As thousands of nurses across England take to picket lines in a historic strike, Tribune sits down with the RCN’s Denise Kelly to discuss the NHS crisis behind the dispute.

Last year, the RCN’s workforce showed 80% of members felt that there weren’t enough nursing staff to meet patients’ needs. (Getty Images)

As ministers turn their focus to cutting away at workers’ basic civil liberties and waging war on their trade unions, the NHS crisis—said to be resulting in hundreds of deaths every week—continues.

At the base of that crisis are a series of political decisions to underfund the health service and undervalue the workers within it. Nurses alone have seen their pay collapse by 20% in the last decade, resulting in a spiralling recruitment and retention crisis that leaves wards desperately understaffed, and those still in them overworked beyond the point of burnout.

Along with that comes the direct results of low pay in a cost of living crisis, with one survey by nurses’ charity the Cavell Trust in January and February finding almost a third of nurses were struggling to cover the cost of heating their homes and putting food on the table, and that as many as 14 percent reported using food banks.

It’s against this backdrop that thousands of nurses in England are beginning their second round of strike action, with two twelve-hour stoppages taking place today and tomorrow. Tribune spoke to Denise Kelly, chair of the Royal College of Nursing’s Trade Union Committee and a frontline nurse based in Northern Ireland, about the struggle of life on the wards, the government’s hollow platitudes, and why nurses have now been left with no choice but to fight back.

Ronan Burtenshaw

Can you explain the background to this historic strike by the Royal College of Nursing (RCN)?

Denise Kelly

In the first instance, the Royal College of Nursing (RCN) is in dispute over the 2022-2023 Agenda for Change pay award, which was imposed on us. Our demand was for an across-the-board pay rise at the current inflation rate, which was measured by RPI, plus 5%. We called on the UK government to revisit the Pay Review Body pay round because we felt they weren’t independent and what they offered didn’t reflect the twelve years of austerity that nursing staff had faced, with a real-terms cut of 20% to our salary.

But the other reason we’re striking is to protect patients. That was one of the drivers for getting our members to come out and vote to strike. Patients aren’t dying because nurses are striking, nurses are striking because patients are dying.

Last year, we did a workforce survey that showed 80% of our members felt that there weren’t enough nursing staff to meet patients’ needs, and only 18% of those surveyed said they had enough time to provide the level of care they would want for themselves or their family. That really is a disgrace.

The public can see the level of pressure and stress that we’re all under in the health service—the challenges we’ve had, again because of austerity policies and the real-terms pay cut, but also because of the lack of workforce planning. We’ve seen huge reductions in terms of recruitment and retention in the workforce. We’re finding a lot of our newly qualified nurses are getting six months’ experience on a ward and then leaving to join an agency, where they’re getting properly remunerated for the safety-critical skills that they have.

So we’ve called again on the UK government to tackle the workforce crisis and set up a proper workforce plan to make sure that nursing is an attractive, well-paid, and meaningfully supported profession.

Ronan Burtenshaw

This strike is taking place against the backdrop of the worst NHS crisis in decades. How does that influence your action?

Denise Kelly

There is an important background. The health system faces massive challenges, and nurses are aware of that. Patients are getting older, patient acuity is increasing, we are getting an increase in patient attendances at hospitals, but at the same time our workforce hasn’t increased to reflect that and meet those demographic demands.

With medical interventions and advances in modern medicine, people are living longer, but they’re living longer with a lot of comorbidities and problems. We’re asking: how can we support them not only within the acute health services, secondary care, but in primary care and social care as well? Luckily enough in Northern Ireland we’re already integrated, but I know that’s not the case in the other three countries of the United Kingdom.

We have told the government that we need to plan for the future. If we want to deliver a modernised and transformative health service that’s going to meet the needs of our public, we need to have the staff and the resources that enable us to give the care people rightly deserve. So safe staffing is critical.

As I always say, staff shortages cost lives. There was a poll in the Health Service Journal showing that for every registered nurse short on a shift, there’s an increase of 7% in patients coming to harm. We’re trying to get that message across.

In England alone, there’s nearly 50,000 nursing vacancies. Thousands of those who are working now are completely burned out, especially after what they’ve gone through with the pandemic. They’ve got to the point where they think strike action is the only way we can make ourselves heard and effectively campaign for patient safety and for the long-term future of the nursing profession.

We are aware that it’s probably somewhere in the government’s plans to deprofessionalise and deregulate nursing. Again, bringing in a casualised workforce is a way of capping salaries and having workers on lower wages, trying to deliver and fulfill the work of a registered nurse. That’s where we have to draw a line and say there is a difference. They want to cut back, but you have to invest if you want a highly skilled workforce, delivering the care that our patients and public need.

Ronan Burtenshaw

You’re a frontline nurse yourself. Can you tell us some of the stories behind this strike, things you’ve either experienced yourself or heard from colleagues that give an insight into how difficult it is to work in the NHS at the moment?

Denise Kelly

I have worked for 30 years in the frontline, so I know where we were, which is maybe even harder. I know what the level of care was when I started in nursing and where we’re at today. I’ve seen the evolution of the nursing role. We’re very much doing the role of a junior doctor now, but again, we’re not recognised for that safety critical skill set that we have had to acquire.

Over the years, I’ve seen significant detrimental impacts in terms of patient outcomes and staff productivity. To put it simply, they’re expecting more for less. We’ve got a vacancy rate of 1 in 8 within the NHS. There have been plenty of reports in the media about how the health and social care system has moved from crisis to the brink of collapse. I would concur with that.

The shifts that I worked over Christmas were probably the worst I have seen in 30 years. We had patients in the back of ambulances because there was no room for them in the hospitals. When patients could come in, they were sitting in plastic chairs getting corridor care.

The moral injury that is caused is enormous. We aren’t able to give patients the dignified care that they deserve, especially our elderly, frail patients. There is literally no room for them in the hospitals.

You have those issues at the front door but also at the back door. Our patients can’t get the health and social care services that they need within the community because there’s a shortage of district nursing services and domiciliary care services. That means there’s a bottleneck in the system.

Nurses feel that they’re coming in and firefighting. I do it every night. I firefight every shift. I’m lucky if I get a break. I’m lucky if it’s maybe five o’clock in the morning, and I’ve had a mouthful of water. That’s a good night. You’re constantly running. Not only that, but whenever you get home it’s very hard to switch off.

The impact on the mental health of staff when you’re constantly firefighting is harrowing. I have had people ring me to check on patients long after hours because we care about their wellbeing. ‘Are they keeping well, have I remembered to do the right thing for them?’ That is the reality of what nurses are living with, and it’s so much worse when there is pressure. What other job would have people coming home and worrying in that way every day?

Nursing is a life-preserving service. Somebody can die if we don’t do our job right or per protocol, and nurses are always very mindful of that. So we are constantly going round and checking. But that often means we’re trying to do the job of eight people now. Then there’s the moral injury that causes when you’re coming home from a shift feeling that you haven’t been able to deliver the safe and effective care that patients deserve—it really cannot be overstated.

It is hard out there. It’s a crisis caused by political neglect and inaction. They don’t seem to realise the impact it’s having. We have members having to use food banks. They’re worrying about how they’re going to pay their heating bills, even after all that hard work. One of our nurses a couple of weeks ago said to me, ‘I only have two pounds left in my bank account. I can’t even afford to put nappies on my child.’ That’s how desperate it is.

The majority of nurses, registered nurses, are in band five, which is the lowest band on Agenda for Change. There’s little to no progression. So the most that they can ever earn in maybe a 30- or 40-year career is £14.90 an hour. And, of course, many aren’t getting that. How does that motivate nurses? How does that retain our staff? How does that make them feel valued for the job that they do?

In surveys, nursing is consistently the most trusted profession. We are the people there with the patients 24/7. But how many decision-making tables are nurses invited to? At the recent meeting that the government held, that crisis summit about the health service, there were no nurses present. Why? What are they afraid of?

Nurses are now rising up. They’re now saying enough is enough and speaking out for themselves and, most importantly, for their patients.

Ronan Burtenshaw

At that meeting you mentioned, and in the media afterwards, the government was keen to suggest a deal was close that would end the strike. But the proposal they briefed to the press was a lump sum of £1,000 for all NHS staff, instead of any real long-term change in pay or conditions. How did nurses respond to those stories?

Denise Kelly

They see them for what they are: platitudes.

It’s like the Covid bonus that they gave to certain regions. It’s a pat on the back, a clap, but that’s not going to pay the bills. It’s not going to pay into our pension. It’s not going to encourage people to come back and work in the horrendous conditions that we’re seeing. It’s not going to fix the NHS or the deep crisis.

Our members see beyond that. They know what the long-term vision and strategy has to be to deliver for our patients. But as I said, those talks didn’t even happen with nursing, so the figures being thrown around in the media weren’t even put to us.

Ronan Burtenshaw

Another aspect of the government’s media strategy has been to raise the prospect of patients dying because of these strikes. Has that got under nurses’ skin?

Denise Kelly

Massively. Nurses are seeing the reality of what patients face day-to-day. If you ask any member, they’ll tell you that the reason they’re going on strike is not just pay, it’s patient care.

They can see the real harm that’s being caused due to the lack of investment and not being able to recruit and retain in the nursing profession. We have a derogation process in nursing to provide life-preserving measures and safe staffing during any strike action, and the government knows that. But they do very little to provide us with the means to save lives on the other 364 days of the year.

I feel the same with these anti-strike laws that they’re trying to impose at the minute in Westminster. What about passing a law that mandates a minimum service level on non-strike days? One that ensures that staff shortages are filled and hospitals are properly funded, and means minimum numbers on wards? Are they going to commit to safe staffing legislation? Because we would support that.

There are nearly 50,000 nursing vacancies, thousands of burnt out and underpaid staff, and the government is showing no plan to improve the situation or to invest. But now they’re seeing in this strike that it’s hard to break people that are already broken.

This strike is nurses’ last resort. It’s the last resort to make ourselves heard. Why is it that we have nurses who work so hard every day resorting to foodbanks or relying on charity? None of those parliamentarians that have their second jobs and different incomes and subsidies for food or expenses would put up with these conditions. So why should we?

It has to be fair for all workers. We all deserve good pay, good terms, and good conditions. They talk about ‘productivity’ in the NHS. If you have the right environment for people in which they’re able to thrive, you’ll see a ripple effect in terms of outcomes and service delivery. If you don’t, you won’t. The blame lies with our politicians and their indecisiveness.

Ronan Burtenshaw

This is the RCN’s first national strike in over 100 years. As the second round of strike days kicks off, is morale holding up?

Denise Kelly

Morale is strengthening. Through our organising and campaigning we have engaged, educated, and empowered members at a grassroots level. They can see, hear, and feel just how bad things are on the ground and they’re determined to make their voices heard. Nurses are getting a lot of motivation from the level of public support that we’re seeing, the kindness shown, and the solidarity from other trade unions. We’re all standing together collectively fighting for a better future. We know we’re not in this alone.

We’ve got to this absolute last resort. Thousands of nurses felt that they had to take strike action for themselves and for their patients. Once that line is crossed, it’s very hard to shake their resolve. We’re not buying into the government’s platitudes or threats.

We can see the reality in a way no minister can. We’ve endured a mess and things getting worse for the last twelve years with this Tory government, and we’re not going to endure it much longer. We’re standing up and fighting until we win.

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