Over 400,000 National Health Service workers are being balloted for strike action against a government-imposed pay freeze.

The freeze has denied even a 1 percent cost-of-living pay increase to over 600,000 health workers, 60 percent of all NHS staff and 70 percent of nurses and midwives.

Members of the main health service trade unions—Unison, Unite and the GMB—will complete voting by the end of September, with strike action set to follow in October depending on the outcome. For the first time in its history the Royal College of Midwives (RCM) is holding a ballot of its 26,000 members for strike action.

Conservative Party Health Secretary Jeremy Hunt dismissed the recommendation of the NHS Pay Review Body (PRB) for a consolidated pay increase of 1 percent in addition to incremental pay increases for all NHS staff in 2014. From April this has meant that in England only those NHS staff at the top of their pay band, and therefore not entitled to an incremental increase, received the meagre uplift. The non-consolidated pay is not included in the hourly rate, so overtime, unsocial hours and pensionable pay do not increase accordingly. The government has demanded a freeze in all incremental increases for next year as a precondition for the miserly 1 percent consolidated pay increase.

While pay restraint is the order of the day for all NHS staff, the same does not hold true for those making the demand. NHS Employers chief executive Dean Royles received a £14,000 pay rise, the equivalent of the annual salary for a NHS employee on Band 1.

While the unions talk about a fight for “fair pay”, in practice they agree to real term pay cuts. Unison, Unite and the GMB are not balloting their membership in Scotland, based on a pay settlement with the Scottish government along the lines of the PRB’s recommendation of the below inflation uplift of the hourly rate for all NHS staff of 1 percent, as well as an additional sum which lifts the pay of the lowest paid to the “Living Wage” level of £7.65 per hour.

Unison, the largest union in the NHS, has decided to ballot only its 300,000 members in England, with its members in Wales to be balloted separately over the terms of a pay settlement put forward by the Welsh Assembly. The latter has agreed to pay the Living Wage but has only offered a lump sum of £160 for all other NHS staff.

Along with separate negotiations in Northern Ireland, the door has been opened to four separate pay rates for NHS staff performing the same job across the UK. It is aimed at sowing divisions within the largest workforce in the country, 1.3 million, and to facilitate the dismantling of the NHS through cuts and privatisation.

Within the framework of the ongoing £20 billion cuts to the NHS national budget, which the unions have done nothing to oppose, any pay settlement will be clawed back through the further depletion of services or job losses.

The government claim that NHS workers in England entitled to an incremental increase will all receive at least the equivalent of a 1 percent increase is false. This is no longer guaranteed due to the revisions agreed by the unions to the national pay framework Agenda for Change in 2013. Based upon the concessions made, incremental pay progression has been made dependent on meeting performance criterion, which ties NHS staff to managing the fallout from the cuts.

A guide produced for local union representatives by Unison demonstrates how the union has championed the move away from incremental increases, based on years of service and additional skills, to increased workloads. It states, “These changes are not designed to be a tool for organisations to cut pay in response to financial pressures; instead they should be used to enhance performance of staff through properly structured appraisals leading to improved productivity of the workforce.”

Unison, Unite, the GMB and other health service unions have attempted to justify the concessions as the necessary price for retaining the national framework of pay contained within Agenda for Change. On this basis they claimed to have seen off the attempt to establish a breakaway cartel formed by NHS Trusts in the South West of England 2012, aimed at setting the precedent for locally based pay agreements.

However, the unions have in fact paved the way for the governments’ demand for ending incremental pay altogether, with the pay freeze extended indefinitely. The main entitlement preserved by Agenda for Change is the privileged position of the union bureaucracy in negotiating away the pay and rights of NHS workers. This year’s pay freeze is the fourth in a row, with a 1 percent increase for 2013 and a pay freeze in 2012 and 2011 for those earning above £21 000, with those earning less only entitled to the single percentage uplift. Since 2010 this has led to a reduction in pay in real terms of between 10 to 15 percent.

A mandate for strike action by the members of Unison, Unite, GMB and the RCM will not be used to galvanise opposition to pay restraint but to dissipate and demoralise resistance, while convincing the government that the services of the unions are required to forestall a general mobilisation. Where they cannot prevent strikes, the unions are only prepared to hold them on a token basis. General Secretary of Unison Dave Prentis has proposed a stoppage of four hours, with only a vague reference to further brief periods of industrial action short of a strike.

The NHS pay ballot has been proclaimed by the pseudo-left Socialist Workers Party and Socialist Party as proof of a resurgence of the unions as a force to defend the working class and oppose austerity. Nothing could be further from the truth.

Since 2008, confronted with the drive to reverse all the remaining social gains of the working class in over half a century, the Trades Union Congress organised only one national stoppage, in 2011, over the issue of public sector pensions before it was brought to an end on the governments’ terms.

Since then the few coordinated one-day stoppages by a handful of public sector and teaching unions have been cancelled or scaled down, while the attacks on jobs, pay and pension rights have proceeded. While NHS and local government workers both confronted successive years of a pay freeze, Unison, Unite and GMB balloted for strike action separately.

The most recent national stoppage on July 10 was confined to local government workers. Following this, Unison decided to reschedule a planned strike for September 30 until October 14, as the GMB and Unite only agreed that date for a further stoppage.

The role of the trade unions fully vindicates the initiative of the Socialist Equality Party to establish the NHS Fightback campaign. The only basis for taking forward a struggle against the attack on pay and conditions is for NHS workers to establish rank-and-file committees and link struggles to the fight against the cuts and privatisation. The defence of universal health care requires the adoption of a socialist programme that puts social need before the profit motive.