The vote by members of the Royal College of Nursing (RCN) in England to reject the government’s derisory below inflation pay offer and continue their industrial action is a courageous step.

At the same time, it is necessary to sound a sober warning. Left in the hands of the RCN bureaucracy, which recommended acceptance of the rotten deal, nurses face a campaign of attrition by the union apparatus aimed at forcing capitulation. RCN leader Pat Cullen speaks of a possible six months of strike action without presenting any perspective for actually winning the dispute. Her aim is to grind down nurses’ resistance with the prospect of sporadic, costly and designedly ineffectual actions.

After months of determined strikes by nurses and other health workers, how have they arrived at the present situation?

The National Health Service (NHS) is regarded by working people as a supreme achievement, providing comprehensive health care to all, free at the point of delivery. Nurses and other NHS workers have made enormous sacrifices for decades, especially during the pandemic when many paid with their lives and health, to ensure vital services were kept running. The response of the Conservative government was to mount the cynical “Clap for Carers” stunt while they threw billions at their big business friends, including contracts for substandard PPE, before telling NHS staff there was no money for a decent pay rise.

Strike action by health workers is supported by millions, who understand that without adequately paid staff, the NHS faces collapse. Yet rather than mobilise their members based on this massive level of support, the fight for pay restoration and the defence of the NHS has taken the form of a head-on confrontation between nurses, junior doctors and other health workers against the union leaders.

The health unions have divided strikes by nation, region and profession, and even separate NHS trusts, into a series of limited actions on different days in different locations. The numbers involved in strikes on which the survival of the NHS depends have already been slashed by the betrayals of the health unions in agreeing rotten below-inflation settlements in Scotland and Wales with the Scottish National Party and Labour-led devolved governments.

Now the strategy of division is in full swing in England. The vote by RCN members in England to reject the latest insulting pay offer was made in defiance of a massive campaign of intimidation, including threats to call in the police against those organising a petition for an emergency general meeting to replace the union leadership.

But the RCN did succeed in whittling down the vote to 54 percent in favour of continued strike action and lowering the turnout to 61 percent. The same day the RCN result was reported, Unison, the biggest health sector union, announced acceptance of the same deal by 74 percent of those who voted after the union recommended it.

This leaves RCN members in England and junior doctors increasingly isolated in the pay battle—one that the RCN and British Medical Association offer no means of winning. Speaking to the BBC on Sunday, Cullen even categorically ruled out coordinating action with junior doctors.

More ballot results are due in the GMB and Unite unions on April 28. The GMB has also recommended the government’s offer to its members, presenting it as a “big win”. Unite did not make a recommendation and has reported “large numbers” voting against. Such is the strength of feeling among its members that the union has felt forced to announce strike dates on May 1 and 2, but only in certain local trusts.

Every statement by a union leader, national and regional, even now still speaks of the possibility of securing a compromise with the Tories—no matter how often the likes of Health Secretary Steve Barclay kick NHS workers in the teeth. The function of these endless, one-sided and fruitless “negotiations” is not to restore the many thousands of pounds health workers have lost over more than a decade of austerity and below inflation pay settlements, but to agree on the size of a pay-cut.

The Tories have even declared publicly that there is nothing to negotiate with nurses, citing Cullen’s insistence that “this is the final offer” when she recommended accepting the latest deal. A government spokesperson responded, “The Royal College of Nursing was clear that talks will not be reopened if members reject the pay offer and we agree.”

The government has made clear that the only money they will spend is on corporate bailouts, tax cuts for the rich and funding NATO’s war in Ukraine against Russia. By the end of this year, the UK government will have spent almost £5 billion on weaponry for Ukraine, more than enough to provide every health worker with a liveable wage.

The central issue facing nurses, junior doctors and all health workers is therefore to make a political and organisational reckoning with a union bureaucracy that functions as a fifth column of the Tory government in imposing the capitalist crisis on their backs.

NHS FightBack fully supports the demand for a no confidence vote and the removal of Cullen, National Executive Council members who endorsed the deal, and the RCN’s negotiating committee. We urge that the same action be taken in every union that has imposed filthy sell-out deals on its members and denounce the attacks on the NHS Workers Say NO group for campaigning against the leadership’s recommendation of the government’s offer.

But NHS FightBack insists that breaking the stranglehold of a bureaucracy working hand-in-glove with the Tory government and the state and restoring control to health workers means waging a civil war in the unions. It is not enough for the old leaders to be thrown out. Something new must be built.

Victory depends on the formation of workers’ own representative organisations, rank-and-file committees, independent of the structures of the union and run by the most trusted workers.

A campaign linking the fight of health workers with those at Royal Mail, on the railways, and in universities, colleges and schools, linked together through rank-and-file committees, would provide the basis for a powerful counteroffensive to break through the trade union bureaucrats’ division and suppression of workers’ struggles.

Above all, the efforts by the unions to keep workers in the UK isolated from their class brothers and sisters internationally must be politically opposed.

Not once, not ever, does any union leader speak of the fight for the NHS in anything but national terms, under conditions where millions internationally are fighting against identical pay cuts and the gutting of essential services and social provisions.

Millions have taken to the streets in France, in opposition to cuts in pensions being imposed by the Macron administration. But while workers popularly adopt the hashtag #BeMoreFrench, the bureaucracy fears the contagion of class struggle spreading across the 20 miles of the Channel.

Strikes by public sector workers in Germany have included nurses and other hospital staff; in Galicia, Spain, doctors walked out on indefinite strike last week.

Tens of thousands of workers in the Americas, Asia and Australia have been involved in bitter struggles to secure their pay, including many nurses and health care workers in the US.

Two essential conclusions must be drawn that will guide the fightback in the NHS:

The claim that the Tories can be persuaded to preserve the NHS with a bit of pressure from below cannot stand up when measured against the universal drive by the ruling class to make workers pay for the billions handed over to the corporations during the pandemic; the rampant inflation eroding living standards; and the escalation of militarism and war. The fight must be for the bringing down of the government in a general strike.

In the fight against this ruling class offensive, the allies of workers in the UK are their brothers and sisters in Europe and throughout the world. Fighting in unity, the international working class will become an unstoppable force.

NHS FightBack will provide every assistance in this battle. Contact us today.