Letter from the frontline. A nurse’s view of the continuing sabotage of the NHS on the road to total privatisation
The Labour Party has for many decades been seen by the British working classes as the champion and protector of our National Health Service (NHS). Whilst the Attlee government did create this entity, it was a tactic to appease working class Brits post WW2 and aimed to prevent the spread of the desire for proletarian revolution from the great Union of Soviet Socialist Republics (USSR) to our nation.
Any illusions of a Labour administration benignly bestowing goodness or succour to the proletariat must surely have been smashed by the experience of the 21st century. Their abysmal record speaks for itself both on the international and domestic fronts. We can expect nothing better from the present Labour government.
The NHS itself has been crippled financially by Private Finance Initiatives (PFIs) and divided into the 4 home regions, with the effect of accelerating regional health inequalities, and dividing the opposition of both the NHS workforce and British workers’ opposition to the privatisation ‘reforms’.
Roll forward to spring 2025 and Sir Keir Starmer has announced the abolition of NHS England, the body brought in by the Health and Social Care act 2012 to run the NHS at ‘arms length’ when direct ministerial responsibility for the NHS was formally abolished. The body under the leadership of Simon Stevens and Amanda Pritchard has been wedded to the agenda of privatisation, and first pushed the internal market further by giving funding to GP consortia – Clinical Commissioning Groups – who controlled around £90bn of the health budget. They were encouraged both to ration services, and also to ‘commission’ services outside the NHS – awarding huge sums to the private sector. These have now been transformed into 42 ‘Integrated Care Systems’, which spend our health budget in their regions. They are managed by integrated care boards (ICBs) composed of a few token local authority councillors, a few token NHS doctors, the same NHS England managers together with private care and private health insurance managers. In 2022/23, Integrated Care Boards (ICBs) in England received £107.8 billion in funding, representing just over 70% of NHS England’s total budget. Notably, almost all ICBs are overseen by Optum, the UK subsidiary of United Health – the largest US health insurance company!
Following the announcement of the “bonfire of the quangos”, the immediate response from most hospital Trusts was to inform their staff that further cuts are looming. Cuts have become the usual policy of the NHS trusts – all of which have become operated as businesses, and all of which are given instructions to cut their budgets each year. Wages in the NHS are ‘banded’, and the lowest pay band of NHS staff is below minimum wage. Every year, the paltry minimum wage rise outpaces the pay increment of our health support workers. Management at our hospital this year responded by ‘promoting’ most of this band to a higher banding – so that they are a few pence above minimum wage. It is scandalous how little these workers earn, considering the heavy responsibilities they bear and the broad range of skills they possess. The pay review body is notoriously slow in awarding NHS staff their annual pay rise and it is routinely well below inflation.
The multiple unions representing NHS staff pay lip service to ‘demanding’ restorative pay rises but tend to capitulate to their cronies in the Labour Party – not wanting to ‘embarrass them’ for fear of hurting their ‘electoral chances’ and instruct members to accept what are in effect pay cuts.
Another blow to NHS staff relates to the rules relating to what are called ‘bank shifts’. This is a system under which NHS employees can sign up to a ‘bank’ of employees who are willing to do overtime as needed. In future, however, staff doing overtime will no longer be paid in accordance with their seniority, but only at the lowest rate for a person of their status. Additionally, despite massive staff shortages, hardly any overtime is offered as the Hospital Trusts are forced to scrimp and save.
This is all very demoralising and necessarily staff feel overworked and under-appreciated. Low staffing levels compromise patient safety. Despite this most staff still work hard to actually put their patients first and give them the best care that they possibly can. But nurses carry the increased risk of the environment that is being financially rather than clinically engineered.
The unions are in thrall to the Labour government and, as the Prime minster has already warned public sector workers to be more productive (!) in order to receive a pay rise above inflation, it is unlikely that workers will receive any meaningful redress. Our unions have failed us and will continue to do so until and unless the grass roots organise and act creatively to force the government to meet their demands, the least of which should be to demand a living wage for all, with additional benefits for those with greater qualifications, experience and responsibility. We need to be imbued with the spirit of the valiant miners’ strikers, though, bearing in mind that the NHS is being deliberately undermined in order to pave the way for more and more privatisation, we also need to be creative in the ways we resist, ensuring that our actions hurt primarily the privateers and the political parties who serve their interests.
Our NHS is, and has been, in crisis for a long time. It is exactly in the state desired by the ruling class as they openly plot to slice and dice it into sellable entities to their cronies and start the roll-out of American style healthcare systems – the so-called ‘accountable care organisations’ of which our ‘Integrated Care Systems’ are the British equivalent.
It is clear from our experience as patients and NHS professionals that access to front-line care is worsening. Long waiting lists effectively ration care, and more and more British workers – who can afford it – are choosing to have private health insurance. The downside will of course be, firstly, the legions of working-class people unable to afford adequate medical care; and, secondly, the unashamed looting of NHS funds by the private sector. Private healthcare in the US and elsewhere is also notorious for subjecting patients to unnecessary tests and procedures in order to boost profits.
There’s trouble at the mill. Most student nurses are encouraged to read and assimilate the horrendous failings of Mid Staffs NHS Trust in order to ensure it “never happens again” but no amount of reading and assimilation will of themselves change the conditions of a service geared to delivery of profit rather than considerations of care. It is these deliberate managerial decisions that lead to staff cuts and down-skilling, overwork and a general environment of penny-pinching which were the basic reason why those failures emerged.
The Francis report ‘Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry – GOV.UK’ was damning, rightly so, about the negative culture and failings in delivery of patient care in Mid Staffs NHS Foundation Trust. But the ‘solutions’ put in place to ensure it “never happens again” are underwhelming, to say the least. In 2013 the “6 Cs of Care” (NHS Staffing Pool Hub – Working in Healthcare – The 6 Cs of care), the so-called NHS Professionals. was introduced, basically to teach granny to suck eggs! Each Trust brandishes their Trust Values from on high as well as producing positive statistics about how they “make the patient the centre of the care”. Indeed, candidates at interview for NHS jobs receive negative feedback if they are unable to hold forth upon said values – allegedly unique to each trust, but overwhelmingly homogenous and corporate.
Yet, notwithstanding all this righteous virtue signalling, there have been multiple incidences of sub-optimal patient care, serious neglect and even deaths in recent weeks, let alone years, across the whole of Britain.
‘Corridor care’ is the new normal as well as ‘boarding areas’ (temporary installation of patients wherever it might be possible to find space) even though it is clear that care delivered in these condisions is sub-standard. Patients at our overcrowded Accident and Emergency ‘waiting room’ are routinely hooked up to drips or left to sit uncomfortably for hours regardless of their mobility, whilst waiting for admission or test results.
In fact one NHS Trust has recently advertised for a specialist corridor care doctor despite calls for this practice to be halted and for the government to take action (see Rachel Clun, ‘Sussex hospital advertises for “corridor care doctor” as A&E crisis deepens, The Independent, 27 February 2025.
It is difficult to spot ‘Trust values’ being followed despite the tremendous efforts of the beleaguered staff.
Where staff try to intervene to prevent malpractice occurring before their very eyes, they are frequently silenced by management bullying tactics in spite of the much vaunted Freedom to Speak up guardians.
The introduction of culture wars to demoralise staff
If there is one thing that NHS workers are very well acquainted with it is the basics of human biology. What better weapon, therefore, can be used to demoralise them than forcing them to deny realities and subjecting to disciplinary action anyone who deliberately or even accidentally claims that it is the biological difference between them that distinguishes men from women and vice versa. They are forced on pain of dismissal to accept that men can be pregnant, give birth to children and lactate. A mother therefore becomes a birthing parent, and he or she (!) is encouraged to ‘chest-feed’ their babies, although that is literally impossible for a biological male. Trusts appears more concerned to silence staff who point out the idiocy of asking adult men whether they may be pregnant prior to being offered x-rays: one member of staff who failed to enquire about the pregnancy status of a male patient was required to attend mandatory training to support them address their ‘bias’, and was supplied with copious rainbow badges to wear and share with their colleagues. In another case a very experienced nurse was called to assist with a highly aggressive patient, a man to all appearances as well as according to hospital notes, brought in handcuffed to two prison officers. In trying to persuade that person to calm down, she politely addressed him as Sir, which set the patient off in a torrent of racist abuse against the nurse, amidst a claim that to address him as Sir, when he identified as female, was equivalent to addressing a black person using the N word. Although the nurse responded to all this abuse in a highly professional manner and saw to it that the patient received the appropriate treatment, and despite the fact that she had had no possible way of knowing that the person identified as female, the nurse was suspended! Could anyone blame her if she decamped to a private hospital?
Case studies in gender bullying and the response of the nursing union
Sandie Peggie is a nurse working for the National Health Service in Fife, Scotland. Sandie, who has an unblemished record and has worked for the NHS for thirty years, brought a case before the employment tribunal against both NHS Fife and Dr Beth Upton, a male member of staff who self-identifies as a woman, after she was suspended from work for complaining that she had been forced to share a changing room with a man, namely Dr Upton. Peggie has claimed that by being forced to share a changing room with a man she has been unlawfully harassed under the 2010 Equality Act.
Sandie told the employment tribunal, which commenced on 3 February 2025, that she felt “embarrassed and intimidated” when Dr Upton began to use the female changing rooms in accordance with a policy, adopted by NHS Fife in accordance with wider NHS guidance, which states that changing facilities are available to anyone in accordance with their ‘gender identity’. The term ‘gender identity’ in this context meaning whatever gender the person in question decides that they are, regardless of their biological sex.
Sandie had raised the issue of Dr Upton accessing the women’s changing room on three occasions. The first of these was in August 2023, when she entered the changing room to see Dr Upton using the facility. She raised the matter with her line manager, who assured her concerns would be addressed. Yet despite this assurance, Sandie found herself again having to share the changing room with Dr Upton on or around late October 2023, when Dr Upton entered the changing room while Sandie was in a state of partial undress.
The third occasion was on Christmas Eve 2023, when Sandie challenged Dr Upton’s presence in the women’s changing room, telling him that it was inappropriate for him to be there and that she felt intimidated in his presence. Dr Upton claimed that he believed that he was entitled to be there because he was a ‘woman’, to which Peggie reiterated that Dr Upton was not a woman and that her safety was put a risk by him being there.
When Dr Upton complained to the health board about Sandie’s behaviour towards him after this exchange, she was placed on leave and then suspended by NHS Fife pending an investigation. According to a report in The Daily Telegraph, NHS staff even considered calling in the police to investigate Dr Upton’s allegations that he had been ‘misgendered’ by Ms Peggie. She was suspended whilst working at Victoria Hospital in Kirkcaldy, but was encouraged by her employer to work at a different hospital, whereupon her suspension from work would be lifted.
The response of the trade union movement to Sandie’s case has been little short of appalling.
Unison, a trade union which ‘organises’ thousands of workers in the NHS, held its Women’s Conference in Edinburgh from 13th to 15th February, at the same time as Sandie Peggie’s tribunal was taking place. It was at this conference that delegates carried Motion 1, which included:
“This Conference believes:
i. That Trans women are women and Trans men are men, all our LGBT+ comrades must be respected.
ii. That Trans equality is a trade union issue. Trade unions are about uniting us to make us stronger and we oppose all divisions amongst our class.
iii. Women’s rights are not diminished by Trans people having more rights. Rights are not in finite supply. In fact, when we unite and organise together, we can often win more rights for all.
iv. Therefore, that women have a vested interest in standing alongside our Trans comrades in solidarity and in resistance and all of us fighting back together.”
The motion went on to call for the production a “myth-busting factsheet” to counter the idea that an increase in trans rights would mean a decrease in the rights of others and to campaign for the Labour government to introduce self-ID for trans people “as they had originally pledged to do in 2019”.
Steve North (he/him), President of Unison, took to social media to proclaim that “Today UNISON’s Women’s Conference passed a motion stating:
“’That Trans Women are women and Trans men are men, all our LGBT+ comrades must be respected.’ Not one delegate spoke against [probably because nobody dared!]. In a world of increasing hate and division, I’m proud that our union is a beacon of unity”.
Mr North opted to restrict replies to his post to his followers on X. However, those who read his post would almost certainly have speculated as to why a motion which claimed that “women’s rights are not diminished by Trans people having more rights” was not challenged by a single delegate at the Conference. Arguably the actions of the union in abandoning its own women members when in strife was foremost in the minds of any gender-critical delegates. Unison’s contemptible actions in sacrificing their own members on the altar of this unscientific, idealist and divisive gender identity ideology will be detailed later in this article.
Meanwhile, Sandie’s own trade union, the Royal College of Nursing, refused to represent Sandie either at the employment tribunal or at a separate disciplinary hearing – a hearing which was called whilst she was at employment tribunal, in a poorly-disguised and deliberate act on the part of NHS Fife to intimidate and harass her. The RCN’s own website states that “We celebrate trans nursing staff, and remain unwavering in our commitment to end transphobia in nursing”.
Peggie’s solicitor, Margaret Gribbon, said that “Many trade unions’ track record on this issue is poor, causing many of their members, especially women, to feel abandoned and betrayed. If they are to fulfil their core function of representing their members, they must be at the forefront of advocating for women’s right to single-sex spaces in the workplace and to challenging employers who discriminate, harass and victimise those holding lawful gender-critical beliefs”.
The Royal College of Nursing made an unsurprisingly mealy-mouthed statement: “We do not comment on individual cases, treat all our members’ right to confidentiality with the utmost importance, and believe it is vital that all parties are treated with dignity and respect”.
The employment tribunal has now adjourned until July. We will then no doubt see how it applies the recent Supreme Court ruling to the effect that the word ‘woman’ denotes only an adult biological female.
The Darlington Nurses
Eight nurses working for the County Durham and Darlington NHS Foundation Trust are pursuing a case at employment tribunal over their employer’s decision to allow a man identifying as a woman, Rose Henderson, to use the changing facilities at Darlington Memorial Hospital. The nurses are claiming sexual harassment, discrimination, victimisation and breaches to private life under Article 8 of the European Convention on Human Rights.
The trust, again following the guidelines as issued by the NHS, permitted a fully intact male who self-identifies as a woman to use the women’s changing facilities – facilities which have no cubicles. The nurses reported that the man appeared to be ‘very masculine’ and was accused of staring at their breasts and lingering in the changing room for longer than was considered reasonable, which made the nurses feel vulnerable and intimidated.
Twenty six nurses wrote to the NHS trust in March 2024 to raise their concerns. The nurses claimed that more staff, who were working here on visas, wanted to sign the letter, but were worried about having their visas revoked, which would mean that they would lose their jobs, so declined to sign. In response to the letter, the ward manager was called to a meeting with human resources and was informed that the nurses needed to be “re-educated”.
The story hit headlines and everyone from JK Rowling to Health Minister Wesley Streeting proclaimed their support for the nurses. However, one entity which declined to offer its support was Unison, the union that the nurses had paid their subscriptions to in order that, when they needed help, it would be offered freely.
Unison declined to support their own members in this case and, given the content of the motion quoted earlier which was carried at their Women’s Conference in February 2025, it is easy to see why. The nurses decided to found their own trade union, which they called the Darlington Nursing Union. When they did this, they were invited to London to meet with Wesley Streeting in October 2024. Unison were deeply displeased at this meeting, with Steve North (he/him), the President of the union mentioned earlier in this article, taking to X to condemn Streeting for ‘pandering to anti-trans bigotry’.
The nurses were forced to found their own trade union, but still needed the aid of an organisation called Christian Legal Centre for the financial assistance to pursue their case at employment tribunal. The tribunal opened on 2 April, only to be immediately adjourned when the NHS Trust claimed that it needed time to carry out an internal investigation, despite the case being over eighteen months old. Judge Stuart Robertson, who chaired the preliminary hearing, said that the trust’s actions “subordinated [proceedings] to an independent investigation”.
The tribunal will reconvene in October.
Freedom of speech
In addition, hospital staff have absolutely no freedom of speech. It may be fair enough to expect them when at work not to bring their political or religious opinions to the attention of patients, since they have no relevance to their treatment, but this lack of freedom extends to what staff do in their spare time or in private conversations among staff members themselves. Any suggestion of speaking out about the ongoing genocide in Gaza and Palestine where genuine victims abound is frowned upon by most Trusts and those who disseminate factual information that counters the establishment narrative can expect serious repercussions.
Conclusion
The whole system is broken but it is exactly how the ruling class need it to be. This includes the Labour government who make so much play of being the ‘party of the NHS’. The truth is that Labour are fully complicit in driving the NHS into crisis – and using the crisis to further the agenda of privatisation.