Intended for healthcare professionals


The NHS is under siege and ambulance workers need pay justice

BMJ 2023; 380 doi: (Published 24 January 2023) Cite this as: BMJ 2023;380:p172
  1. Sharon Graham, general secretary
  1. Unite the Union

Unprecedented strike action is a direct response to low pay creating soaring vacancies and leading to the current NHS crisis, writes Sharon Graham

People in the UK under the age of 50 are unlikely to remember the last national ambulance strike in 1989-90. The then health secretary, Kenneth Clarke, provoked outrage by describing the workforce as “professional drivers—a worthwhile job but not an exceptional one.”1 National pay strikes of ambulance workers have been rare because the workforce is dedicated to patient care and their roles are so obviously lifesaving.

Considering this, it is shameful that government ministers like Grant Shapps falsely claimed that during the strike in December ambulance workers put lives at risk by not agreeing national minimum levels of cover.2 Nothing could be further from the truth: derogations were worked out at regional level with ambulance trusts to agree the necessary “life and limb cover” that was needed during the strike. We agreed to full cover for emergency and life threatening calls, and made provision for striking workers to leave picket lines and attend calls immediately if emergency cover was unable to cope.

It might help resolution of disputes if Shapps and the health and social care secretary, Steve Barclay, stopped demonising workers and started tackling the problems that have created the first national pay strike in 32 years. On the first day of the ambulance workers’ strike Barclay claimed that staff deliberately organised strike action to harm patients.3 Given ambulance workers’ role and their commitment to patients, strike action is clearly a last resort.

Nor is the dispute solely about wages. In actuality, the action is pushing to save the NHS from an unmatched crisis. Waiting times across the NHS are at an all time high. To resolve the staff exodus and the NHS crisis generally, consistent funding and recruitment of staff by offering decent pay and conditions is needed.

There are a record 130 000 vacancies in the NHS,4—with some of the highest rates in emergency care. This means that services are unable to function safely. The social care crisis has resulted in monumental hospital bed blocking, causing delays across the entire system. Thus, there are queues of ambulances outside hospitals because there is nowhere to discharge their patients.

Health workers know that this crisis has been years in the making, it has not suddenly resulted because of the strikes. The crisis has become so grave, that extremely ill patients are often being assessed, treated, and discharged in ambulances, without stepping foot in a hospital. Worse, current figures demonstrate that this ambulance crisis is causing an unknown number of unnecessary deaths.

Ambulance staff tell of their distress in waiting outside hospitals to discharge a patient while receiving radio calls to attend emergency and life threatening calls. They know there aren’t any crews available, nor can they go. Recent figures from West Midlands Ambulance Trust show that in 2020 one patient died because of a delay in an ambulance arriving—but in the first nine months of last year that figure was 37.5 This is not an isolated problem, similar tragedies are occurring across the UK.

The quality of NHS care has been eroded for over a decade. NHS pay has declined by an average of over 20% in real terms, across almost all grades. The cost of living crisis has made a grim situation far worse. With the real rate of inflation reaching 14% at the end of 2022, overstretched NHS workers have found themselves unable to make ends meet.6 This is not about restricting luxuries. Huge swathes of workers can no longer afford the basics—food, accommodation, heating, and travel. It is grotesque that a growing number of NHS trusts, including many ambulance trusts, are being forced to establish food banks or introducing free breakfasts to ensure staff are properly fed.

Healthcare workers are dedicated to the NHS but the escalating challenges mean that increasingly they are finding better paid, less demanding jobs elsewhere, exasperating the crisis. The government must take its head out of the sand and find additional funding, outside of existing NHS budgets, to give workers the fair pay increase that they need and deserve.

It’s not that the money is not there, it is a question of priorities.

The government’s choice has been to let bankers’ bonuses surge and reduce taxes for the super rich while nurses and ambulance workers pay is frozen. The government has chosen to let Britain’s energy sector pay regular taxes for six years despite being forecasted to make excess profits of £170bn in 2022-23.7 Given the emergency, why not take £50bn in a windfall tax this year to plug the “fiscal hole” in the government’s budget, and leave £10bn for a 10% pay hike for all NHS staff. The crisis, driven by staff shortages, cannot be solved unless workers are paid a decent wage.

Ambulance staff love the NHS and are dedicated to treating patients, but they can’t live on fresh air. Only renewed conditions and decent wages can break the current staff exodus that is driving the service towards collapse. The government must pay the bill before it is too late.


  • Conflicts of interest: None.

  • Commissioned, not externally peer reviewed