Nurses could refuse to carry out any further strikes alongside other health workers amid fears over patient safety, The Independent has learned.
A mass walkout billed as the largest strike in NHS history is due to take place on Monday as tens of thousands of nurses, paramedics and 999 call handlers walk out in a bid to force ministers to the negotiating table.
But the co-ordinated strikes could be a one-off if nurses feel direct action has been compromised by concerns over patient safety, The Independent has been told.
One union source said walkouts are not carried out on a “come what may” basis and that the unions would have to assess whether striking together was “helpful” or not.
Unions have been escalating industrial action in recent weeks in an attempt to secure higher pay rises. Any de-escalation in tactics will be seen as a blow and a boost Rishi Sunak’s hopes of riding out the wave of protests.
“Let’s see what happens Monday and Tuesday and whether having other [health] professions out at the same time was a helpful impact or not,” one source said. “It is always about patient safety.”
On the co-ordinated action, the union source added: “We will review what the additional impact has been of having other professions [out on strike at the same time].”
He added that his union had very tight rules based at local levels. If local committees decide there is a risk because of their strike or strikes by others “they will just call it off or they will derogate other people from the picket line and tell them, ‘You have to go in I’m afraid’.
“There is a very careful way to manage patient safety risk and then the strike is changed or broken. It is not this hard rule of strike come what may.”
With patient safety the priority, sources insisted there were strong local controls that would pull nurses from picket lines if they thought there was an issue.
And a senior health source said co-ordinated strikes from health workers were actually an “accident” by unions rather than design and feared there wasn’t a “conscious strategy” over industrial action.
In January Pat Cullen, RCN general secretary told The Independent: “We have no plans to co-ordinate strikes with any other part of health and (social) care. It is not in our agenda because we have to be mindful that safety is paramount in all of our decision making.”
An RCN spokesperson said the union has “our own mandate and chose our own dates” for strikes, saying members have a mandate to take strike action for another 100 days.
The nursing union believes that the ultimate responsibility for patient safety lies with the government, arguing that nurses are striking to ensure safe staffing and safe patient care in the NHS.
Strikes in Wales were called off on Friday after the Welsh government made a new pay offer to unions, putting more pressure on Westminster to engage. One union source said that it was “getting harder to agree derogations” compared to strikes before Christmas.
“There is a sense that staff attitudes are hardening a bit, and derogations aren’t as easy to agree. I think some staff are being clear they’ll work a bank holiday but they won’t necessarily agree to work in anything above a bank holiday service,” they said.
“Members of the unions are starting to push back a little, it’s not in every trust but in some, some of the good will, and derogations rely on good will, and some of that is ebbing away and I think that’s true on the hospital side and ambulance side.”
Addressing Monday’s strikes, the source said: “On a human level, people will wait longer, people will be in pain a bit longer, people’s operations will be cancelled whereas perhaps before Christmas which might have not been cancelled.
“I think it is a sign the impact of strikes is going to increase, and that’s before we’ve even got to the junior doctors. If they strike for two days in March the disruption of that is going to be enormous. Elective care will be cancelled on a much bigger [scale] and that will be every trust, we’re predicting.”
RCN director for England Patricia Marquis appealed to Mr Sunak to “come to the table” for pay talks in order to avert more strike action. “Where there are genuine negotiations with a view to seeking a resolution, then we will call off the strikes,” she told Times Radio.
Business secretary Grant Shapps said on Sunday that he is concerned that the planned strike by ambulance staff on Monday will put lives at risk.
Mr Shapps said the RCN had “very responsibly” told the NHS about where they will be striking and enabled emergency cover – but claimed Unite, Unison and GMB unions representing ambulance workers have not provided such information.
Unite general secretary Sharon Graham accused Mr Shapps of lying about minimum cover during industrial action. “The idea that he is saying that ambulance workers did not do minimum cover in the dispute is an absolute utter lie,” she told the BBC.
Meanwhile, Labour’s shadow business secretary Jonathan Reynolds suggested a Labour government would not be able to offer double-digit pay rises to public sector workers.
Asked if his party would give nurses a 10 per cent pay rise, Mr Reynolds told Sky News: “Realistically the top opening offer, we probably wouldn’t be able to meet that – but we would negotiate.”