As a new recession begins to take effect and inflation has outpaced wage growth, a wave of industrial action has hit the UK, Germany and other European countries. While many strikes have been in industries accustomed to industrial action, there have also been strikes in essential healthcare roles like nurses, ambulance crews and doctors. This has been divisive, triggering some to accuse healthcare workers of neglecting their duty of care for their patients and jeopardising already overstrained health services. In Germany, for example, health workers in the Verdi trade union staged a two-day strike in March 2023. [Ref: The Local Germany]
In reaction to the upheaval caused by this fresh phase of striking, the UK government has put forward a bill to further curb the right to strike and ensure, by law, minimum levels of service [Ref: UK Government]. This has been heralded by some as a saver of the public’s time (in the case of transport, communications and postal strikes) and protector of many lives (in the case of healthcare strikes). On the other hand, opponents argue this takes away the fundamental democratic right to withdraw one’s labour, as well as ignoring the fact that minimum levels of service are already maintained during healthcare strikes. In Germany, there are certain legal guidelines in place concerning who is allowed to strike and under what conditions [Ref: Artz.de]. But even where there is legal guidance, a number of ethical questions remain [Ref: BDI.de].
The overarching question raised is: are there professions that perform a function so essential that it overrules the right for workers to withdraw their labour in the form of a strike? While still subject to debate, this is legally already the case in the UK, as the police are thought so essential to the survival of the state that they have not had the right to strike since 1919 [Ref: Guardian]. So, there also exists a debate as to whether the medical profession should be put in this category with the police.
DEBATE IN CONTEXT
Industrial action is nothing new, nor are attempts to stop it. Ever since there has been a mass workforce, there have been disputes with employers and strikes. And since the brief reign of the notorious Taff Vale case [Ref: Britannica] that gave companies the right to sue unions for the damage of strikes, there has been a continuous legislative fight between those who want to protect the right to strike and those who want to restrict it.
Today, as the cost of living crisis has seen inflation ramp up to around 10 per cent [Ref: Guardian], conditions are ripe for pay disputes. Added to this, the decade of austerity before and the real terms pay cut of 4.3 per cent the public sector saw throughout the 2010s [Ref: Guardian] in combination with the dire state the NHS is currently in [Ref: The Conversation] have given good reason for healthcare professionals to feel disgruntled, many believe. This has meant the main nursing union, the Royal College of Nursing, has carried out the first strikes in its over 100-year history [Ref: Royal College of Nursing].
Public opinion on the matter of medical professionals striking has historically polled against the right to strike, but recently, YouGov found this to have changed, with 47 per cent being in favour of a doctors’ strike versus 43 per cent polling against in November 2022 [Ref: YouGov]. So, does this change in public opinion illustrate social conditions where NHS workers can justify striking?
THE RIGHT TO WITHDRAW LABOUR
Defenders of striking healthcare workers argue that all workers must have a right to withdraw their labour. Labour is part of a voluntary transaction and to be forced to work in any circumstance is an immoral restriction on an individual’s freedom. Having tried other means of achieving better working conditions, it has now got to the point where, some believe, ‘the only option is to withdraw labour’ [Ref: Guardian]. As a last resort, then, it is essential that workers are protected by the law and have a right to strike in order to uphold fair working conditions and pay. The right to strike is even said to be more than just the right to withdraw labour by some. Philosopher Brian Smart argues the right to strike encompasses ‘a right to free expression, association, assembly and power’ [Ref: JSTOR].
But not everyone is convinced. Some people question whether there ought to be a right to withdraw labour [Ref: UK in a Changing Europe]. Unions only wield power because they are so heavily protected by the law. In a freer society, some argue, companies would be allowed to fire their workforce in retaliation to industrial action. This would create a fairer climate, some think, because if conditions were actually exploitative, companies would fail to rehire a workforce, therefore giving the unions fair power to fight for better conditions and pay.
In response to this, a defender of the legislated right to withdraw labour would likely argue that it is only thanks to unions’ actions that we have seen an improvement on the awful conditions workers were subjected to during the Victorian era [Ref: Tribune].
However, there is a significant proportion of people who agree that the right to withdraw labour is fundamental in theory, but who think in practice it is often misused and exploited by ‘union barons’ [Ref: Daily Mail] to hijack unions without the best interests of their members at heart. In this view, strikes often are of great cost and injustice to the public, while bringing little benefit to union members as they are used as pawns in a power game played by union bosses. In other words, while the right to strike ought to exist, many believe restrictions should be imposed to make sure the act of carrying out a strike is ‘a necessarily difficult and properly considered one’ [Ref: Independent].
PERSONAL RIGHTS VS PUBLIC RESPONSIBILITY
Doctors and nurses swear a Hippocratic oath [Ref: BBC] when they begin their career. This is a commitment to, among other things, act in the best interest of their patients, to the fullest of their ability. This raises an issue when planning a strike. A nationwide absence of any medical staff for just a day would mean disaster for the 50,000 A&E visitors and 94,000 hospital admissions the NHS receives on average [Ref: Sanctuary Personnel], let alone the patients in ongoing intensive care. Even if a skeleton staff is kept in place to respond to emergencies and care for critically ill people, there will inevitably be individuals who are harmed to some extent by the cancellation and delaying of other appointments and procedures.
It is by appealing to the risk to patients of strikes that the government has brought forward the Strikes (Minimum Service) Bill [Ref: UK Government]. By legally requiring a minimum level of service during a strike, they argue public safety and convenience are not overly infringed by strike action. However, opponents of the bill point out this is already done by NHS staff to protect the critically ill and account for emergencies. Moreover, the bill does not define what level of service constitutes the ‘minimum’, essentially granting ministers power to stop strikes completely.
In further defence of healthcare workers’ right to strike, one could argue there is a trade-off we are making at all times between the volume and therefore cost of healthcare and the ‘damage’ of its absence. There is always more we can do to make people live longer, but with decreasing marginal benefit. For example, if everyone had a cancer screening every day, fewer would die of cancer than if we all had a screening every two years. However, the cost (both in money and time) of this means that, given the choice, most would opt for less frequent checks.
Adding to this, while critics have been fast to accuse healthcare workers of putting their own selfish desires above patient safety, some healthcare workers who have been striking argue, this not just a protest about their pay and working conditions, but also one calling for overall improvement to the state of the health service. Furthermore, with better working conditions and less strenuous hours, standards of care will be higher, these people add. From this perspective, a striking doctor, nurse or paramedic could very well be striking in the name of their patients’ overall safety. In other words, it can be argued that, in order to fulfil their duty of care, healthcare professionals need to strike. Health workers in Berlin successfully went on strike not just for higher pay but to improve staff-patient ratios and conditions for trainees, too. [Ref: RCN Magazine]
However, there are plenty who don’t take this argument at face value, seeing it at merely a cover for a self-serving act in a profession that is supposed to have care for the community at its centre.
So, can healthcare professionals’ right to withdraw labour in the name of improved pay and conditions usurp their commitment to the Hippocratic oath? Or can NHS workers even exercise their right to withdraw labour in the name of patient safety?
ASKING FOR THE IMPOSSIBLE?
One defence of the government’s stance on all public sector strikes is that the wages increases being demanded are simply not affordable. The cost of living may be high, but this is due to external factors like the after-effects of the Covid-19 pandemic and the current global trade effects of the Ukraine war. Private-sector workers are having to put up with cuts to living standards so why should the public sector be treated differently? [Ref: The Sun] It is therefore, in their opinion, an economic reality that living standards have to drop slightly for the time being, in order to save our economy in the long run.
This is dismissed by defenders of the current wave of strikes, citing again that the public sector has been behind the private sector in pay increases for the entire time the Conservatives have been in government. Adding to this, the transport minister has admitted that rail strikes have cost more to the government purse so far than meeting rail workers demands would have [Ref: Mirror]. Rail workers have been striking since the summer of 2022, so they have had more effect than health workers’ strikes, having started only in the winter. But, say trade unionists, it won’t be long before the financial costs of repeated strikes will have outweighed the cost of simply paying nurses, paramedics and doctors more. This, they say, exposes the political goal of today’s government, to vilify the unions and working people more broadly.
But supporters of the government argue this is an attempt to turn to ideology as a distraction from the economic reality that higher wages will fuel inflation [Ref: The Sun]. If everyone’s wages increase without any of the scarcity that created inflation in the first place being addressed, then prices simply rise faster, potentially creating a spiral leading to hyperinflation and economic disaster.
This is often countered, however, by the very fact that wages are not the initial cause of inflation [Ref: The London Economic]. Wages are chasing inflation. In the view of some, it is the government’s responsibility to fix the root causes of inflation, while maintaining people’s standard of living. The argument that improving people’s lives will destroy the economy comes from a determinist outlook, it is argued, rooted in ideological, capitalist dogma, again exposing the government’s agenda to restrict workers’ rights for the sake of entrenching a system that makes the rich richer and the poor poorer.
10 theses of the clinic directors on the upcoming strike at the University Hospital Gießen and Marburg
Prof. Dr. dr H.-P. Howaldt Prof. Dr. HFW Wulf University Hospital Gießen and Marburg (UKGM) 23 March 2023
This is looking increasingly like a general strike
Stephen Glover Daily Mail 7 December 2022
Giving in to trade unions’ demands risk plunging UK into recession
Institute of Economic Affairs 20 July 2022
If nurses vote to go on strike there is blood on their hands
Patrick Christys GB News 7 October 2022
Steve Barclay: nurses going on strike is in nobody’s best interest
Steve Barclay MP GOV.UK 23 November 2022
Rebellion of the nurses: “So far nothing has happened”
Christoph Holland RND.de 14 June 2022
Rishi Sunak’s proposed anti-strike laws aren’t just insulting – they’re stupid, too
Angela Rayner Guardian 16 January 2023
In defence of the December strikes
Brendan O’Neill spiked 12 December 2022
‘Civilised European nations’ sack striking workers, do they, Grant Shapps? What nonsense
Polly Toynbee Guardian 12 Jan 2023
Striking workers are telling the truth about Britain. No wonder politicians want to silence them
Nesrine Malik Guardian 16 January 2023
Strikes in the medical sector – are doctors allowed to strike? (in German)
Nursing strikes – an ethical dilemma (in German)
RND.de June 2023
Government introduces laws to mitigate the disruption of strikes on the public
GOV.UK 10 January 2023
Is there a right to strike in the UK?
UK in a Changing Europe 31 August 2022
Strikes in Essential Services: Time for further protection for the public?
Nicholas Finney Centre for Policy Studies 14 September 2017
As Britain’s workers reach their limits, the government has no option but to negotiate
John Harris Guardian 11 December 2022
A World Without Unions
Len McCluskey Tribune 11 February 2020
Is it moral for ambulance workers to strike?
Leo McKinstry Spectator 11 December 2022
Majority of Britons support strikes by nurses and ambulance workers
Basit Mahmood Left Foot Forward 21 December 2022
‘My mum spent 13 hours in an ambulance after a fall, I can see why NHS staff are striking’
Connie Dimsdale inews 20 December 2022
Should nurses be allowed to go on strike?
YouGov 28 November 2022
Striking nurses don’t deserve a bumper pay rise
Mary Dejevsky Spectator 15 December 2022
Is it ethical for doctors to strike?
Marika Davies the bmj 19 October 2015
Should doctors be allowed to go on strike?
YouGov 28 November 2022
‘Galling’ for police to cover for strikes when they cannot walk out
Margaret Davis Evening Standard 21 December 2022
Guardian view on anti-strike laws: bad in practice, wrong in principle
Guardian 11 January 2023
Britain is braced for a winter of strikes – yet a public backlash just hasn’t happened
Gaby Hinsliff Guardian 9 December 2022
The Tories’ shameful attack on workers
Tim Black spiked 16 January 2023
How public sector pay has fallen in real terms – in charts
Ashley Kirk Guardian 19 July 2022
Strikes (Minimum Service Levels) Bill
Tory Transport Minister admits cost of rail strikes more than settling dispute
Ashley Cowburn Mirror 18 January 2023
Watch: Mick Lynch on the myth that wage increases cause inflation
Joe Mellor The London Economic 22 July 2022
IN THE NEWS
New law should stop union barons from putting ‘lives at immediate risk’, Health Secretary says
David Churchill The Daily Mail 16 January 2023
Thousands of patients to have operations cancelled, as nurses push ahead with strikes after pay talks break down
Kit Heren LBC 12 December 2022
Grant Shapps unveils new powers in strike laws
Becky Morton BBC News 10 January 2023
‘NHS is broken’ say striking ambulance staff in West
Emma Elgee and Matthew Hill BBC News 21 December 2022
‘Govt considering strike ban for essential services’, Business Minister says
Megan Hinton LBC 20 June 2022