The vote to strike by 300,000 UK nurses is a powerful show of opposition to entrenched low pay and appalling working conditions. It gives expression to a broader determination of workers throughout the National Health Service (NHS) to fight.

Nurses delivered the largest ballot by the Royal College of Nursing (RCN) in the union’s 106-year history.

Despite anti-strike laws requiring a 50 percent turnout to allow strikes to proceed, nursing staff at 176 out of 311 NHS organisations voted for industrial action. Nearly half the trusts in England reached the threshold. All NHS employees in Northern Ireland and Scotland met the threshold and all except one trust in Wales.

The RCN ballot paper called for a pay deal of retail prices index inflation (RPI) plus five percent, against the Conservative government’s fixed sum of just £1,400. For newly qualified nurses, this is approximately 5.5 percent, and for most others around 4 percent. RPI inflation is over 12 percent and rising.

Nurses are already £6,000 worse off on average, in real terms pay, than in 2010. An experienced nurse’s salary has fallen by at least 20 percent in real terms since 2010.

According to analysis published this month by the London Economics consultancy an experienced nurse in 2022-23 is being paid the same amount for 5 days’ work as for 4 days’ work in 2010-11.

The nurses’ fight involves the very future of public health care. Years of budget cuts and privatisation have collapsed the NHS, leaving it unable to provide proper care. In August, for the first time ever in England, the NHS waiting list for routine operations breached 7 million. Almost 390,000 patients have been forced to wait over a year for treatment.

Staff numbers have collapsed, meaning nurses bear an intolerable workload, threatening patient safety. In 2021, 25,000 nursing staff left the Nursing and Midwifery Council register.

The number of vacant positions for registered nurses in England increased to 46,828 between April and June of 2022—up from 38,814 in the same period in 2021. In London, with a population of over 9 million, a staggering 15 percent of nursing posts are unfilled.

Bed capacity has been severely eroded, with 40,000 fewer beds available in England than in 2009.

The onslaught against NHS workers is summed up by the fact that hundreds perished from COVID during the pandemic, as they worked on the front line while the government allowed the virus to let rip. By May 2021, over 1,500 health and social care workers had died of COVID , including 639 working-age healthcare employees.

The fact that so many workers in England did not vote is an indictment of the role of the RCN and other health unions over years in sabotaging a fight against terrible pay and conditions in the NHS.

If the strike is to be won, or even to go ahead at all, independent rank-and-file committees must be built to lead the struggle. Left in the hands of the RCN apparatus, it will be defeated.

For the vast majority of its history, until 1995, the RCN did not even allow its members to strike. But ever since, the experience of hundreds of thousands of workers with this union is that it will not wage a fight. The strike ballot in the current dispute—due to open on September 15—was delayed for weeks immediately following the death of the queen that month “out of respect” for the monarch.

In 2018, the RCN and 13 other health unions, including the largest public sector union, Unison, reached a pay deal with the Tory government, selling a miserly 6.5 percent pay “increase” as “the best deal in eight years” and bombarding members with misleading information to secure acceptance.

As soon as the real impact of the deal was expressed in their pay packets, health workers rebelled. RCN members called for an Extraordinary General Meeting and overwhelmingly passed a motion of no confidence “in the current leadership of the Royal College of Nursing”, calling for them to “stand down”.

The leadership Council was forced to step down in September that year, but with no alternative leadership the despised union functionaries were able to exploit the widespread disengagement of members and secure re-election. These bureaucrats are responsible for the disaster now facing RCN members.

Last year the health sector unions organised nothing after workers in the GMB, Unite and Unison voted by huge majorities to reject the government’s insulting 3 percent pay offer. RCN members voted by 91.7 percent in England to reject, and by 93.9 percent in Wales.

Every union bureaucrat, whether nominally “left” or “right”, plays the same role in suppressing the class struggle. They feel the same dread as the employers when presented with a mandate to strike, as a movement of the working class threatens their cosy relationship with the bosses and their comfortable lifestyles.

The NHS workforce of over 1 million is a powerful battalion of the working class, which enjoys widespread support for their struggle. Over 400,000 NHS staff in Unison—the largest NHS union—and others in different health unions are also balloting for action. Were they to be mobilised in a joint offensive, in alliance with hundreds of thousands of other workers in the rail, postal and other sectors, they would be able to defeat not only to attempts to hold down their pay and worsen conditions, but a government agenda intent on privatising the NHS, and transferring over £150 billion in welfare state spending to the military budget.

But at the first opportunity the RCN will move to sell out the nurses and negotiate a rotten deal with the government.

This has already taken place in Scotland where Unison negotiated a below inflation deal that the health unions nationally want to emulate. Last month the union suspended its strike ballot of 50,000 NHS members to recommend a Scottish National Party government offer of just £2,200 a year. Following that deal, Unison general secretary Christina McAnea declared, “Strikes across the NHS this winter are not inevitable.”

Following Wednesday’s RCN strike vote announcement, the union’s General Secretary Pat Cullen declared, “While we plan our strike action, next week’s budget is the UK government's opportunity to signal a new direction with serious investment. Across the country, politicians have the power to stop this now and at any point.”

This is not what the Tories are about. Chancellor Jeremy Hunt, who is tasked by the financial markets to carry out tens of billions in spending cuts in what will be a scorched earth budget this month, was the health secretary in 2016 when, in collaboration with the British Medical Association, the Tories defeated a national strike of 50,000 junior doctors and imposed an inferior contract.

Nurses and workers throughout the NHS must not be led to another hideous defeat.

NHS FightBack was established in 2012 by the Socialist Equality Party to provide an alternative, fighting leadership and organisation for health workers. Today, as part of a growing network of workers across the globe in the International Workers Alliance of Rank-and-File Committees (IWA-RFC), it must be built among NHS workers.

NHS FightBack calls for the leadership of the struggle to be taken out of the hands of the union bureaucracy and placed in the hands of rank-and-file committees in every hospital and workplace. We will help you set up such committees.

The fight for better pay must be linked to a broader struggle on conditions and a struggle to defend the NHS against privatisation and sell-off. All the resources of society must be placed in the hands of the working class and used for the benefit of all, not the enrichment of a few. This socialist programme would see the NHS given the necessary vast resources of which it has been starved.

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