Immediately following the death of the queen last Thursday, the Royal College of Nursing (RCN) announced it was suspending a strike ballot of almost 300,000 members in England and Wales over pay.

The RCN noted the queen had been its royal patron since 1953 and “out of respect, the NHS pay ballot due to open on 15th September will be delayed and campaigning will pause until further notice.” In doing so the RCN joined the postal and rail unions in suppressing a significant section of the working class in their fight against the erosion of pay and intolerable working conditions.

The suspension comes after months of delay by the union under conditions in which the NHS is disastrously understaffed and under-resourced. Earlier this month the NHS Confederation, representing health trusts, took the unprecedented step of calling on the government to act to avert a “humanitarian crisis” of ill health and excess deaths caused by the cost-of-living crisis and rising levels of inequality.

A surge in ill health would increase pressure on the beleaguered service, already set—in the words of NHS Confederation chief executive Matthew Taylor—to face “the most difficult winter on record”. NHS leaders are urging people to avoid “unnecessary” visits to A&E departments around winter.

At the end of July this year, the government announced its pay “rise” for 2.5 million public sector workers, including school teachers, senior civil servants, prison officers, the judiciary, and over one million NHS staff in England.

For broad sections of the NHS workforce, the pay increase is a fixed sum of just £1,400, rather than a percentage rise based on salary. For newly qualified nurses, this amounts to an approximate increase of only 5.5 percent. But for many nurses, it will be around 4 percent, when inflation is over 12 percent and rising. Nurses were already £6,000 worse off on average, in real terms pay, than in 2010.

A recent snap poll by Nursing Notes found that 74 percent of respondents “plan on working overtime or agency shifts to be able to pay for gas and electric.” More than half said they expected to work more than 37.5 hours extra a month to be able to make ends meet.

In another snap poll of 1,000 NHS staff, 150 reported they had sold holiday days—accepting payment instead of the time off. 700 staff said they had worked extra shifts “to get by” according to the Mirror.

NHS trusts have resumed charging staff for car parking, which had been suspended during the pandemic after public outcry. Some trusts are increasing these charges.

While there is supposedly no money to increase health workers’ pay, unlimited funds are available for the war machine. Prime Minister Liz Truss outlined that she would increase military spending from 2.1 percent of GDP to 3 percent.

The Royal United Services Institute for Defence and Security Studies (RUSI) think tank complained in a report last week that since the mid-1950s the increase in the share of GDP taken up by NHS and state pensions has come at the cost of defence spending. It pointedly declared that the era of the “peace dividend” over.

Truss has already made clear her eagerness for health spending cuts. In 2009 she wrote in The Spectator, “No department can be a no go area. This means the NHS, accounting for a sixth of government expenditure, cannot be put on a pedestal. Doctors’ pay which has risen inexorably needs to be restrained.”

Health trusts were struggling with heavily constrained budgets even before Truss took office. A hospital on the south coast recently asked staff to suggest “Cost Improvement Planning ideas” to reduce annual spending by £14 million.

The NHS’s million-plus strong workforce, the largest in Europe and one of the largest in the world, wields enormous collective power, but they have been systematically demobilized by the trade unions. No moves were made by the health unions to organise strikes in unity with national industrial action by rail and postal workers. They joined the other public sector unions in holding back millions of workers wanting to fight against similar paltry pay offers.

Members have been tied up in months of “consultative” balloting across different unions and parts of the country.

In June, the Scottish National Party government offered yet another below-inflation pay deal of just 5 percent for nurses in Scotland. The RCN, Unite, Unison and the GMB organised only consultative ballots, reporting results two months later. Over 90 percent rejected the deal and large majorities were in favour of strike action. Only Unison has announced a real strike ballot, closing October 31.

Unison’s 500,000 members in England and Wales will be balloted separately, closing November 25, with the union reporting that the “earliest possible” date for strike action in the “very end of December”. Meanwhile, it is encouraging its members to carry out “lobbying of new PM [Truss] and Chancellor [Kwasi Kwarteng]”, calling on these ardent Thatcherites to “act now to avert industrial action”. Unison pledges, “If at any point the government makes a meaningful attempt to open negotiations, we will take part in a constructive manner.”

Combined with the RCN’s indefinite postponement of its ballot, originally due to close on October 13, this keeps the vast majority of workers out of action for months more.

Unite’s ballot of 100,000 NHS members in England closed September 11, and in Wales will do so tomorrow (September 15). The GMB’s vote of tens of thousands more workers closes September 27.

The unions are continuing their years-long sabotage of health workers’ struggle. In 2018, fourteen different unions conspired to impose attacks on pay and conditions in the NHS which the RCN proclaimed, “the best deal in eight years”. It included below-inflation raises, productivity increases and cuts to sickness and unsocial hours entitlements.

RCN members responded with a huge vote of no confidence in the union’s leadership. Within a few months, however, the union had reassembled half of the expelled bureaucrats alongside some like-for-like replacements in its leading body.

Workers are so disgusted with the health unions that only a quarter voted in ballots last year against the government’s insulting 3 percent pay rise for NHS staff. The vast majority did not trust the likes of the RCN or Unison to lead anything other than a rout.

A struggle to defend the NHS, and the pay and conditions of health workers, cannot be based on these rotten organisations. A fight must be undertaken independently of and in opposition to the trade unions. We call on workers to join NHS FightBack, an initiative of the Socialist Equality Party launched to unify the struggles of health workers and establish rank-and-file committees of trusted workers to lead them.