Above Photo: Nursing staff and supporters chant and wave placards as they protest outside University College Hospital during a day of strikes, on 18 January 2023 in London, England. Leon Neal / Getty Images.
Years of attacks on terms and conditions have pushed nurses to the brink.
Now they’re striking not only for fair pay, but to protect the NHS for future generations.
In 1990, Helen O’Connor came over from Ireland to train as a nurse at Whittington Hospital in North London. ‘In those days, you had decent pay, subsidised canteens, and subsidised accommodation,’ she explains.
It was a great career. You could move up the grades, earn money to get a mortgage and buy a house. If you got to sister level, which I did, you could have a really good life.
Today, things look different. Fourteen percent of nurses rely on foodbanks, a third have difficulty covering food and heating costs, and three in four NHS Trusts say more nurses are visiting mental health services because of stress, debt, and poverty. As a result of all of this, nurses are leaving the profession in droves.
Where did it all go wrong — and how do we put it right?
Wartime Conditions
For one thing, since the late nineties, years of pay freezes have meant the value of take-home pay has dropped dramatically. According to analysis by the Trade Union Congress, nurses’ real pay is down £5,000 since just 2010. Then, in 2015, the Conservative government announced that bursaries for future nurses — previously worth up to £16,454 a year, to help boost the NHS’ nursing supply — would be scrapped in favour of loans.
Jodie, a mental health nurse from Sheffield, has seen the effect first-hand. When she began her training in 2011, she was given a £500 monthly bursary and didn’t have to pay university fees; since fees were introduced, there’s been a significant drop in applications, and many of Jodie’s newly qualified colleagues are thousands of pounds in debt — one to the tune of £75,000, which it will take her until retirement age to pay off.
This collapse in pay and conditions has exacerbated an already serious shortage of NHS nurses: coupled with an exodus of senior nurses due to poor pay, the financial burden of training has been disastrous for the profession. In the last year alone, 40,000 NHS nurses — one in nine — have left.
And shortages cause their own, self-perpetuating problems. ‘In the old days, we had support,’ continues O’Connor. ‘The training was excellent, and there was investment. It would be very rare to be asked to do something you weren’t comfortable with.’ As numbers continue to fall, that’s no longer the case: ‘Now, by the time trainee nurses come onto the wards as qualified nurses, they’ve got no one around [to help] them because all of the experienced staff who know what they’re doing are actually the ones leaving.’
This means growing stress and anxiety for junior nurses, who, in turn with newly qualified staff, are often expected to operate above their level of competency — with obvious consequences for patient well-being. ‘To perform a procedure or wound care, you need to have relevant knowledge, skills, and experience,’ O’Connor points out. In other words: ‘If you’re in A+E and a patient is dying, you need to know what you’re doing.’
Covid-19 exposed and further aggravated the crisis. ‘I’ve had nurses say to me it was like wartime conditions,’ O’Connor says of the pandemic.
You already had a situation where nurses were skipping their breaks and maybe working an hour after their shift just to finish notes. They don’t get paid for that. You’re expected to go over and above the whole time, and it gets exhausting.
At the same time, the consequences of a decade of austerity, not only for nurses’ pay but for their resources and workplaces, pushes things further. The number of beds in NHS mental health hospitals alone has fallen by a quarter since 2010. For Jodie, who works in a community psychosis service in Sheffield, the shortfall means caring for patients in their homes, instead — while using her own car to travel, and unable to claim back the full cost of the fuel. She sums up the outcome succinctly: ‘I am paying to work.’
O’Connor also notes the impact of austerity on nurses’ ability to care for patients. ‘I was working in an assessment team in Croydon, and I couldn’t get anything for patients — not the long-term therapies, not the housing, not the benefits. We were barely managing to cover them with foodbank vouchers.’
The resulting sense of powerlessness is one of the reasons O’Connor left the profession after 28 years. ‘When you feel as a nurse that you can’t actually help desperate people coming to you for help, it’s very demoralising,’ she continues. ‘I did two different sets of training – psychiatric training, as well as adult nurse training. And I am thinking: I’ve got all this experience and my pay is dropping and I can’t help the patients anyway.’
Fighting Back
This year, in the wake of the consistent corrosion of austerity and the battlefield conditions of Covid, the cost-of-living crisis has hit; and with it, there’s a wave of headlines about NHS staff relying on food banks or ‘buy now, pay later’ loans. For Mary, a 45-year-old nurse from North London, it’s left her fearing for her survival. ‘If prices go up further,’ she tells Tribune, ‘I don’t know how I’ll be able to live.’
Some nurses report skipping meals to feed and clothe their children; more than a quarter of NHS trusts already operate food banks for staff, and another 19 percent plan to open one. These circumstances have pushed the nurses’ exodus to its limit. A report by NHS Providers found that 68 percent of trusts are seeing a ‘significant or severe impact’ from staff leaving for other sectors.
Jodie, for one, feels ‘unappreciated, demoralised, and undervalued’. Managing bills and money is a constant source of stress, with an unavoidable impact on her mental health. ‘How am I supposed to look after our most poorly people and give good quality, compassionate care when my own health is at risk?’
The present situation is devastating and the feeling of hopelessness high. But this latest crisis has also led to a growing wave of anger — and it is that anger, Helen O’Connor points out, that the Enough is Enough campaign seeks to turn into action. O’Connor now works as an organiser for the GMB union, and has spoken at Enough is Enough rallies in London and Luton about the plight of nurses, to be met with huge support. She believes the campaign is resonating with people, above all because it provides a clear alternative and engages en masse; but, as she acknowledges, there’s still a lot of work to do.
‘What needs to go hand in hand with this campaign is organising in the workplace and in local communities,’ she tells Tribune.
People will listen to me, but they are far more likely to listen to the colleague who stood beside them every day. It’s important we draw those people in and get them working alongside us. That’s organising.
And as Enough is Enough swells in size to hundreds of thousands, we are in the midst of the biggest nursing strike in NHS history. At the time of writing, the Royal College of Nursing is calling for pay rises for nurses of 5 percent above RPI inflation, and members at the majority of NHS Trusts across the UK have voted to go on strike for it — with a poll showing two-thirds of the public are behind them. Many of those polled likely recognise that if we don’t undo the degradation nurses’ conditions have suffered in recent years, the 47,000 nursing vacancies in England alone will remain unfilled or spiral higher — and that the existence of the NHS itself will quickly reach a critical point. There is simply no time left to waste.
‘Everyone deserves a pay rise,’ says Mary.
We are being shafted by the government, who are giving tax cuts to their mates while we, the working class, have to scrimp, steal, and borrow just to get by. We need change. And we need it now.