It was one of the most bitter disputes in the history of the NHS, with the Royal College of Nursing staging its biggest strike to date. But as an agreement was reached with ministers in England this week, the BBC can now reveal details of the secret and unprecedented talks.
On the cold, frosty mornings of the nurses’ columns, the rhetoric was fiery and loud. Striking nurses condemned the government for not opening pay negotiations. Ministers criticized the walkouts affecting patients.
But behind the scenes it was a completely different story. There were secret contacts between the two countries.
Since early January, there have been confidential approaches from an unofficial source to the Royal College of Nursing (RCN), the nurses’ union, about the possibility of starting negotiations in England. This involved putting out feelers to see what the nurses union could bring to the table.
Strikes by nurses and other health unions – representing paramedics, midwives and other NHS staff – were sparked when ministers insisted they stick to the recommendations of the independent Pay Review Body (PRB). It proposed average increases of 4%.
The RCN’s initial demand for a pay rise of 5% above inflation – equivalent at one point to 19% – was unaffordable, ministers said.
The government is ultimately responsible for setting NHS pay in England, funded by the Department of Health and Social Care. NHS employers are involved in detailed negotiations.
But once these secret contacts were made, it was not apparent to the RCN how closely they were connected to Downing Street or other parts of Whitehall.
The approaches seemed highly unorthodox. It would normally be obvious whether ministers or officials are making a proposal.
But everything became clear on February 21 with a call from Downing Street to the Royal College of Nursing. There was an invitation for talks to include the idea of a lump sum payment for the current financial year, which is a key demand from nurses. The public announcement came as a big surprise even to some government officials.
The prime minister signaled a change of course. He had previously denied having more money. In exchange for the invitation to talk, the RCN had to agree to call off the escalating two-day strike in England, affecting all care, including emergency.
And so began the chain of events that led to last Thursday’s pay offer for nurses, paramedics, midwives and other health staff in England.
There were shades of international diplomacy and intrigue in the negotiations. Back channels and unacceptable contacts had steered a disastrous dispute into calmer waters.
The stakes could not be higher as NHS strikes and widespread disruption seemed destined to last for months on the surface. But so far these preliminary talks have only been with the RCN. Other health unions representing paramedics and a range of health workers were incensed. They were not invited to the table.
The government appeared to be deliberately targeting the nurses’ union because of what appeared to be growing public support. RCN General Secretary Pat Cullen had a high profile in the media.
The RCN’s discussions with ministers remained shrouded in secrecy. The first meetings were held at an undisclosed location to avoid the media.
But that changed on March 2 when other unions were invited to join the talks. Assurances were given that more money was available, but the unions had to agree to keep the process confidential.
The result was an intense series of meetings at the Department of Health and Social Care in Victoria Street, near Westminster Abbey.
They were held on the ninth floor in offices traditionally occupied by ministers. Health Secretary Steve Barclay had opted to move one floor down to an open-plan office with civil servants.
Union officials were intrigued to note that they were meeting in an office once occupied by Matt Hancock. It was the scene of his kiss with his then-assistant Gina Colaangelo that was caught on CCTV and the images were leaked to a newspaper. They joked about the possible presence of cameras.
The six members of the NHS staff council, representing the main health unions, along with one other staff member, were used to talk to employers. Unison’s Sarah Gorton, who chairs the council, said of the unprecedented situation they were in: “The process was unique in that the Secretary of State was personally involved and negotiated directly with the unions.”
What was also highly unusual was the presence of Treasury officials as well as negotiators from NHS employers and health staff. It seems they wanted to keep a close eye on the money being offered.
One union source said it had become clear that “we are negotiating with people who are not used to this”. Another added that they had “never worked like this before”.
There was a determination on the part of ministers to avoid leaks. The data sheets given to the negotiators had to be returned at the end of each day. When the union team took the documents for their own private discussions, they had to hand over their phones to prevent pictures being taken. No papers were allowed to leave the building.
Perhaps in an attempt to demonstrate the austerity of Whitehall, there was no regular supply of refreshments. One participant recalled “coffee and the occasional biscuit”. Another said they decided to bring their own water glasses.
For lunch they were taken to the department’s canteen, escorted the entire time around the building. Every now and then they would go out for fresh air and make a quick visit to a local sushi bar.
The days were long with formal talks in full sessions interspersed with negotiating teams retreating to smaller offices. Sometimes they ran after midnight. They knew that the outcome of their work would be vital to the whole of the NHS in England.
Steve Barkley attended most of the proceedings, as did Health Secretary Will Queens – although he had to take a day off because the King was visiting his constituency.
According to one union source: “Steve Barkley was constructive and didn’t have the heated atmosphere seen before Christmas.”
One government source described the secretary of state’s style: “What makes him work is seeing a problem – like a maths problem – he doesn’t make a big fuss and keeps his head down.”
At times there was tension, but no serious arguments. Late Wednesday night, the deal was done. Exhausted bidders retreated, relieved but knowing it had to be sold to members.
GMB’s Rachel Harrison reflected on the result: “It was a very long day locked on the ninth floor, but it was what we asked for – we wanted to be invited and they did.”
Unions had insisted before entering negotiations that there had to be “new money” to fund any pay offer. After the deal, ministers said the funding would not come from first NHS budgets.
But there is still uncertainty over the source of the money, with government sources saying some of it will come from the Department of Health and Social Care’s existing planned spending and the rest following negotiations with the Treasury.
The pay row began with ministers insisting they would follow the pay review body’s recommendations and not negotiate directly with unions. But face-to-face talks broke the deadlock.
The deal — a one-time payment and a 5 percent salary increase for the year starting in April — included an agreement to review the composition and mission of the PRB.
But this is not the end of the process. The dispute will only end once members of the health union give their approval – and that is far from certain.
But the strikes, which caused frustrating delays for patients and damaged staff morale, are now over in England. As one union source reflected: “What a shame it took so long.”