Rishi Sunak is hoping that a split among health unions will allow the government to settle a long-running NHS pay dispute next month, as new figures on Monday revealed the vast disruption caused by strikes.
About 195,000 NHS appointments, including hospital operations and scans, had to be cancelled last week in England because of four days of industrial action by junior doctors.
The prime minister admitted the strikes could make it “more challenging” to meet his promise to cut waiting lists for NHS treatment.
Ending the NHS pay dispute is critical for Sunak, with opinion polls showing the public continue to support striking nurses and with the state of the health service set to be a key issue at the next general election.
The prime minister has been contending with the biggest wave of strikes in the public and private sectors for decades, as workers demand higher pay amid the cost of living crisis.
While the pay dispute with junior doctors appears intractable, Sunak is hopeful that a wage deal can soon be reached with about 1mn other health workers covered by so-called Agenda for Change contracts, including nurses, ambulance staff and porters.
He insisted on Monday that a 5 per cent wage rise for 2023-24 and a one-off payment for last year was “reasonable”, and Downing Street said it was the “final” offer.
Last week members of the Royal College of Nursing rejected the offer, in spite of it being recommended by the union’s leadership — throwing into confusion Sunak’s efforts to end months of public sector industrial action.
The prime minister’s allies have calculated that if NHS workers accept the pay deal, there would be a snowball effect, with pressure mounting on public sector workers in other areas to end their strikes.
Senior government insiders said on Monday they were “hopeful” that the RCN’s rejection of the offer could be overcome next month if members of other big health unions voted to back it.
The final verdict on the pay deal will not become clear until a meeting on May 2 of the NHS Staff Council, a body that could decide to accept the offer in spite of resistance from RCN members. The body represents unions or staff associations whose members are covered by Agenda for Change contracts.
Ten of these have been consulting members on whether to accept the pay deal, with most ballots closing by the end of April. The council operates an electoral college-type system, with bigger unions carrying greater weight.
Unison, whose members decisively accepted the offer last week, has the most votes, raising the prospect that, provided a number of other large unions — notably the GMB — also support it, the deal could be approved.
“It all depends on what the GMB do,” said one government insider.
The GMB leadership recommended the pay deal and is currently balloting its members.
The union will get the result of the vote on April 28, and GMB insiders said the outcome was likely to be “very close”.
If the NHS Staff Council accepted the latest pay deal, precedent suggests that the government would simply impose it on members of the RCN and any other unions that rejected it.
In 2018, for example, another pay offer for NHS workers secured the support of every union on the council except the GMB. Its members ended up having the settlement forced on them.
In such a situation, the RCN would have to decide whether to carry on with strikes in the hope of securing a better offer.
After its members rejected the offer last week, the union leadership announced a 48-hour strike starting on April 30.
Sunak tried to play down the significance of the RCN vote, noting that only 54 per cent of the union’s members voted to reject the pay offer on a turnout of 61 per cent.
“When you look at the turnout, it’s a minority of members of that union who are voting to strike,” he said.
But according to YouGov polling, the public continue to support striking nurses. The research firm’s most recent survey showed that 67 per cent of people backed the strikes.
The sensitivity of the NHS was highlighted in a separate YouGov survey showing that voters made health their second biggest issue, behind the economy and ahead of immigration and asylum.
In spite of political pressure to settle the pay disputes, Sunak and his chancellor Jeremy Hunt have argued that the overarching priority this year is to bear down on inflation, which they blame for the wave of strikes.
Speaking in Washington last week, Hunt said core inflation of over 6 per cent was “directly related to pay rises”.
He added: “The worst possible thing we could do for junior doctors, nurses . . . or anyone is to manage the economy in a way that they are still worried about 10 per cent inflation in a year’s time.” Consumer price inflation stood at 10.4 per cent in February.
However the industrial action in the public sector — including strikes by civil servants and teachers — has added to an air of chaos at a time when the prime minister is trying to exude an air of managerial competence after the turmoil of his predecessors.
Voters will have their first chance to deliver a verdict on Sunak’s performance on May 4 in the local elections in England.
Greg Hands, Conservative party chair, has tried to manage expectations by warning the Tories could lose 1,000 seats.