Nurses across the UK have voted overwhelmingly to reject the Starmer Labour government’s 3.6 percent pay award, but the Royal College of Nursing (RCN) is doing nothing to oppose its unilateral imposition at the end of this month.

Nine out of 10 nurses voted last month in a consultative ballot in England, Wales and Northern Ireland to reject the government’s below-inflation pay award. Turnout was 56 percent, with 170,000 nursing staff in England taking part, the highest ever. 

Ahead of the ballot, RCN General Secretary Nicola Ranger admitted: “This pay award is entirely swallowed up by inflation and does nothing to change the status quo – where nursing is not valued, too few enter it and too many quit.”

Pay for nurses in the National Health Service (NHS) is lower today in real terms than it was in 2010. Starting salaries are £8,000 behind where they should be, according to data published last month. Some experienced nurses have suffered pay cuts of up to 20 percent. This collapse in wages has fuelled a retention crisis, with nurses unable to meet basic living costs. Many nurses work two jobs, or work extra hours in the nurses resource pool (bank), as they try to keep their heads above water.

Announcing the ballot results, the RCN reported, “91% said the NHS staff pay award of 3.6% was not enough to turn around a profession gripped by widespread vacancies, years of pay erosion and thwarted career progression. Nursing staff are struggling to keep patients safe amidst an NHS corridor care crisis and other unsafe conditions.” 

NHS staff who are members of GMB and Unite have also rejected the government’s pay award, by 67 percent and 89 percent respectively. Unison members indicated they would back walkouts if the union balloted for strike action.

But Unison, RCN and Unite have refused to authorise anything beyond toothless, non-binding consultative ballots. These are a calculated delaying tactic, aimed at softening resistance and wearing down NHS workers’ anger. Past ballots were similarly drawn out or manipulated, with health union officials including the RCN overriding strike mandates.

Instead of balloting for strike action, the RCN is channelling members into futile appeals to the Labour government, with Ranger begging ministers to: “wake up, sense the urgency here and do what’s right.”

RCN officials appealed to Labour to negotiate over the summer to “invest in the nursing workforce” and to reform the NHS Agenda for Change pay structure imposed more than two decades ago to suppress wages. But Health Secretary Wes Streeting has made clear the government has no such intention.

Streeting’s “Fit for the Future: 10 Year Health Plan”—a blueprint for accelerating NHS privatisation—is proceeding apace with no opposition from the health unions. Under the pretext of delivering improved “patient choice”, Labour is expanding the role of private providers, embedding a two-tier system where those who can pay receive faster treatment, while those who cannot, will face worsening delays.

Labour is handing £2.5 billion to private companies for elective procedures, while NHS trusts have been directed to deliver 12 percent efficiency savings. This means more understaffing, longer hours, and worsening patient care. It is the systematic cannibalisation of the NHS in the interests of private profiteers.

The RCN refuses to challenge this agenda. It is working with the other health unions to block unified action across the UK, isolating different sections and dissipating momentum. In Scotland, it accepted a pitiful 8 percent pay offer spread over two years.

The anger among nurses is palpable. When results of the consultative vote were announced on the RCN’s Facebook page, members immediately questioned why the RCN was refusing to ballot for strike action.

Julie, a nurse in Cornwall, wrote: “Where has the RCN been hiding since 2010? Pay freezes then 1% for best part of a decade, real terms pay cuts for nurses. The profession is on its knees now, can’t think why! You should have fought harder back then. Those highly trained staff may have stayed if you had.”

Danny commented: “[ I ] think people get tired of voting to have a vote about a vote that inevitably nothing happens from.”

Mark challenged: “Members voted to reject the offer, yet you have already decided not to press for more pay, instead waffling on about Banding changes… Which would take years… What a bunch of charlatans and con artists the RCN leadership are.”

David answered RCN’s talk about negotiations over summer with the government: “But they’ve ignored you for the last year, and now they’re on holiday, so you’re wasting the summer. It will be Christmas before you decide on a ballot, which you as leaders have made more difficult—so any momentum is lost.”

He also challenged RCN’s refusal to coordinate action with striking resident doctors: “We should have gone for a strike ballot and worked with the doctors, but I guess you know best.”

There is growing hostility towards the union bureaucracy after years of betrayal. Nurses have experienced more than a decade of pay freezes and deteriorating conditions—years in which the RCN refused to mount a serious struggle.

The RCN’s role in sabotaging united action is shown in its isolation of industrial action by doctors. That struggle is at a crossroads with the British Medical Association’s Resident Doctors Committee grovelling before Streeting. Instead of joining forces to demand pay restoration and the defence of the NHS for all workers, the health unions have kept the doctors’ strikes at arm’s length. This calculated strategy has blocked the emergence of a powerful movement capable of defeating the government.

Streeting has branded the doctors’ strikes “unreasonable” and “reckless.” The unions’ collective silence in the face of these attacks speaks volumes.

After more than a decade of declining real wages, nurses launched historic strikes in 2022 and 2023—the first in the RCN’s 106-year history—demanding a 19 percent rise to restore pay levels. This fight was betrayed by the RCN leadership, which endorsed a deal worth around 5 percent, plus a one-off payment, far below inflation.

Last year, after nurses rejected a 5.5 percent pay award for 2024/25, RCN leaders blocked any ballot, suppressing opposition to the incoming Starmer government.

The experience of recent years makes one thing clear: nurses cannot rely on the health unions to defend them. Rank-and-file committees must be created in every workplace, uniting workers across the NHS to prepare a fightback.

NHS FightBack proposes the following demands:

• Rescind Labour’s cuts to NHS Trusts! Fund hospitals not NATO!

• Billions for the NHS not private profiteers! Oppose privatisation in all forms!

• Full pay restoration, starting with a 25 percent increase for 2025/26 to reflect nurses’ real value and reverse the staffing exodus!

• Abolish Agenda for Change pay structures. For the mass hiring of new nurses and allied health professionals on full pay from day one!