The struggle of National Health Service workers to secure a pay increase and better working conditions is at a crossroads.

On December 15, over 100,000 nurses, members of the Royal College of Nursing (RCN), took strike action. They were joined later by other health workers, including ambulance crews and junior doctors. Today, less than five months later, the health unions have all but ended the dispute.

Without the initiation of a rank-and-file rebellion, workers will go down to a crushing defeat with dire consequences for the future of the NHS.

On May 2, the 12 unions on the NHS Staff Council representing health workers in England—apart from doctors and dentists—voted by majority to accept the government’s below inflation 5 percent pay award for 2023-24. This is a massive real terms pay cut, not even half the rate of inflation. Unison, with around 500,000 members in the NHS, was among those who voted to accept the deal. The only unions voting in opposition were the RCN and the Unite union.

The vote means that the government can impose the deal on more than one million NHS staff employed under the Agenda for Change contract. The NHS Staff Council “jointly requested that the government confirms that the pay aspects of the offer for both 2022/23 and 2023/24 can be implemented by employers as soon as possible.”

The RCN is the largest nursing union in the NHS with 280,000 members in England, while Unite claims around 100,000 members, including thousands of ambulance staff. Since the vote, neither union has called any industrial action, instead pleading for further negotiations.

The RCN would have voted to accept the deal at the NHS Staff Council meeting had its members in England not already voted in April to reject the derisory offer, in defiance of a recommendation to accept by the leadership under General Secretary Pat Cullen.

The RCN did everything possible to foist the rotten pay deal on nurses, mounting a campaign of bullying and censorship and even attempting to criminalise its members—threatening to call police against organisers of a petition calling for an Extraordinary General Meeting to move a no-confidence vote in Cullen, the National Executive and the union’s negotiating committee.

Alleging voter fraud, the RCN ruled the petition void and commissioned security firm Dionach to “conduct a digital forensic and eDiscovery investigation”. Dionach reported that “approximately half of all signatures were submitted fraudulently – that’s without the individuals’ consent”. The “likely source of the data used in this fraudulent activity was from a similar EGM petition in 2020.”

Dionach concluded that “the 2023 EGM petitioners are unlikely to be responsible” for the fraudulent signatures, refuting the national executive’s claims.

Responding to the report, Ed Freshwater, the nurse behind the earlier 2020 petition, said evidence suggested that his petition was not the only source of the fraudulent data and that involvement of RCN staff in submitting the bogus signatures had not been ruled out.

Following the NHS Staff Council vote, Cullen shamefacedly stated in a letter to Tory Health Secretary Steve Barclay that the pay deal was not an “offer that matches their [nurses] true value”. But it was the same deal she had earlier tried to impose!

She then pleaded again for Barclay to offer something that she could sell as an improved deal, saying, “Though the pay offer was not enough for our members, I have repeatedly said that the government’s approach should be to build upon it and that remains our position.”

Cullen informed the government that the RCN membership will be balloted to extend its strike mandate for a further six months as is legally required. The union has confirmed the ballot will be held from May 23 to June 23. But the fervent wish of the union will be that a No vote is recorded by its members, after being worn down for months in a dispute which has seen them achieve nothing and lose pay on strike days.

Even if members do vote to strike, the bureaucracy has assured the government no action will be called if it agrees to further futile negotiations. The RCN’s statement released on the day of the NHS Staff Council vote read, “The government can stop the possibility of strikes at any point by getting around the table immediately and talking about pay. Our strike ballot will continue regardless, but any mandate that members give for strike action does not need to be acted on if we can come to an acceptable deal.”

Unite General Secretary Sharon Graham said that her union “will be escalating strike action,” but has also made no announcement.

The continued determination of NHS workers to fight for a living wage was clear in this week’s vote by RCN members in Wales, rejecting by 53.21 percent the latest below inflation pay offer from the Labour Party-run Welsh administration. The offer consisted of a lump sum worth just 3 percent of wages for 2022-23 and a 5 percent pay increase for 2023-24.

In response, the RCN sanctioned four strike dates, with the first on June 6, but combined this with a plea to the government for action to avert any further strikes. “I have asked for pay talks to be opened immediately with the Minister for Health and Social Services [Eluned Morgan] so that our members do not need to return to picket lines,” said RCN Wales director Helen Whyley.

Unison Cymru/Wales is expected to imminently announce the result of a ballot of its membership in Wales, having recommended the terrible deal. Jess Turner, the union’s Welsh head of bargaining and campaigns, spun the union’s cave in as “a significant step forward”, declaring “Whilst we know they deserve more” the offer was the “best that could be achieved through negotiation.”

A sell-out also faces the thousands of junior doctor members of the British Medical Association (BMA). Delivering a massive mandate, almost 100 percent of BMA members supported strike action in pursuit of a 35 percent pay rise in a ballot result announced February. The BMA held a 72-hour strike in England in March and a 96-hour stoppage in April.

But on May 5, the pro-Tory Telegraph revealed that, after talks, “junior doctors’ leaders are prepared to consider a ‘credible offer’ from the Government as they appeared to back down from their 35 percent pay demand.”

There is no fight that the bureaucracy will not try to throw, no matter how determined the struggle of workers. The action taken by nurses and other health workers was by far the most popular of the ongoing strike wave, winning massive popular support from workers well aware of the awful conditions in the NHS as a result of its deliberate rundown by the government. In every single health union, there were substantial mandates for strikes. But in the space of five months, the health unions have all but ended every dispute.

This Sunday the RCN meets for its five-day annual congress. It will face substantial anger and opposition. But the experience of the petition calling for an EGM demonstrates that defeating the sabotage of this ossified and unaccountable bureaucracy demands the formation of a genuine rank-and-file movement. The issue is not simply adding names to a list in opposition to the current union leadership but actively driving them out, abolishing the bureaucracy and placing the union and its assets under the control of its members.

NHS FightBack, the Socialist Equality Party, the World Socialist Web Site and the International Workers Alliance of Rank-and-File Committees will provide every assistance in this battle. Contact us today and link up with likeminded workers to stop this sellout!