Thousands of nurses took strike action Monday impacting around half of England's hospitals, mental health and community services. The 28-hour strike which hit 125 National Health Service (NHS) trusts began at 8 p.m. Sunday, ending midnight on Monday.

The walkout is the latest action in a series of stoppages held since last December by NHS workers to win an above-inflation pay deal. The strike was the first time that nurses walked out in all sectors of the NHS, including intensive care units, cancer care and emergency departments. As is standard, the nurses’ union—the Royal College of Nursing (RCN)—put in place exemptions to the strike so nurses could leave picket lines to ensure the provision of life-preserving care.

Despite the action only hitting around half of NHS Trusts in England, due to others not reaching ballot legal thresholds under anti-strike laws, the action had a major impact with NHS England warning patients would face “disruptions and delays to services over the strike period”.

NHS services were also hit by separate strike action by Unite union members at Guy’s and St Thomas’ Trust in south London and the Yorkshire Ambulance Trust.

The nurses strike went ahead after legal action at the High Court by the Conservative government, utilising anti-strike laws to secure a ruling that the RCN’s six-month mandate for industrial action did not extend to May 2.

It is not only the Tory government that nurses are fighting against to secure their demands but the RCN union bureaucracy which did everything it could to pressure workers into voting to accept a sell-out one-off 4 percent payment, and a 5 percent consolidated pay award for 2023-24. This would leave most nurses around £4,400 worse off in real terms than in 2008 and is less than half the 13.8 percent RPI rate of inflation for February.

RCN head office had threatened to call in the police to investigate rank-and-file nurses organising a petition for an emergency general meeting to move a no confidence motion in the leadership. Workers defied these threats and rejected the deal last month, forcing the RCN to call the latest strike.

While talking up the “biggest strike yet” of nurses, which she did everything to try to prevent, RCN General Secretary Pat Cullen continued to make entreaties to the government to come up with an offer that could be sold to the union’s angered membership. In a statement on the RCN web site she said, “After a three-month pause, strike action by nursing staff regrettably recommences tonight… Only negotiations can resolve this and I urge ministers to reopen formal discussions with the College over pay specifically. “

On Monday, she told the media that the dispute “will end when our government will do the decent thing for nurses, does the decent thing for the people of England and actually does the decent thing for the NHS.”

The RCN is opening in mid-May its statutory industrial action ballot for more strike action, declaring that if it passes, “We’ll have a mandate to conduct strikes for a further six months.” But everything the union bureaucracy has done so far, in calling a series of sporadic strikes, with three months since the last action, and then attempting to ram though a filthy sell-out, shows their intention to end the dispute at the first opportunity.

So nakedly did the RCN try to enforce the below inflation deal that Tory Health Secretary Steve Barclay was able to declare during the strike that workers had to accept the government/RCN offer because, “Here’s a deal that Pat Cullen herself recommended to her members that we reached after days of negotiation in a fair and reasonable settlement.”

To push the pay deal through, ensuring around 1.1 million NHS workers under Agenda for Change contracts face more years on rock bottom pay—after already suffering over a decade of austerity—the government is also relying heavily on the other health trade unions who recommended the deal. Among these were Unison, the GMB and the Royal College of Midwives whose members concluded that the unions had surrendered to the government, after which they reluctantly voted to accept it.

The government now plans to utilise the support of the main unions for its pay offer as the basis to impose the deal on RCN and Unite members. On Tuesday, the NHS Staff Council, comprising representatives from the 14 NHS trade unions, will meet to decide whether to accept the government’s offer. Barclay commented ahead of the nurses strike, “The NHS Staff Council will meet to vote on whether it accepts the agreement that we negotiated with them. I think it’s right to wait for the NHS Staff Council to come to that decision. And I think this strike is premature and disrespectful to those trade unions that will be meeting on Tuesday.”

On Sunday, the Observer reported, “Ministers plan to impose a pay deal on NHS workers even as nurses continue to reject it… as health service unions prepare to hold crunch talks on the package this week.”

The newspaper commented, “Most insiders expect it [government pay offer] to be voted through [by the unions], despite some continued opposition.” It added, “Should the unions opposing an agreement be outvoted, sources said that ministers would simply press on and apply the agreement.”

Health workers cannot allow their fight to go down at the hands of the trade union bureaucracy to what would be another devastating defeat of the working class. Control of the dispute must be taken out of the hands of the RCN and other union bureaucracies, who will continue to live their privileged lives while workers suffer under the worst cost of living crisis in living memory. This requires the formation of rank-and-file committees, organising independently of the union leaders—a move now carried out by postal workers who reject the Communication Workers Union betrayal of their fight.

We call on all health workers to contact NHS FightBack to discuss how to take this work forward. NHS FightBack’s Facebook page is here and Twitter here.