Tens of thousands of nurses began a 48-hour strike on Wednesday to demand higher pay. The members of the Royal College of Nursing (RCN) union struck at 55 National Health Service (NHS) hospital Trusts across England.

Nurses participated in well-attended and lively picket lines with many bringing homemade placards and chanting slogans in defence of a safe and fully funded NHS.

Nurses and other NHS staff are fighting an imposed £1,400 pay award backdated to last April, worth on average just 4 percent—well below the current RPI rate of inflation at 14 percent. It is less than half even of the lower CPI inflation measure which dropped slightly on Wednesday to a still high 10.5 percent.

Nurses initially struck in December after overwhelmingly supporting an RCN strike ballot calling for a pay increase of RPI inflation plus 5 percent. Research by the RCN shows the pay of an experienced nurse has collapsed 20 percent in real terms since 2010, meaning nurses “are effectively working unpaid one day a week”.

The strike was the first by NHS workers since the government’s successful second reading this week of its new anti-strike law. The Bill, expected to be made legislation later this year, will enforce minimum service levels in the rail, health, education and other sectors—requiring a set number of workers, individually selected by the employers, to come into work on a strike day.

Claims that the law is necessary for “safety” reasons are bogus. Government cuts have left the NHS unsafe every day of the year. During strikes, nurses have staffed chemotherapy, emergency cancer services, dialysis, critical care units, neonatal and paediatric intensive care. Some mental health, learning disability and autism services are also exempted from striking.

Weeks of entreaties by the RCN leadership for the government to compromise have secured nothing. RCN leader Pat Cullen declared prior to the first nurses’ strike that the union would be prepared to call it off if only the government would join them in the room for negotiations.

Despite Conservative government health secretary Steve Barclay’s repeated statements that the 2022 pay deal cannot be changed, the RCN’s next move was to declare readiness to meet the government “halfway” on pay and settle for 10 percent. The humiliating climbdown was not taken up by the Tory government.

In an RCN press release Monday, Cullen said, “It is with a heavy heart that nursing staff are striking this week and again in three weeks. Rather than negotiate, [prime minister] Rishi Sunak has chosen strike action again. We are doing this [striking] in a desperate bid to get him and ministers to rescue the NHS.” Cullen begged, “My olive branch to government—asking them to meet me halfway and begin negotiations—is still there. They should grab it.”

This followed the issuing of an open letter from Cullen to Sunak which pleaded, “On behalf of the nursing profession, I implore you to see sense. Protect nursing to protect the public. Nursing staff will always speak up for patients—when will you speak up for us, and the people we care for?”

The only response from the government has been to up the ante in insisting that the 2022 pay round is over and any additional pay will have to come from the NHS’s cash-strapped budget. According to the Guardian, Barclay is auditing the NHS to see what can be cut to free up just £2-3 billion for a pay deal covering 2022-23.

This confirms how far away NHS workers are from winning a pay deal that recoups anywhere near what they have lost in wages over the last decade. According to the RCN, the 17.6 percent they were demanding in November would cost the government £9 billion when paid to all NHS staff apart from doctors and dentists.

On Wednesday, Barclay authored a column in the Independent, provocatively headlined, “Pay hikes for NHS staff are unaffordable—and will cut patient care”.

While cynically declaring, “I recognise the cost of living pressures on NHS staff and I know how hard they work,” he wrote, “But if we provide unaffordable pay rises to NHS staff, we will take billions of pounds away from where we need it most. Unaffordable pay hikes will mean cutting patient care and stoking the inflation that would make us all poorer.”

Recognising the role of the union bureaucracy in helping successive governments to impose billions of pounds in NHS “efficiency savings” since 2008, Barclay stated, “I want to work with the unions to identify areas where the NHS can become more efficient”. This would “unlock additional funding to top up affordable pay rises for the coming financial year.”

Barclay pledged in relation to draconian anti-strike laws, “I also want to agree minimum staffing levels during industrial action with unions to ensure patients are always protected. We will keep talking to find common ground and seek to put these disruptive strikes behind us.”

The health secretary’s comments underscore that the government sees defeating the NHS workers, the largest contingent of the public sector workforce, as critical to enforcing its austerity programme.

In the face of this offensive, the RCN and other health unions have worked systematically to undermine a united offensive by health workers.

The RCN received a powerful strike mandate from its 300,000 members last November. Despite anti-strike laws requiring a 50 percent turnout to allow strikes to proceed, nursing staff at 176 out of 311 NHS organisations voted successfully for industrial action. Nearly half the trusts in England reached the threshold. All NHS employees in Northern Ireland and Scotland met the threshold and all except one trust in Wales.

In response, the RCN has kept industrial action limited to a small fraction of those members entitled to walk out. This week’s strikes are confined to only some of the health Trusts that met the threshold in England, and the union has sanctioned no further action until next month on February 6/7.

Upon announcing those strikes, the RCN was sure to stress that they could be called off at any time if the government would only agree to talks. A press release Monday announced “further strike action in England and Wales in February following the Government’s refusal to negotiate with the union. If progress is not made by the end of January, RCN members in England and Wales will strike again for 12 hours on both Monday 6 and Tuesday 7 February 2023.”

Less than two dozen more hospital Trusts are set to be involved in that action—up to just 73 compared to 55 striking this week. Moreover, the union said, “The RCN will not take action in Northern Ireland on this occasion. In Scotland, strike action remains paused while negotiations continue.”

This is a fraud. The RCN along with the GMB union and Royal College of Midwives has agreed to ride roughshod over their members’ rejection of the revised pay offer for 2022-3 in NHS Scotland worth on average just 7.5 percent. It has been enforced based upon an agreement with the Scottish First Minister Nicola Sturgeon to begin negotiations on the pay award for 2023-4.

Such is the unions’ sabotage of a unified offensive by health workers that if the RCN action does go ahead in February, it will be the first time that nurses will strike alongside their ambulance co-workers. The GMB announced Wednesday that more than 10,000 paramedics, call handlers and other ambulance service staff will strike on the same date as nurses on one of the four more days of industrial action they have sanctioned in February.

The health unions have ensured that they will not strike alongside civil servants, rail workers, and university workers on February 1—the only co-ordinated strikes set to be carried out by unions in different sectors in a strike wave that began eight months ago.

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