The Ward Round: Fight, or walk

The die has been cast and battle lines are being drawn.

The government’s public sector pay announcements were made earlier this week and – unsurprisingly – they amounted to a real-terms pay cut for most NHS staff.

The Department of Health and Social Care has been clear about the need to balance a fair pay rise with keeping a cap on public spending, but the outcome of this deal has still seen unions react with anger and frustration.

The Royal College of Nursing immediately announced a strike ballot, with other unions later following suit.

Jon Restell, chief executive of union Managers in Partnership, told HSJ the pay cut “might be the final straw” for Bands 8 and 9 staff — who will see their pay increase by no more than 2.6 per cent — and called on employers to pay staff in these bands overtime “to show they are valued”.

Considering this clear strength of feeling, how real is the risk of strike action?

Major bodies such as the British Medical Association and the RCN will need their leaders to convince members disaffected by the pay award that they can be relied upon to lead the charge, and considering their various debacles in recent years, this could be challenging.

It is yet to be seen if either, or both, will join forces with other unions to launch large-scale industrial action. Early indications suggest this is unlikely.

A workforce policy expert, who wished to remain anonymous, said they would be surprised if there was not at least one successful ballot, and suggested junior doctors were most likely to do something “given the scale of anger, given the outcome they got [and] given how far apart the sides are”.

However, they warned of the potential fallout for local leaders: “Even if the strikes aren’t happening, I’m sure this will play a part for some people in wanting to leave the service. Certainly, the overall anger that it might cause for some staff.

“[It could be that] staff are angry but there are no strikes. That’s still very difficult to manage at a local level because there’s that simmering tension that’s slightly unresolved,” they added.

A trade union insider who also wished to remain anonymous believes there will be “a lot of noise”, but felt the smaller unions had a stronger chance of delivering industrial action than large ones.

Another speculated to the Ward Round that some unions may ballot trust-by-trust, rather than nationally, since the larger ones often struggle to achieve legally compliant results in these scenarios.

They said: “I think members are at the end of their tether and the question is [whether to] fight or walk.”

Burnout emergency 

On the subject of staff at the end of their tether, the General Medical Council’s latest Training Survey has reported a worsening picture of burnout among medical professionals.

The results revealed that two-thirds of medical trainees and over half of trainers reported either a moderate or high risk of burnout, which was the highest level since questions relating to burnout were introduced in 2018.

The trainee group feeling this most acutely were emergency medicine doctors; one in three doctors were at a high risk of burnout, an 11 per cent increase from last year’s survey. The same can be said for emergency medicine trainers, with almost a quarter reporting high levels of burnout.

The GMC noted that burnout and stress have “profound behavioural, psychological, and physiological consequences for doctors”.

It also noted the link between burnout and retention, as doctors are more likely to leave the profession, reduce their hours and take early retirement if burnt out.

Royal College of Emergency Medicine president Katherine Henderson described the survey as “grim reading”.

“The statistics on burnout and the current pressures facing emergency care are huge threats to both trainers and trainees and their ability to supervise or learn,” Dr Henderson said.

She continued: “For many senior staff it is the worst it has ever been, for trainees it is completely unsustainable. Resilience, adrenaline, and goodwill will only take you so far.”

This survey was of course done before the NHS’s “worst night ever”, which saw record ambulance handover times and very severe pressures in accident and emergency departments. It would follow that this particular group of doctors are feeling the strain even more now.

Dr Henderson has called again for the government to deliver the fully funded workforce plan, and include measures to retain existing staff as well as recruit new staff.

However, as confirmed in Health Education England’s board this week, the first part of the workforce plan – Framework 15 – was due to be published before the summer but governmental chaos has put the breaks on.

The NHS is being forced to make serious sacrifices to fund the staff pay bill. Will this also curtail the amount available to invest in recruitment and retention?