I’m a former Tory minister and a doctor – and I say give striking nurses a better pay deal Dan Poulter

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For the first time in its history, the Royal College of Nursing has taken a pay strike. Next week, nurses in England will be joined by ambulance workers and other NHS staff in line to picket, and they may soon be joined by junior doctors. We must be clear that a strike on this scale is unprecedented in the history of our NHS.

As a doctor, I would never strike, because I worry about the effect on my patients. But it is important to recognize that many NHS workers are experiencing real financial hardship due to the ever-rising cost of living, and the Government’s failure to offer a reasonable wage offer does not help. So how did the government get into this mess, and what can be done about it?

Each year in February, the independent NHS wage review boards meet to look at the evidence, including the potential rate of inflation, in order to make recommendations about annual increases in wages for NHS workers. Government assertions that it is simply following the advice of independent wage review bodies should be treated with some scepticism.

In the recent past, the government has chosen to ignore the advice of the independent wage review body and offer lower-than-recommended wage adjustments for NHS staff. So, it is disingenuous for the government to now accept the recommendations because it is financially expedient for them to do so.

Wage review boards made their recommendations for the year before the war in Ukraine, which had a significant impact on inflation and the cost of living. In other words, the recommendations were made without reference to the single most important factor influencing take-home pay.

The government is certainly right about one thing: inflation makes everyone poorer, and a 4-5% wage offer makes nurses and other NHS workers poorer. Inflation alone warrants reconsidering the recommendations of pay review boards to ensure nurses get a better deal.

The government also needs to look properly at the healthcare economics of conflict. There are already a large number of nursing and other vacancies in the NHS, and as a result some £6bn a year is spent on temporary staffing costs, a bill that has doubled from around £3bn in 2015.

The cost and reliance on temporary staff is bad for patients, but while unacceptable and financially unsustainable, it appears to lack ministerial interest.

The government’s decision to squeeze nursing pay will push more nurses to vote with their feet, to leave the NHS and to earn more money either by working for temporary NHS staffing agencies or working for private healthcare providers. This can even lead to the harmful situation where real pay cuts mean that the same nurse can leave her NHS job and go back to working in the NHS, perhaps even in the same hospital department, as an agency nurse. The NHS will foot the bill for agency costs and the increased salary paid to the nurse.

This is bad health care economics. Wages must be set at a level that is conducive to recruiting and retaining the NHS workforce and it is time for some joint thinking from government. Investing in better salaries for nurses and other NHS staff will help improve staff retention and reduce the ever-growing temp bill.

Nursing Union demands for a wage increase of close to 20% are unreasonable, but it is equally unreasonable for the government to fail to acknowledge that the current independent wage recommendations were made without consideration of hyperinflation caused by the war in Ukraine.

The Scottish government has recognized this and has introduced an improved wage offer for NHS staff of nearly 8%, funded by adding an extra penny to the higher rate of income tax. The UK government should consider a similar enhanced pay settlement for NHS staff in England. This would cost around £2 billion and could be found without the need for tax increases if the government looked at NHS efficiencies, such as improving procurement practices, and recognized that investing in improving staff recruitment and retention would itself generate significant savings.

This is the worst time for an industrial strike in the NHS. There is an ever-increasing backlog of care resulting from the COVID pandemic – with 7 million people on waiting lists and growing – and the stress of winter. Unless the government and NHS staff can find a solution quickly, the real losers in this dispute will be patients.

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