As we finalise this issue of the Lowdown, UNISON has just announced that it is to suspend its strikes by NHS staff across Northern Ireland, and put a new deal to a ballot. The battle for pay parity with staff doing the same jobs in the rest of the UK was supported by all of the health unions – including the first-ever strikes by members of the Royal College of Nursing.

Patrick Lawlor (writing here in a personal capacity), in an article written on January 7 for Health Campaigns Together (before the agreement was reached in talks with the unions) is a Neonatal Intensive Care Specialist Nurse Practitioner in Belfast, and Vice-President of Northern Ireland Public Service Alliance (NIPSA), whose members have also been on the picket lines.

The health service across Northern Ireland has been at crisis point for many years as a direct result of chronic and systematic policy of under-funding and pay austerity.  This has resulted in £millions of pounds taken out of the health budget of the devolved Regional Assembly of Northern Ireland.

These cuts are part of Westminster Conservative austerity strategy to making working people pay for the financial crisis of 2007/8 caused by the greed of wealthy profiteers and big business.

However these cuts have been implemented without resistance by the local political parties, who fully accepted the neo-liberal agenda of public sector cuts and privatisation.


The impact of these attacks has caused overwhelming pain and suffering to both patients and staff for over 10 years.  As I write,  not one clinical target has been met in all main health priorities such as cancer, cardiac and emergency services and many more.

Official figures starkly show 108,582 people were waiting over a year for their first hospital appointment.  That is over a third (35%) of the total number of 306,000 patients currently on hospital appointment waiting lists.

This is an all-time high for Northern Ireland, increasing by 8% in the last year.

According to local Health and Social Care Board statistics, the number of people waiting longer than a year for a first outpatient appointment rose by more than 3,000 in just three months between June and September 2019.

This is at a time when the number of people waiting longer than a year for surgery has risen from 22,638 to 25,279.

This situation has become so serious that thousands of patients across Northern Ireland have been forced to pay privately for treatment.

The overriding objective is to undermine confidence and support for a fully publicly-owned health service and to open it up to the private sector and insurance-based health system.

Tipping point

The current working environment for staff has reached tipping point of unachievable workloads resulting in work-related physical and mental health conditions impacting many workers.

Many health workers are having to work far beyond their finish times without pay just to keep services going.

The imposition of the cuts agenda on services and pay austerity has seen a recruitment crisis unfolding over the last decade.

There are currently 7,000 vacancies across our health service of a workforce of 60,000, a vacancy rate of over 10% that is getting worse!

This has seen thousands of pounds of public money given away to private sector recruitment agencies to cover vacant posts.  Public sector agency spending has surged by 160% since 2015, and estimated to hit £230 million at the end of 2019.

This disgusting and unaccountable waste of money is commonly understood by health workers as money, which could easily go a long way to resolve the recruitment and training crisis in our health service.

Parity of pay

However, it is also recognised that recruitment can only be sustained if the pay cap on wages is broken and staff get parity of pay with their colleagues across the regions of England, Scotland and Wales.

A decade of 1% pay awards has seen a divergence of pay across the National Health Service (NHS) for workers doing the same job.

On average a health worker in Northern Ireland is approximately £2000 worse off than their counterpart in other regions.  It has been reported that many staff including nurses are regularly having to go to food banks to feed their families as they struggle to pay their utility bills.

This is the context that saw the explosion of industrial action by health workers spill out across Northern Ireland on the 18th of December 2019, with many of the picket lines having the quality of mass pickets.

It is not unreasonable to say the action on the 18th resulted in one of the largest health strikes across Northern Ireland since the 1980s.

It was reported 20,000 health workers (15,000 nurses) came out on strike from 12 to 24 hours across all areas and departments.  The strike action involved all groups of workers from cleaners, porters, caterers, transport, ambulance staff and nurses.

First ever strike

It was also historic as the Royal College of Nurses (RCN) came out on strike for the first time in its 103 year existence.

This event in itself illustrates the anger and militancy of health workers.  Their confidence and strength of their own power was transformed into an uncompromising approach on that day, with every staff member I spoke to across unions stating emphatically that there was no going back!

This has resulted in the RCN Executive agreeing escalating their work to rule action planned for the 8th and 10th January to strike action, with further action proposed for the 20th, 22nd and 24th February.  Other unions are currently looking at these dates to coordinate action.

Keep up pressure

It is positive that some health unions have agreed taking strike action again in the coming weeks to keep up the pressure.

This action will be augmented with the likely positive results at the end of January for industrial action ballots on pay from Allied Health Professional organisations (AHP), Royal College of Midwives, Society of Radiographers and Royal Society of Physiotherapists.

It is essential that all health unions and AHPs maintain the momentum and immediately coordinate a series of strike dates to maximise the impact.

Maximum coordination is necessary in this battle, that means not just at the top but at all levels, including cross-union committees in workplaces to ensure that the dispute is democratically controlled by health workers.

There is also a need for increased coordination when it comes to action short of strike action, to cut across any confusion that exists in multi-union workplaces.

There is also no doubt that there is overwhelming support for the health workers dispute across all communities.

Any attack on the strikes by anti-union and conservative commentators facilitated through mainstream media has fallen on deaf ears across working class communities.

This was illustrated during the strike on the 18th, when local people routinely visited picket lines to show support, many bringing coffee, tea and sandwiches etc.

It is likely, given the pressure that is being brought to bear and potential for further action, that a revised pay deal is likely to be offered and maybe accepted by staff. However, it is also recognised that this dispute is not only about pay but also staffing and the provision of gold standard health services.

A win on pay will only augment this demand and see this campaign refocus onto the defence of our publicly-owned health service and opposition of privatisation.


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