‘The way the NHS is managed is breaking workers’. Bristol nurses take historic strike action
Photos: Luc Lacey
“It was -8 degrees when I arrived at 7 this morning!” Elena* tells me, wearing a black Royal College of Nursing (RCN) beanie and clutching a hot water bottle. A 7am start she tells me is typical for a twelve-hour day shift as a nurse. Except today, Elena is not going to work, she’s on strike.
I meet Elena and her friend Sara* at the picket line outside the Bristol Royal Infirmary (BRI). This is the first of two planned days of strike action by the RCN – for the first time in its 106-year history. Some 100,000 nursing staff are taking part in strikes in England, Northern Ireland and Wales
Elena has worked as a nurse in the BRI for seven years, Sara for five. They met while working together on the critical care ward. Neither Elena nor Sara took the decision to strike lightly, “We were all worried about our patients safety, but they assured us there would be enough cover,” says Elena.
“Understaffed, overworked, underpaid, overstretched” – this refrain about the NHS is repeated so often on placards, in conversation, in the media – it’s easy to become desensitised to its true meaning. But speaking to Elena and Sara brings home the reality behind these words, and its human cost.
“The way the NHS is managed now – it’s breaking people,” says Sara.
Scenes at the picket
The picket line was some 100 strong, bedecked with placards and banners. Nearby cafes had donated boxes of cakes, biscuits and coffees, while members of the public clapped and dropped off boxes of celebrations. A YouGov poll commissioned by the RCN found that 65% of the public supported nurses in their decision to strike, which is reflected by the near continual honking of the cars driving down Maudlin Street.
Ambulances, bus drivers, builders driving past toot their horns and wave fists of solidarity. It’s a reminder of the other workers’ struggles that rage on, and the wider context of a nationwide ‘winter of discontent’.
Suddenly a chant of “Pat, Pat, Pat” begins, and we turn to see that head of the RCN Pat Cullen, who’d been visiting pickets up and down the country. “She’s a hero,” Sara says to me. Her rousing speech is met with roars of applause, her presence a much needed morale boost as she hugs nurses along the picket lines.
“I was scared the public was not going to support us, because that’s the whole point, we are fighting for them and the health system,” says Elena.
Underpaid
A 3% pay rise offered to nurses in February this year was rejected by unions demanding a 5% pay rise above inflation. The Trade Union Congress found that the real-terms pay of nurses was already down £5,200 compared to 2010, following a decade of “standstill wages”.
Added to this, the bursary for student nurses has been scrapped. “So now you have to study for three or four years, paying fees, doing your unpaid placement hours, and work part time and do uni work to make ends meet!” says Ellie – another nurse at the picket.
On top of that, nurses must pay £130 a year to pay for their official registration, buy and wash their own uniform and pay for travel costs and parking. Paying to make ends meet comes at the expense of your social life, nurses tell me, taking on night shifts and weekend work where the pay rate is higher.
Still they count themselves lucky. “I have colleagues who have two kids and can’t pay bills for heating,” says Sara.
“I heard they have a food bank in the trust for workers – and it’s empty. I had tears in my eyes when I heard that. My colleagues are struggling, they cannot buy food, and then there is no food for them to get from us [the trust]!” says Elena, welling up as she speaks.
“I have friends who are leaving to work in Aldi – and I don’t blame them,” she adds. “After all the studying that we do, you get paid the same money as you would to work in a supermarket – and without the risk.”
“But for me this is not just about money, this is about our patient’s safety,” says Sara. “We need to improve conditions for future generations or there will be no nurses in 20 years.”
Overworked and understaffed
Sara points behind us to the ambulance parking bay. “Last winter, there was a 10-12 hour waiting time to go to A&E. There were queues of ambulances outside and doctors and nurses were looking after patients in the ambulances!”
According to these nurses, the crisis in the NHS has felt most acute since 2020 – with many nurses leaving after Brexit, then due to the stress of the pandemic. The cost of living crisis is just the latest event in a steadily worsening picture. As reported by the Guardian, the number of posts lying vacant across the NHS in England has reached a record high of 132,139 – almost 10% of its planned workforce.
The RCN have long warned of the pressures from nurse to patient ratios diluted to meet demand, strikers I speak to tell me that staffing ratios which used to be 1 to 6-8 are now up to 15 to 20.
And job shortages are across the board, from nursing assistants to housekeepers. Nurses are now having to add food delivery, medication rounds, personal care responsibilities such as going to the toilet and washing, as well as their regular duties.
Nurses are often moved to whichever ward is shortest staffed. “There’s no one to show you around, you don’t know where things are,” says Sara. “What if there’s an emergency? It’s not safe!”
Mental health struggles
Naturally, such levels of pressure and stress take a toll on nurses’ mental health, but, for Elena, it’s the guilt that weighs on her the hardest.
“People don’t realise how bad Covid was for us. I still have nightmares.” Elena found herself at a crisis point last summer. “When people were getting back to normality, and everyone was carrying on with their lives and I couldn’t. I was too stressed, feeling too guilty for not being able to give more.”
When her mental health was reaching a suicidal point, Elena’s managers were supportive and told her to go home. “That would make it worse – because my guilt is around neglecting my patients,” she says.
“I still feel we are not able to mourn for our patients, to process seeing them struggle and suffer with their family members. And we were the ones holding their hands, we were holding up iPads so they could talk to their relatives while they were dying.”
Both nurses now use the Healthier Together service, which provides five free counselling sessions for NHS workers.
Feeling undervalued
As I speak to Elena and Sara, various colleagues come and go. Managers, doctors, senior nursing staff. The nurses say they have received strong support from their team.
“Knowing what I know now,” another nurse tells me, “I wouldn’t go into this profession.”
There is agreement from other strikers who’ve joined our group. “Yeah it’s frustrating when you’re doing so much and through it every day and you feel like – is it worth it?
They have supported the junior doctors who went on strike. “Everyone in the hospitals – from the cleaners, porters, assistants – everyone needs to be paid more to work as a team,” says Sara.
And a strong political resentment underlies this dispute. The paradox of the strike is many feel that while conditions should be improved, years of budget cuts have brought the NHS to its knees.
“I feel there is an agenda to underfund the NHS until it collapses – and people are here to voice their discontent with the government,” another nurse tells me.
There are also upcoming strikes in the ambulance service, with three unions representing the service going on strike on 21 December and a smaller one-union strike a week later. The Royal College of Midwives also balloted workers on potential strike action but it was announced on Monday that they had not reached the threshold for strike action.
On Monday, Eugine Yafele, chief executive of the NHS trust that runs Weston General as well as hospitals in Bristol, told a meeting of the trust’s board: “We are still working through the number of colleagues who will be taking strike action and as a consequence how we might be able to have contingencies in place to ensure that we can deliver safe services.”
Health Secretary Steve Barclay insists a pay increase for nurses is “not affordable”
Until negotiations begin more strike action is promised by both by Unison and the RCN as soon as January.
*Names changed to protect identities
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Hard-hitting interview. Good work, Cable.
Student nurses have to pay for their books, uniforms, shoes and parking too, and when my friend’s grand-daughter, who had almost completed her four year course, said that she had been offered employment, she was told that it wasn’t her decision to choose where she would be working.