The Government’s ongoing battle with NHS strikes has entered a new, deeply entrenched phase. Nurses across England, Wales and Northern Ireland have joined resident doctors (formerly known as junior doctors) in overwhelmingly rejecting a government pay offer, sending an unambiguous message: the issue is no longer just about money.
Resident doctors have already set the tone, refusing to be placated by the pay uplift offered by Health and Care Secretary, Wes Streeting. The uncomfortable truth is that no government – Labour or Conservative – will succeed in resolving industrial action in the NHS until it delivers on the promises of the NHS Long-Term Workforce Plan and future workforce strategy due for Autumn publication.
The warning signs were always there. From the moment Streeting granted the resident doctors a pay increase, it was clear that goodwill alone would not be enough. Working conditions, career development, leadership culture, and even basic safety are central to what health workers want to see change. And on those fronts, things have scarcely moved.
Patient safety must be placed front and centre in this debate. Safe staffing is not a bonus – it is the essential condition for delivering care that protects patients and avoids harm. Resident doctors and nurses are not just fighting for themselves; they are advocating for the right to practise their clinical judgement in environments that are properly resourced, where they can be safety-critical professionals rather than stretched responders in crisis conditions. Without adequate staffing, the system cannot function safely – and everyone, including patients, suffer.
The Pay Myth: Why Uplifts Aren’t Enough
The recent pay rejection by nurses highlights a critical misunderstanding by political leaders.
Ministers appear to believe that numbers on a payslip can address deep structural dysfunction – a notion not borne out by evidence or experience. While inflation-linked uplifts matter, they do not repair the culture of burnout, bullying, and unsustainable rotas.
The previous Government’s workforce plan itself, published last year, promised to grow the NHS workforce by hundreds of thousands. But warm words have not translated into visible change. Staff on the ground still report toxic working environments, understaffing, outdated IT systems, and senior leadership that is distant at best and obstructive at worst.
Nurses and doctors are not demanding luxury. They are asking for functional workplaces, support from colleagues and management, and systems that allow them to do the job they trained for. These are not unrealistic expectations and could indeed avert some of the calls for their inflation busting pay increases. Could these be desperate cries for help from an undervalued workforce. Changes are fundamental to safety and dignity at work.
Workforce Exodus: A Crisis of Culture, Not Just Capacity
Health Foundation analysis suggests that retention, not recruitment, is the Achilles’ heel of the NHS. Thousands of staff are leaving not because they want higher pay, but because they are demoralised, exhausted, and unsupported.
“Accountability of managers, bullying, and racism all need to be tackled head-on if we’re serious about retaining the workforce.”
Professor Ann Keen, Former Health Minister and Curia Health, Care, and Life Sciences Research Group
Nurses surveyed by the Royal College of Nursing have repeatedly cited unsafe staffing levels, systemic racism, and relentless pressure. There is little doubt that these are all leading reasons for rejecting the Government’s pay deal. The results of the union’s online survey of 345,000 members in England, Wales, and Scotland, which is due later this week, will show a “clear” rejection of the award citing several of these issues. “What good is an extra 5%,” one nurse asked, “if you’re on a ward where three people are doing the work of seven?”
This is a crisis of culture. And culture is shaped by leadership. Yet management accountability remains the least discussed and least reformed area of NHS strategy. Until ministers confront the reality of daily working life for NHS staff, industrial action will continue – and it will grow in intensity.
Tackling Management Accountability, Bullying, and Racism Head-on
Former Labour Health Minister, Professor Ann Keen, who led the last comprehensive NHS workforce review for Gordon Brown, has issued a stark warning about the state of NHS workforce culture: “Accountability of managers, bullying, and racism all need to be tackled head-on if we’re serious about retaining the workforce. These three areas are so fundamental – without change, we cannot build the open culture needed to address harm or improve patient safety.”
She warned “sadly, things are getting worse, and there is no place for these behaviours in a modern workforce.”
Professor Keen’s words echo those of frontline staff and unions. Although Streeting has pledged to do more on NHS management accountability, the NHS frontline is yet to receive full guidance on what is outlined in the workforce plan. Unless this changes, the NHS risks losing its most experienced and dedicated professionals – not to competitors, but to burnout.
Too often, health workforce policy has been reduced to short-term fixes and rhetorical commitments. Ministers pledge increases. The Department of Health and Care rolls out new taskforces. Yet the day-to-day reality for NHS workers remains stagnant. Until working conditions fundamentally improve – with real protections from bullying, meaningful professional development, and fully staffed rotas – no amount of pay negotiation will stabilise the system.
We are in danger of repeating the same mistakes: over-reliance on overseas staff, failure to invest in mid-career progression, and top-down leadership structures that breed resentment rather than trust.
The NHS workforce plan must not be left on the shelf. It must be launched after the summer, implemented fully, and transparently, with timelines, local oversight, and independent scrutiny.
What Needs to Happen Now
A serious strategy to end NHS strikes must do three things:
- Deliver on the workforce plan – with visible progress on staffing levels, skills, and pay transparency.
- Fix workplace culture – addressing racism, harassment, and mismanagement with zero tolerance.
- Empower local leadership – ensuring Boards and Trust executives are held to account for retention and staff wellbeing, not just performance targets.
These are not radical ideas. They are practical, overdue interventions to rebuild a broken relationship between Government and NHS professionals.
“We must stop asking staff to give more than they have left to give.”
Curia’s Role in Supporting Solutions
Later this year, Curia’s Health, Care, and Life Sciences Research Group will launch a national inquiry into the NHS workforce challenge. This programme will explore:
- The impact of current working conditions on staff retention
- Leadership culture and accountability across NHS Trusts
- New models of workforce planning and flexible deployment
- Barriers to implementing the Long-Term Workforce Plan
Drawing on roundtables, frontline surveys, and expert panels, the group will publish practical recommendations to inform policymakers and NHS leaders. It is time for evidence, not excuses, to shape the future of NHS employment.
For more information on Curia memberships, please contact Partnerships Director, Ben McDermott at ben.mcdermott@chamberuk.com.
