Rishi Sunak appears set on trying to face down unions in a high-risk strategy to tough out a renewed wave of NHS strikes in England that health service leaders warned were unsustainable and could put patient safety at risk.
With the prime minister and his health secretary, Steve Barclay, seemingly offering no fresh concessions for nurses or junior doctors, they risk the possibility of combined strike action, a scenario one NHS leader said would put the health service “into uncharted territory”.
The British Medical Association (BMA), which represents the doctors, has so far only ruled out combined action for the next nurses’ strike, starting on 30 April, and is holding out the possibility of joint strikes if the disputes drag on as a means to push the government into action.
Pat Cullen, the general secretary of the Royal College of Nursing (RCN), whose members narrowly rejected what was billed as a “final” pay offer last week, said on Sunday there were no plans to coordinate strikes with junior doctors.
While Cullen recommended that RCN members accept the offer of a 5% pay rise this year and a cash payment for last year, the decision of members to reject it by 54% to 46% means there will be a ballot on further strikes.
“And if that ballot is successful, it will mean further strike action, right up until Christmas,” she told BBC One’s Sunday with Laura Kuenssberg.
The formal government reaction, outlined by the Conservative party chair, Greg Hands, on Sunday, is to await ballots on the pay offer from two other health unions, Unite and the GMB. However, Downing Street appears ready to take a tough line.
No 10 sources said that while RCN members rejected the pay deal only narrowly, members of Unison, which represents the greatest number of NHS staff, supported it by a margin of 74% to 26%.
A letter to Cullen from Barclay, sent on Sunday and later tweeted by the health secretary, showed no signs of movement from the government side, offering new talks but calling the rejected pay offer a “fair and reasonable settlement”.
The stance towards junior doctors, who ended their 96-hour strike on Saturday morning, appears even more uncompromising, with one government source saying ministers could not even begin an “adult conversation” with the BMA unless it reduced its 35% pay demand and called off any further action.
The BMA says it has had no contact with the government since it asked the industrial relations conciliation service Acas last week to try to help find a compromise.
NHS leaders have expressed grave worries about the possibility of a joint strike, as well as the RCN’s proposal to escalate action, meaning areas such as accident and emergency and cancer care would not be excluded from new stoppages.
“It’s very difficult to see how either of those things wouldn’t endanger patient safety and dignity,” Matthew Taylor, the chief executive of the NHS Confederation, the membership body for the health service across the UK, told Sky’s Sophy Ridge on Sunday show. “And when we’re talking about the possibility of combined industrial action, this type does take us into uncharted territory.”
Saffron Cordery, the deputy chief executive of NHS Providers, the membership organisation for NHS trusts in England, said ministers had to act. “It’s really clear to me that it’s not sustainable going forward for the NHS to manage strike action,” she told the Kuenssberg show.
“It feels like a really ugly situation to say we are going to have strikes now until Christmas. We really, desperately need the government to come to the table, alongside the unions coming to the table, to sort this out.”
Wes Streeting, the shadow health secretary, castigated Barclay for writing a newspaper article expressing worries about patient safety, saying the health secretary was acting “as if he’s some kind of commentator or observer”.
“Newsflash, Steve Barclay: you are the health secretary, with both the power and the responsibility to resolve these disputes,” Streeting told Times Radio. “And as for the prime minister, I mean, he doesn’t bother to show up in this discussion at all.”
Speaking earlier to Sky News, Streeting urged the RCN not to escalate its method of striking, saying he was “deeply worried” at the idea.
Cullen defended the possibility. Asked why it was proposed, she said: “Because this government has not listened. That’s that, frankly, the answer to that.
“This government can’t say on the one hand we value nurses so much that they shouldn’t go on strike, and then we don’t value them enough to pay them. That’s why we’re in the crisis we’re in.”
Asked why RCN members had rejected a plan that she recommended, Cullen said they had seen it as “neither fair nor reasonable”, with the “bribe” of a one-off payment unlikely to fix long-term problems of recruitment and retention.