UNISON’s annual health conference, in Edinburgh, opened this morning with a rousing celebration of the union’s successes and an introduction to a busy and important year ahead – not least for the union’s strategy over NHS pay.
In presenting the service group’s annual report to a packed hall, chair Tanya Pretswell opened on that key issue.
She told delegates: “Conference, it was hugely disappointing for health workers in England, Cymru and Northern Ireland to discover in February that their governments had opted – yet again – to lurch back to the Pay Review Body process, and to impose a 3.3% award.
“You don’t need me to tell you that this represents another real-terms pay cut – you can see it in your bank balance and certainly feel it in your pocket. And with this, the Westminster government missed another opportunity to move away from the failed policies of its predecessors.”
Ms Pretswell compared this situation to that in Scotland. “UNISON Scotland is to be commended for securing their own inflation-proofed, two-year deal, with members getting at least 3.75% in this coming year. On top of this, they have also won a reduction in the standard working week.
“What has been achieved in Scotland speaks volumes for the hard work and persistence of the union up here. It also shows the benefits of collective bargaining and moving decisively away from the discredited PRB process.”
Leading the negotiations
In an important development, the other UK governments have now stated that they want unions to join negotiations on structural improvements to Agenda for Change. “There is clearly a long way to go with this, but it is something we have been campaigning on for several years, which has only come about due to sheer persistence, and our ability to foster a united position across the health unions for this pay round,” Ms Pretswell said.
“So, UNISON will be entering – and leading – these negotiations after conference. They give us a chance to repeat our message that 3.3 % cent is simply not enough, alongside pressing for long-overdue structural reform.”
Branches and activists can help strengthen the hand of the union’s negotiators, she said, by boosting sign-ups to the joint union open letter to ministers.
Ms Pretswell noted that the issues around pay reflected the urgent need for extra investment in the NHS, as do the latest UNISON findings on job cuts and health service finances – with at least 21,000 jobs set to be lost in provider trusts across England alone, on top of the 20,000 job losses across NHS England and integrated care boards.
With trusts running up large deficits, even more NHS staff could lose their jobs, with the remaining workers being asked to do more to fill the gaps. “And all of this is happening at a time when workforce surveys show record levels of stress, burnout and declining morale.”
Fighting privatisation
While the Employment Rights Act has heralded welcome changes to workers’ rights, UNISON continues to push for much more, she said, particularly in ending privatisation and winning insourcing.
There have been a number of wins in the past year, such as the one at Liverpool Women’s Hospital, where the branch and region were able to bring facilities staff back in-house.
And the union successfully opposed yet another attempt by NHS England to actively steer trusts towards outsourcing their support staff to subcos.
“It took six months, but by September [health secretary] Wes Streeting did step in to demand a policy change. This halted all ongoing transfers and made clear that any future ones could only go ahead if there was union support – which, let’s face it, is never going to happen.”
However, Ms Pretswell added that with a number of trusts still wishing to use subcos to save costs, particularly in the North East, “we must remain vigilant, and keep speaking out against subco plans wherever they appear”.
Defending overseas workers
UNISON is constantly seeking to hold Mr Streeting to account on a range of other issues, she said, including the government’s targeting of overseas workers, with changes to visa salary thresholds leading to members being dismissed from their jobs or threatened with deportation, over a shortfall of just £63 pounds per year.
Pressure from the union and its members led to Mr Streeting holding the visa salary threshold at £25,000, rather than further increasing it, easing some of the difficulties for those who have struggled to meet the requirement. But the campaign goes on, to remove the longer-term uncertainty around visa thresholds.
“Conference, UNISON must always be there to stand up for our colleagues from overseas, without whom the NHS could simply not function,” Ms Pretswell told the conference. “We will continue our work to fight the alarming rise in racism – both across the NHS and in society more generally. This has become a painfully real part of working life for far too many of our members. It shows up in survey after survey, often accompanied by totally unacceptable levels of violence and abuse.
“Our union takes its equalities commitments very seriously. For health workers, these aren’t just words. After all, we all work every day in our NHS, one of the largest and most diverse workforces on the planet, and all the better for it.”
We’re capable of winning
Ms Pretswell reported “another amazing year” for the Pay Fair for Patient Care re-banding campaign, which by the end of 2025 had won £200 million for members.
Recent months have seen big victories for healthcare assistants in south west London, Durham and Darlington, Nottingham and Northumbria, for district nurses in Glasgow, phlebotomists in Homerton, and for healthcare support workers across Wales – and the phlebotomists in Gloucestershire, who secured a pay review deal after nearly a year of strike action.
Ms Pretswell concluded: “These strides are all essential, not just for boosting the income and morale of workers, but also for building the engagement and belief of our members. They also show that UNISON is capable of winning both industrially and politically.
“So, Conference, while we face challenges on many fronts, there is every reason for us to be confident. Confident in the ability of our activists and our union to fight for the change we need.”
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