Nurse strike Q&A: How much cash do they want? When will walk-outs happen? And how will patients be affected? All the big questions answered as Royal College of Nursing confirms ‘historic’ action
Tens of thousands of NHS nurses, healthcare assistants and midwives will strike this winter over pay, it was confirmed today.
There are fears that the resulting drop in staffing levels will lead to thousands of diagnostic tests and elective operations being cancelled at a time of record care backlogs.
Strike action could also pile even more pressure on to the health service at its hardest time of year, as it battles winter pressures and expected waves of Covid and flu meaning both admissions will rise and more staff will be off from work sick.
The RCN is arguing for an inflation-busting pay rise for its NHS nurses amid reports staff are being forced to use food banks or quitting the profession entirely due to the rising cost of living.
Here, MailOnline answers all of your key questions surrounding the strikes and what happens next.
This graph shows the Royal College of Nursing’s demands for a 5 per cent above inflation pay rise for the bands covered by its membership which includes healthcare assistants and nurses. Estimates based on NHS Employers data
What is the Royal College of Nursing?
The RCN is Britain’s largest nursing union, with its membership consisting of nurses of all specialties.
This includes general nurses working in NHS hospitals as well as specialists working in mental health, cancer and paediatrics.
Its members also include some other health and care staff groups like midwives and healthcare assistants.
Why are members striking?
The RCN argues that its members working in the NHS are not paid enough and this is contributing to crippling staffing problems in the health service.
While this argument has been brewing for years, soaring inflation due to the cost-of-living crisis has exacerbated concerns.
There have been reports of nurses struggling to pay their bills or leaving for better-paid jobs in sectors like retail.
On October 6, the RCN launched a historic ballot asking 300,000 members working in the NHS across the UK if they would on taking strike action.
Ballots closed on November 2 and the results were revealed today.
What was the result?
In total, 178 NHS organisations voted to strike across the UK after meeting the legal thresholds for industrial action.
This includes all of the NHS employers in Northern Ireland and Scotland and all bar one in Wales. In England, this includes 130 NHS organisations.
The types of NHS bodies impacted by strike action includes NHS trusts and health boards which manage hospitals, ambulance trusts, and Integrated Care Bodies, which broadly manage NHS services in areas of England.
Of the total organisations that returned a valid strike ballot in England, roughly 50 are acute NHS trusts that provide hospital care. Six out of 11 ambulance trusts also voted to strike.
What does the RCN want?
The union wants nurses to get a pay rise 5 per cent above inflation, which currently sits around 12 per cent.
This would grant the average nurse, who earns roughly £35,600 each year, an extra £6,000 annually.
This is far above the Government’s offer of about 4 per cent.
So what happens now?
The RCN is expected to unveil further details of the strike action in the weeks to come.
This will include which parts of the NHS will be affected by strike action on what days, as well as for how long.
Previous strike action by nurses in Northern Ireland in 2019/20 saw nurses walk off the jobs from almost all services minus those providing life saving care in 12-hour blocks.
I have an operation scheduled at my local NHS hospital in the next few months, could it be cancelled?
Previous strikes by NHS staff have led to the cancellation of non-emergency ops and appointments.
If your appointment is already scheduled for days where action takes place, it could be cancelled because it is probably not classified as urgent.
If an individual appointment is axed or not will depend on if the date falls on a strike action day, and if nurses at the trust are walking off the job.
Another factor is how long the dispute between the Government and the union runs.
Some appointments not on strike days may also be delayed because more urgent procedures cancelled need to be prioritised.
What determines which hospitals or NHS services will strike?
The RCN balloted nurses at 300 NHS organisations and 178 came back with a valid result in favour of strike action.
What makes a valid strike action ballot differs depending on the trade union law across the UK nation.
In England and Scotland, 50 per cent of the eligible membership must vote for the ballot to be valid, and at least 40 per cent of votes must be in favour of the action for the result to count.
For Wales, at least 50 per cent of the eligible membership must vote but only a simple majority is needed to determine the result.
Northern Ireland has the least restrictions on strike action ballots, only a simple majority of those who vote is required with no minimum turnout threshold.
When could nurses go on strike?
Northern Ireland requires strike action to take place within one month of the ballot closing, so before December 3.
The law in England, Scotland and Wales states strike action has to be held within six months of the ballot closing, so by the start of May.
Industrial action is expected to begin before Christmas, with reports that it will take place over two dates, potentially a Tuesday and a Thursday.
Have any dates been announced so far?
No. It is also unclear if the strike will be held continuously, as in for multiple days in a row, or on certain days spaced throughout the month.
The junior doctors industrial dispute in 2016 led to staff withdrawing labour on four dates.
They performed a general strike on January 12, February 10 and March 9-10.
And on April 26-27 junior doctors withdrew from providing both routine and emergency care.
In total the strikes led to the cancellation of 100,000 patient appointments.
We don’t know if the RCN strike will follow a similar model.
Won’t a strike put patients in danger?
Unlike other staff groups who take strike action, nurses are required by law to maintain a minimum staffing level to keep patients safe.
Therefore, some nurses will be exempt from the strike to provide this minimum level of service.
The exact numbers remaining on the job will be negotiated locally between the RCN and each NHS Trust/Board.
What kind of NHS services could be scrapped?
Senior health officials have warned patients are expected to only receive a ‘bank holiday’ level of service on days nurses walk off the job.
This means vital cancer and kidney disease treatments and routine operations like knee or hip replacements could be axed, or rescheduled.
Other procedures and treatment that might be scrapped include chemotherapy and dialysis.
Emergency care is not expected to be impacted by strike action, as this is needed to ensure life-saving care is provided to the public.
Won’t some patients suffer from elective procedure being cancelled?
Yes. Patients on waiting lists for elective care often have a reduced quality of life as they live in pain for months at a time and can suffer health problems from a lack of treatment.
However, the RCN argues that improved pay is needed to help boost staffing in the NHS which is considered to be one of the main reasons contributing to long elective care waiting times in the first place.
The NHS waiting list for routine operations in August in England breached 7million for the first time ever. This includes almost 390,000 patients who’ve been forced to wait over a year for treatment
NHS data shows efforts to get more nurses into the health service are only barely keeping pace with the number of experienced nurses quitting
The latest NHS data recorded that about 45,000 nursing posts in England are vacant as of the end of June. London has highest percentage missing, with 15 per cent of nursing posts unfilled
If some nurses are still working what’s the point of a strike?
While life-saving care will be provided, a nursing strike is likely to lead to cancellation of hundreds of routine operations.
Similar large-scale strike action by junior doctors in 2016 led to the cancellation of 100,000 patient appointments.
Can nurses be sacked for striking?
No. NHS workers cannot legally be sacked if they participate in official and lawful industrial action.
The nurses regulator the Nursing and Midwifery Council, which has the power to strike off nurses from the profession, has also made it clear it will not penalise nurses for taking industrial action.
Are the strikes avoidable?
The RCN says the Government can stop the strikes if it agrees to meet their demands on pay.
However, the Government has refused to even say it will meet with the union following the result of the ballot.
Will the Government cave to RCN demands?
Unknown. But if the No10 gives in to nurses it will face pressure to provide similar pay rises to other NHS staff groups, with junior doctors, midwives and other health service staff also arguing for inflation busting pay rises.
At a time when state services are being asked to tighten their belts due to financial pressures the Government is likely to argue it can’t afford to pay NHS staff more than it has offered.
What is the NHS doing to prepare for strike action?
At the start of November hospitals in England were ordered to plan a military-style operation to prepare for potential strike action.
Called Exercise Arctic Willow, the multi-day operation is designed to test their ‘preparedness’ for winter and will take place in mid-November.
This is an extension to the normal routine winter preparedness exercises carried out by trusts to prepare for seasonal problems like an increase in flu admissions.
What are other staff groups doing? Is more industrial action on the way?
The RCN is just one NHS union which has or is balloting its members over pay
Nurses aren’t alone in their discontent with NHS pay.
A plethora of other staff groups are mulling over industrial action including potential strikes.
This week the union Unite announced its was expanding its NHS strike ballot to 100,000 members working in the health service in England and Wales.
The new ballot will incorporate nurses, as well as mental health staff, NHS dentists, paramedics as well as health service estate and admin staff.
Unite was previously balloting ambulance drivers in Scotland and England on potential strike action but said the situation in the NHS had prompted an expansion to other groups.
If the Unite ballot returns a yes result, the union said its members would strike in the New Year.
Other previously staff unions that have touted industrial action include the Royal College of Midwives which has asked its 50,000 members to vote in support of action when ballots open on November 11.
Two-thirds have already said they would be willing to strike in a preliminary poll.
More than 15,000 ambulance workers at 11 trusts in England and Wales are being balloted on industrial action over pay and ‘unsafe’ working conditions.
The GMB union said if the strikes went ahead, which could take place ahead of Christmas, it would be the biggest for three decades.
Some 8,000 members in Scotland last week voted ‘overwhelmingly’ in favour of industrial action.
And the Chartered Society of Physiotherapy said more than eight in 10 of its 60,000 members across the UK are prepared to strike.
Members in Scotland last week voted in favour of strike action. Voting in England closes today, while members in Wales have until December 12 to post their ballot.
It makes the first time members have been balloted over pay in the CSP’s 100-year history.
Meanwhile, the British Medical Association will ballot junior doctors in early January on whether it should strike over pay.
Where WILL strike action take place?
ENGLAND
Derbyshire Healthcare NHS Foundation Trust
Northamptonshire Healthcare NHS Foundation Trust
Derbyshire Community Health Services NHS Foundation Trust
Nottinghamshire Healthcare NHS Foundation Trust
Nottingham University Hospitals NHS Trust
Kettering General Hospital NHS Foundation Trust
Cambridgeshire and Peterborough NHS Foundation Trust
Norfolk and Norwich University Hospitals NHS Foundation Trust
Cambridge University Hospital NHS Foundation Trust
Royal Papworth Hospital NHS Foundation Trust
East Suffolk and North Essex NHS Foundation Trust
Norfolk Community Health and Care NHS Trust
Norfolk and Suffolk NHS Foundation Trust
Cambridgeshire Community Services NHS Trust
Hertfordshire Community NHS Trust
West Suffolk NHS Foundation Trust
Imperial College Healthcare NHS Trust
Guys and St Thomas NHS Foundation Trust
Great Ormond Street Hospital for Children NHS Foundation Trust
Hounslow and Richmond Community Healthcare NHS Trust
St George’s University Hospitals NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Royal Marsden NHS Foundation Trust
Tavistock and Portman NHS Foundation Trust
University College London Hospitals NHS Foundation Trust
Mersey Care NHS Foundation Trust
Tameside and Glossop Integrated Care NHS Foundation Trust
Liverpool Heart and Chest Hospital NHS Found Trust
Lancashire Teaching Hospitals NHS Foundation Trust
The Clatterbridge Cancer Centre NHS Found Trust
The Christie NHS Foundation Trust
Wrightington Wigan and Leigh NHS Foundation Trust
Countess of Chester Hospital NHS Foundation Trust
Liverpool University Hospitals NHS Foundation Trust
Mid Cheshire Hospitals NHS Foundation Trust
Bridgewater Community Healthcare NHS Foundation Trust
Wirral Community Health and Care NHS Foundation Trust
Wirral University Teaching Hospital NHS Found Trust
Liverpool Women’s NHS Foundation Trust
St Helens and Knowsley Teaching Hospitals NHS Trust
Alder Hey Children’s NHS Foundation Trust
The Walton Centre NHS Foundation Trust
Cheshire and Wirral Partnership NHS Foundation Trust
University Hospitals of Morecambe Bay NHS Foundation Trust
Northumbria Healthcare NHS Foundation Trust
County Durham and Darlington NHS Foundation Trust
Gateshead Health NHS Foundation Trust
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
South Tees Hospitals NHS Foundation Trust
Kent Community Health NHS Foundation Trust
East Sussex Healthcare NHS Trust
University Hospitals Sussex NHS Foundation Trust
Sussex Community NHS Foundation Trust
Sussex Partnership NHS Foundation Trust
Queen Victoria Hospital NHS Foundation Trust
Southern Health NHS Foundation Trust
Oxford University Hospitals NHS Foundation Trust
Portsmouth Hospitals NHS Trust
University Hospital Southampton NHS Foundation Trust
Solent NHS Trust
Royal Berkshire NHS Foundation Trust
Oxford Health NHS Foundation Trust
Cornwall Partnership NHS Foundation Trust
Devon Partnership NHS Trust
Dorset Healthcare University NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
North Bristol NHS Trust
Torbay and South Devon NHS Foundation Trust
University Hospitals Plymouth NHS Trust
University Hospitals Bristol and Weston NHS Foundation Trust
Dorset County Hospital NHS Foundation Trust
Gloucestershire Health and Care NHS Foundation Trust
Royal Devon University Healthcare NHS Foundation Trust
Avon and Wiltshire Mental Health Partnership NHS Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
University Hospitals Dorset NHS Foundation Trust
Somerset NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
Royal United Hospitals Bath NHS Foundation Trust
Midlands Partnership NHS Foundation Trust
Herefordshire and Worcestershire Health and Care NHS Trust
The Royal Orthopaedic Hospital NHS Foundation Trust
Worcestershire Acute Hospitals NHS Trust
Shropshire Community Health NHS Trust
University Hospitals Birmingham NHS Foundation Trust
Birmingham Women’s and Children’s NHS Foundation Trust
Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Dudley Integrated Health and Care NHS Trust
Sheffield Health and Social Care NHS Foundation Trust
Barnsley Hospital NHS Foundation Trust
York and Scarborough Teaching Hospitals NHS Foundation Trust
Leeds Community Healthcare NHS Trust
Bradford Teaching Hospitals NHS Foundation Trust
Harrogate and District NHS Foundation Trust
The Leeds Teaching Hospitals NHS Trust
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield Children’s NHS Foundation Trust
WALES
Cardiff and Vale University Health Board
Powys Teaching Local Health Board
Welsh Ambulance Services NHS Trust Headquarters
Hywel Dda University Health Board
Swansea Bay University Health Board
Cwm Taf Morgannwg University Health Board
Betsi Cadwaladr University Local Health Board
Velindre NHS Trust
NORTHERN IRELAND
Southern Health and Social Care Trust
Western Health and Social Care Trust
Belfast Health and Social Care Trust
Northern Health and Social Care Trust
South Eastern Health and Social Care Trust
SCOTLAND
NHS Borders
NHS Education For Scotland
NHS Fife
NHS National Services Scotland
NHS Shetland
NHS Western Isles
NHS Dumfries and Galloway
NHS Orkney
NHS Golden Jubilee
NHS Grampian
NHS Tayside
NHS Ayrshire and Arran
NHS Greater Glasgow and Clyde
NHS Lothian
NHS Lanarkshire
NHS Highland
NHS Forth Valley
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