHS strike ballots will require a drive to engage members and to explain to them what trade unionism is all about, and what is at stake if they don’t become active in their trade unions. It is a mistake to think that members are ‘not political’; they understand what is going on around them, and this means in order to ensure that understanding is galvanised into action, the unions have to prioritise explaining what the long-term aims and strategies of the government are.

Widening solidarity

Defending and improving the health service will require a co-ordinated approach to campaigning right across all trade unions, communities, and campaign groups that has not been seen before. There should be no walls between those who have a genuine desire to defend free health care and the staff who deliver it to us. An uncompromising opposition to cuts and privatisation must be the unifying idea that drives all campaigning. Involving NHS union members, and supporting them in struggle should always be a top priority. Campaigners and trade unionists can then unite in strength and utilise a range of tactics and methods to challenge cuts and privatisation robustly, up to and including direct action, protest action, and industrial action.

We can hold onto the fact that NHS staff are still delivering care and treatment to millions in spite of decades of cuts and privatisation all carried out in the name of ‘modernisation’ and ‘bringing healthcare closer to communities’. The media stories of ambulances queuing outside hospitals does not give the complete picture of the incredible work that staff are still doing against all odds, and in spite of repeated attacks on their pay, terms and conditions. Dedicated teams of NHS staff, clinical and ancillary, are still supporting patients, treating patients, and saving lives, but too many are now being driven out of the NHS by government policies that put profit before people every time.

So the struggle is far from over, in fact it is really beginning in earnest, and there are many lessons to take forward from the union ballot results that will enable us to be sharper and better prepared for future struggles.

Therefore it is important for NHS trade unionists and campaigners not to become disheartened, to recognise the scale of the task ahead, and to be prepared to withstand setbacks, because the smaller battles and victories that inspire us will still continue. If anything is worth continuing to struggle for, it is a free and accessible health service, and if any one issue can unite us, it is this one.

The NHS is not some archaic institution that needs modernisation, a national treasure, or a religion like the right-wing press and politicians would wish us to think. Put simply, free healthcare needs to be there for absolutely everyone living in this country when we need it. We don’t just talk about protecting the NHS, we do the groundwork necessary to take united action against the Tories to protect all human beings, and the human right to free, comprehensive healthcare based on need and not on the ability to pay.