UK Prime Minister Boris Johnson’s government has demonstrated its naked contempt for one million National Health Service (NHS) workers it hailed as “heroes” during the pandemic by offering an insulting 3 percent pay rise.

Even this was to have been worse, with the government only dropping plans to make 1.5 percent of the rise a one-off bonus on the July 21 day of the announcement in parliament, forcing a delay. To make things worse, the NHS’s 61,000 junior doctors, all medics below the level of consultant and in training, are excluded from the proposed award.

When it comes to making good a decade of austerity cuts and pay freezes that have blighted the NHS, these “key workers” count for nothing in the calculations of the ruling elite. A report released last week by independent charity, the Health Foundation, finds that in the decade to March 2021, nurses and health visitors were on average £1,600 a year worse off, midwives £1,800, and scientific, therapeutic, and technical staff £3,000. In real terms, doctors’ pay had fallen almost £800, but with wide variations given the different roles and salary grades.

With estimates of inflation over the next year running at four percent, the government’s revised offer of three percent rather than the one percent originally offered still means a pay cut for hundreds of thousands. The original offer stands revealed as a cynical means of sugar-coating the latest outrage.

Low pay and brutal exploitation is a precondition for clawing back the trillions handed over to the banks and corporations and in paving the way for an escalating privatisation of health care, which the Health and Care Bill now passing through parliament will streamline still further.

This is understood by health workers. Comments on the widely read Nursing Notes Facebook page are overwhelmingly hostile, calling the offer “an insult”, “derisory”, “a joke”. One nurse called it “another slap in the face after more than 10 years of effective pay cuts.”

Many supported taking industrial action, “we all need to strike”, “it's time to uprise”, “reject this offer & strike”.

Several were highly-critical of the role of the unions. A retired health worker said, “I would vote no [to the pay offer], and Unison are a waste of space.” Newly qualified nurse Paul wrote, “If we don't strike, we will never get paid our worth and never get respected, and the laughable unions we pay into will roll over like they always do”.

This understanding of the unions’ role has also been informed by bitter experience.

The coronavirus pandemic has exacted a terrible price from the NHS. More than 1,500 working in the NHS and social care have died from COVID-19. Tens of thousands of health/care workers became infected with the virus, leaving many with serious long-term health impacts. More than 220 nurses in Britain tried to commit suicide in the first year of the COVID-19 pandemic, along with 79 paramedic and ambulance staff and 17 medical students.

This took place thanks to the Conservative government’s criminal “herd immunity” policy, as again and again it abandoned lockdowns imposed in it by mass public pressure, and, in the words of Johnson himself, allowed the “bodies to pile high in their thousands”.

Once again, the July 19 “Freedom Day” and the ending of all containment measures heralds a further disaster as the Delta variant hits the not yet vaccinated, particularly younger layers and leaves nurses, doctors, and other NHS workers facing personal danger and intolerable workloads.

But throughout the pandemic, the Tories have relied on the support of the Labour Party and the trade unions to stifle opposition in the working class.

While Sir Kier Starmer offered Johnson Labour’s “constructive opposition”, the Trades Union Congress (TUC) was meeting with ministers and employers’ representatives to ensure workers were kept on the production line and in offices.

When the Tories proposed their 3 percent rise, Starmer tried to cynically pose as the friend of health workers, without even mentioning nurses, declaring, “The Tories have announced a real-terms pay cut for police, teachers, junior doctors and millions of public sector workers.” But the real terms cut of 3 percent is the same figure proposed by the devolved Labour government in Wales and will, after ritualistic grumbling, eventually also be “critically” embraced by Labour in Westminster.

The trade unions are also making noises of protest, with the British Medical Association (BMA) demanding a 5 percent salary increase, and the Royal College of Nurses 12.5 percent—which still does not account for the 20 percent fall in NHS workers’ wages during a decade of austerity and pay caps. But there is no chance of a genuine fight for such a rise by any health union.

There is muted talk of “sounding out” their members over what to do next by Unite and the GMB, but the RCN presently leads the field in producing hot air. Pat Cullen, the acting general secretary of the RCN, warned that nurses in England could go on strike for the first time over the offer, thundering, “The profession will not take this lying down… We will be consulting our members on what action they would like to take next.”

The RCN has boasted of a £35 million strike fund and of having trained 25,000 members as workplace activists. But the real measure of its intentions can be taken by its insistence that “Industrial action is a last resort”. This is the title of a document sent to RCN reps, reported on by Nursing Notes on July 16. Citing the same phrase bolded in red on several occasions, it gives a detailed account of “the long and complex process of taking industrial action.”

The document states, “When the government announces this year’s pay award it will be applied to NHS staff pay. This is NOT an offer and is NOT put to a vote of NHS staff.”

“If you work in the NHS your elected members have committed to asking you whether you think the award is acceptable or not so that they can feed back to the government on your behalf.”

Members must then vote on and pass three ballots if they want to oppose the government, a consultative ballot, a second indicative ballot and then a final statutory industrial action ballot. The document stresses that neither “consultative or indicative ballots… provide grounds to take industrial action.”

Before this happens, the RCN will enter into “formal dispute with employers… in an attempt to solve the dispute without further action.”

After this lengthy process, the final industrial action ballot would be held. And this requires the participation of 50 percent of all eligible RCN members in England, Wales and Scotland, and the backing of 40 percent of all members for industrial action, rather than a simple ballot majority.

This effort to exhaust and demoralise health workers is in line with the historic record of the health unions in suppressing or betraying industrial action. In 2016, the British Medical Association sold out the strike by junior doctors, who had rejected the pay deal reached by the BMA. In 2018, nurses rebelled against the RCN leadership, which had endorsed an effective pay cut, with 78 percent of members passing a motion of “no confidence” and forcing the entire leadership to stand down.

However, as NHS FightBack warned, “Nurses who are fighting the union sell-out cannot take a step forward just by replacing the top union bureaucrats. Over the last three decades, the trade unions have degenerated from defensive organisations of the working class into an industrial police force for governments and employers.”

The fight to build a new leadership is the principal task facing NHS workers. NHS FightBack and the Socialist Equality Party call for health workers to establish rank-and-file committees and take the struggle for a living wage into their own hands.

We urge all those who agree with this perspective to contact NHS FightBack and link up with our Facebook page.