Nurse strike Q&A: All the questions answered as Royal College of Nursing confirms ‘historic’ action

Tens of thousands of NHS nurses, healthcare assistants and midwives will strike this winter over pay, it was confirmed today.

There are fears that the resulting drop in staffing levels will lead to thousands of diagnostic tests and elective operations being cancelled at a time of record care backlogs.

Strike action could also pile even more pressure on to the health service at its hardest time of year, as it battles winter pressures and expected waves of Covid and flu meaning both admissions will rise and more staff will be off from work sick. 

The RCN is arguing for an inflation-busting pay rise for its NHS nurses amid reports staff are being forced to use food banks or quitting the profession entirely due to the rising cost of living. 

Here, MailOnline answers all of your key questions surrounding the strikes and what happens next. 

What is the Royal College of Nursing? 

The RCN is Britain’s largest nursing union, with its membership consisting of nurses of all specialties.

This includes general nurses working in NHS hospitals as well as specialists working in mental health, cancer and paediatrics.

Its members also include some other health and care staff groups like midwives and healthcare assistants. 

Why are members striking? 

The RCN argues that its members working in the NHS are not paid enough and this is contributing to crippling staffing problems in the health service. 

While this argument has been brewing for years, soaring inflation due to the cost-of-living crisis has exacerbated concerns.

There have been reports of nurses struggling to pay their bills or leaving for better-paid jobs in sectors like retail. 

On October 6, the RCN launched a historic ballot asking 300,000 members working in the NHS across the UK if they would on taking strike action. 

Ballots closed on November 2 and the results were revealed today. 

What was the result?

In total, 178 NHS organisations voted to strike across the UK after meeting the legal thresholds for industrial action.

This includes all of the NHS employers in Northern Ireland and Scotland and all bar one in Wales. In England, this includes 130 NHS organisations. 

The types of NHS bodies impacted by strike action includes NHS trusts and health boards which manage hospitals, ambulance trusts, and Integrated Care Bodies, which broadly manage NHS services in areas of England.

Of the total organisations that returned a valid strike ballot in England, roughly 50 are acute NHS trusts that provide hospital care. Six out of 11 ambulance trusts also voted to strike. 

What does the RCN want?

The union wants nurses to get a pay rise 5 per cent above inflation, which currently sits around 12 per cent. 

This would grant the average nurse, who earns roughly £35,600 each year, an extra £6,000 annually. 

This is far above the Government’s offer of about 4 per cent.

So what happens now? 

The RCN is expected to unveil further details of the strike action in the weeks to come.

This will include which parts of the NHS will be affected by strike action on what days, as well as for how long. 

Previous strike action by nurses in Northern Ireland in 2019/20 saw nurses walk off the jobs from almost all services minus those providing life saving care in 12-hour blocks.

I have an operation scheduled at my local NHS hospital in the next few months, could it be cancelled?

Previous strikes by NHS staff have led to the cancellation of non-emergency ops and appointments. 

If your appointment is already scheduled for days where action takes place, it could be cancelled because it is probably not classified as urgent. 

If an individual appointment is axed or not will depend on if the date falls on a strike action day, and if nurses at the trust are walking off the job. 

Another factor is how long the dispute between the Government and the union runs.

Some appointments not on strike days may also be delayed because more urgent procedures cancelled need to be prioritised. 

What determines which hospitals or NHS services will strike? 

The RCN balloted nurses at 311 NHS organisations and 178 came back with a valid result in favour of strike action. 

What makes a valid strike action ballot differs depending on the trade union law across the UK nation.

In England and Scotland, 50 per cent of the eligible membership must vote for the ballot to be valid, and at least 40 per cent of votes must be in favour of the action for the result to count. 

For Wales, at least 50 per cent of the eligible membership must vote but only a simple majority is needed to determine the result.

Northern Ireland has the least restrictions on strike action ballots, only a simple majority of those who vote is required with no minimum turnout threshold. 

When could nurses go on strike?

Northern Ireland requires strike action to take place within one month of the ballot closing, so before December 3.

The law in England, Scotland and Wales states strike action has to be held within six months of the ballot closing, so by the start of May. 

Industrial action is expected to begin before Christmas, with reports that it will take place over two dates, potentially a Tuesday and a Thursday. 

Have any dates been announced so far?

No. It is also unclear if the strike will be held continuously, as in for multiple days in a row, or on certain days spaced throughout the month.

The junior doctors industrial dispute in 2016 led to staff withdrawing labour on four dates.

They performed a general strike on January 12, February 10 and March 9-10.

And on April 26-27 junior doctors withdrew from providing both routine and emergency care.

In total the strikes led to the cancellation of 100,000  patient appointments. 

We don’t know if the RCN strike will follow a similar model. 

Won’t a strike put patients in danger?

Unlike other staff groups who take strike action, nurses are required by law to maintain a minimum staffing level to keep patients safe.

Therefore, some nurses will be exempt from the strike to provide this minimum level of service.

The exact numbers remaining on the job will be negotiated locally between the RCN and each NHS Trust/Board.

What kind of NHS services could be scrapped?

Senior health officials have warned patients are expected to only receive a ‘bank holiday’ level of service on days nurses walk off the job.

This means vital cancer and kidney disease treatments and routine operations like knee or hip replacements could be axed, or rescheduled. 

Other procedures and treatment that might be scrapped include chemotherapy and dialysis.

Emergency care is not expected to be impacted by strike action, as this is needed to ensure life-saving care is provided to the public. 

Won’t some patients suffer from elective procedure being cancelled?

Yes. Patients on waiting lists for elective care often have a reduced quality of life as they live in pain for months at a time and can suffer health problems from a lack of treatment.

However, the RCN argues that improved pay is needed to help boost staffing in the NHS which is considered to be one of the main reasons contributing to long elective care waiting times in the first place. 

The NHS waiting list for routine operations in August in England breached 7million for the first time ever. This includes almost 390,000 patients who’ve been forced to wait over a year for treatment

NHS data shows efforts to get more nurses into the health service are only barely keeping pace with the number of experienced nurses quitting

The latest NHS data recorded that about 45,000 nursing posts in England are vacant as of the end of June. London has highest percentage missing, with 15 per cent of nursing posts unfilled

If some nurses are still working what’s the point of a strike?

While life-saving care will be provided, a nursing strike is likely to lead to cancellation of hundreds of routine operations. 

Similar large-scale strike action by junior doctors in 2016 led to the cancellation of 100,000 patient appointments.

Can nurses be sacked for striking?

No. NHS workers cannot legally be sacked if they participate in official and lawful industrial action. 

The nurses regulator the Nursing and Midwifery Council, which has the power to strike off nurses from the profession, has also made it clear it will not penalise nurses for taking industrial action. 

Are the strikes avoidable?

The RCN says the Government can stop the strikes if it agrees to meet their demands on pay.

However, the Government has refused to even say it will meet with the union following the result of the ballot. 

Will the Government cave to RCN demands?

Unknown. But if the No10 gives in to nurses it will face pressure to provide similar pay rises to other NHS staff groups, with junior doctors, midwives and other health service staff also arguing for inflation busting pay rises. 

At a time when state services are being asked to tighten their belts due to financial pressures the Government is likely to argue it can’t afford to pay NHS staff more than it has offered.

What is the NHS doing to prepare for strike action? 

At the start of November hospitals in England were ordered to plan a military-style operation to prepare for potential strike action. 

Called Exercise Arctic Willow, the multi-day operation is designed to test their ‘preparedness’ for winter and will take place in mid-November.

This is an extension to the normal routine winter preparedness exercises carried out by trusts to prepare for seasonal problems like an increase in flu admissions. 

How long does it take to train a nurse? And how much does it pay?

It generally takes a minimum of three years to train a nurse.

Upon graduating nurses enter the NHS on band 5 which pays £27,055 in England.

Different pay structures apply in the other UK nations.  

What are other staff groups doing? Is more industrial action on the way?

The RCN is just one NHS union which has or is balloting its members over pay

Nurses aren’t alone in their discontent with NHS pay. 

A plethora of other staff groups are mulling over industrial action including potential strikes.

This week the union Unite announced its was expanding its NHS strike ballot to 100,000 members working in the health service in England and Wales.

The new ballot will incorporate nurses, as well as mental health staff, NHS dentists, paramedics as well as health service estate and admin staff. 

Unite was previously balloting ambulance drivers in Scotland and England on potential strike action but said the situation in the NHS had prompted an expansion to other groups. 

If the Unite ballot returns a yes result, the union said its members would strike in the New Year. 

Other previously staff unions that have touted industrial action include the Royal College of Midwives which has asked its 50,000 members to vote in support of action when ballots open on November 11. 

Two-thirds have already said they would be willing to strike in a preliminary poll. 

More than 15,000 ambulance workers at 11 trusts in England and Wales are being balloted on industrial action over pay and ‘unsafe’ working conditions. 

The GMB union said if the strikes went ahead, which could take place ahead of Christmas, it would be the biggest for three decades. 

Some 8,000 members in Scotland last week voted ‘overwhelmingly’ in favour of industrial action. 

And the Chartered Society of Physiotherapy said more than eight in 10 of its 60,000 members across the UK are prepared to strike.

Members in Scotland last week voted in favour of strike action. Voting in England closes today, while members in Wales have until December 12 to post their ballot.

It makes the first time members have been balloted over pay in the CSP’s 100-year history. 

Meanwhile, the British Medical Association will ballot junior doctors in early January on whether it should strike over pay.