Fighting for the National Health Service in the 1970s—and the lessons for today

Table 1: Strike data for NHS 1966-77
Year	Number of NHS staff	Stoppages	Workers involved	Working days lost	Days lost per 1,000 NHS staff	Days lost per 1,000 employees in Britain
1966	728,838	2	500	500	0.69	100.0
1967	753,486	1	78	200	0.27	124.7
1968	761,747	1	80	80	0.11	211.4
1969	778,998	8	2,500	7,000	9.99	309.1
1970	792,307	5	1,300	6,700	8.46	499.2
1971	799,673	6	2,900	4,700	5.88	625.9
1972	831,753	4	97,000	98,000	117.8	1104.3
1973	843,119	18	59,000	298,000	353.5	324.4
1974	859,468	18	4,070	23,000	26.84	661.5
1975	914,068	19	6,000	20,000	21.88	270.6
1976	945,877	15	4,400	15,000	15.86	149.3
1977	970,900	21	2970	8,200	8.44	448.0
Source: Royal Commission on the National Health Service (1979), p163.

The 1972-3 ancillary workers dispute

On 3 December 1972, a group of hospital shop stewards called a small ­conference in the Fountains Abbey pub, near Paddington station in Central London. They were trying to coordinate support for a national strike against the Tory ­government’s wage freeze policy. Union leaders were attempting to persuade Keith Joseph, Heath’s secretary of state for health, to treat them as a special case after an official pay claim of £4 had been rejected. As is also the case today, many ancillary workers were being paid below the poverty line. Socialist Worker reported that many were earning less than £16 a week (the equivalent of £180 now). The stewards, part of an unofficial rank and file movement called the London Alliance of Stewards for Health Workers (LASH), were calling for an £8 rise and had successfully called an unofficial one-day strike on 27 November, with hospitals on strike in Liverpool, Bristol, Bournemouth, Manchester and London. Some 180,000 workers had responded to their call, surprising everyone. They were also demanding a 35-hour week, four weeks’ paid holiday and, importantly, equal pay for women. Backlash, their rank and file newspaper, had a message for the full-time union officials:

You, people who we pay to represent us! In the past you have been doing your job in a lackadaisical way with a couldn’t-care-less attitude. Your members are now saying to us that you must get off your backsides and really do something for us. We are tired of waiting for the “old pals” act with management. We already know where we stand and who our friends really are. It’s a decent living wage now or a long, hard battle. Guaranteed poverty and guaranteed insecurity, that’s our lot. How’s life at your end, Mr Full Time Officer.10

Dave Ling, a porter at Manor House Hospital in North London, was chair of LASH.11 He describes what had happened at his hospital and the role of revolutionary socialists within the wider movement:

It became obvious to a few of us that discontent was building up within the hospital, but no one from the union was contacting us to call meetings or see what we could do. So, a few of us started to push our existing branch secretary, who’d done the job for about 30 years. He did nothing. So, we said, “No!”. We wanted a meeting, and he finally agreed. At the meeting, he announced he was standing down as soon as it became clear to him what was being proposed at the time—namely, a 24-hour strike. So, he stood down, and I ended up being elected as branch secretary. We had action at Manor House Hospital. Through the International Socialists (the predecessor organisation of the Socialist Workers Party), I got to meet other NUPE militants—people like Steve Ludlam and Bill Geddes—and we decided to call a meeting of people interested in trying to coordinate rank and file action, which is where the All-London Health Workers Alliance, later to become LASH started. We had our meetings in a pub in Tottenham Court Road. The meetings were fairly open, and about 50 to 60 people could turn up to them.”12

In the national ballot, a majority of NUPE’s 80,000 affected members voted for a national strike for £4, rejecting an offer of £1.84. Ballots in those days were not postal; some 446 separate branch meetings had to be held to win the national vote for strike action.13 Voting occurred by show of hands in branch meetings. LASH became NASH (the National Health Workers Rank and File Committee), which tried to coordinate the unofficial strike action set off by a “£8 now” walkout in Bristol. In February, once again, unofficial action led the way, with walkouts in Bristol, Birmingham and Pontefract, West Yorkshire, as well as at St George’s Hospital in Tooting, South West London. The militancy forced NUPE and COHSE into talks at national level to coordinate action, but simultaneously the campaign was being undermined by union officials. No sooner had pledges of support to go on unofficial strike been won, full-time officials were ordering stewards to refrain from ­supporting the strike.14

Managements attempted to undermine the strike by sacking leading militants. A steward at St George’s Hospital, Mick Banton, was sacked for putting up a notice that the catering department would refuse to feed ancillary workers who ignored the branch’s decision to strike. He was immediately reinstated when almost the entire ancillary workforce at the hospital walked out, followed by workers at two other hospitals in the same group.

By March 1973, the action was widespread and about 1,000 hospitals were affected, although the strike was uneven across the country. The union ­leadership called for a series of half measures: selective strikes, which was coordinated by the head office, an overtime ban and “withdrawal of cooperation”. In Socialist Worker journalist David Widgery wrote:

The strategy, if it existed, was to let the strong branches take the brunt of the attack. The less militant areas would be allowed to choose their own tactics according to their level of confidence.15

Indeed, tactics were militant in some areas. Striking hospital electricians removed fuses from fuse boxes, and bans on private patients in NHS beds started to become instituted. COHSE was not on strike, but COHSE members at the Salford Royal Hospital joined the strike unofficially. Elected action committees were set up to coordinate the strikes, bypassing union officials.16 Women, scarcely represented in the union hierarchy, pushed their way forward, turning away ­lorries at the hospital gates. Placards on picket lines were multilingual, reflecting the multi-ethnic workforce in some hospitals.

Unfortunately, the strike went down to a partial defeat. In branch meeting after meeting, NUPE members voted for an indefinite strike, but the leadership only conceded selective strikes. The final deal was only somewhat better than the original offer, although it did include bringing forward a scheduled equal pay allowance for women. Still, labelling the strike a complete defeat would be a mistake. The growth of rank and file self-confidence was enormous. Rank and file papers at local level had sprung up, initiated by, though not at all confined to, revolutionary socialists. Moreover, a new national rank and file paper, entitled Hospital Worker, was launched at a delegate conference in Birmingham, attended by 40 leading militants, including a sprinkling of International Socialists members. Though the International Socialists were at the heart of the Hospital Worker project, this network was much broader. Those who attended conferences and distributed the newspaper went far beyond the membership of the International Socialists. New layers of more militant branch secretaries and shop stewards were elected, and union organisation grew. “Defeat” was not on the lips of the thousands who had taken part. As Widgery wrote (and as I well remember):

A new breed of hospital trade unionist was born. More stewards were elected, often young black and female. Meetings were held more often in work time, as established in the Whitley council rules. Joint union committees started up. Offices were acquired and fitted out with scrounged furniture. The issues were often the little ones: grading, unjust dismissals, restrooms. Small beer compared with national strikes. Yet, it was necessary to recover confidence and strength.17

Bill Geddes, a member of the International Socialists and the chairman of Hammersmith Hospital NUPE branch, recalls:

Whenever I joined a new organisation, I read the rule book. I found this rule that said that when people go on holiday, they had to be paid the average of what they were paid throughout the year. That included overtime, extra time, bonuses and all the extras and, because the basic rate was so low, people worked a lot of overtime. But that hadn’t been happening, so then I forced management to pay it in my hospital.

The hospital was run by a board of governors, and I knew the chairman of the board wasn’t going to be cooperative. So, I took a crowd of my members, including a bunch of very vocal West Indian women. So, he was surrounded by about 20 people, very angry people. They scared the shit out of him. After that, our branch could call people out on strike on a regular basis. That victory made me a very powerful person with my members. Even if the members didn’t fully understand the issues, they trusted me. I’d won the confidence of these people. We were on strike many times on small issues, you know, but we won.

Still, we had to beware of the union officials. I saw the union officials as my enemy in this to some extent. At one point, we banned our full-timer from entering the gates of the hospital unless he phoned me beforehand to get permission because we found out he’d been in the hospital negotiating with management and not involving us. So, we told him, “Look you! Fuck off—unless we invite you in!” To my knowledge, that attitude to full-timers applied across a number of London hospitals.18

The shop stewards movement had been successful in many hospitals in terms of undermining the ossified sectional Whitley council mechanisms by creating an alternative power base within the workplaces: joint shop stewards committees, which brought together those different sections of workers. However, the power of these committees was tempered by the fact that pay settlements were ultimately agreed nationally, and the rank and file movement was insufficiently strong enough to be decisive at that level.

Still, the strike left hospital ancillary workers with increased confidence and demonstrated the ability to win battles at local level independent of the union leaders. Importantly, furthermore, the strike highlighted to many ambulance workers and nurses not only that they were regarded as cheap labour, but also that they could do something about it.

The 1973 ambulance strike

Ambulance workers were the next to enter battle. At the time, this was an overwhelmingly male workforce. Moreover, the tradition was a military one, with staff lining up on parade in the morning. They were employed by local authorities on varying pay scales, and they came out in a series of short strikes over wages, challenging the Tory pay code. Following successful action by Glasgow ­firefighters in October and November 1973, ambulance workers took action around the country including in Kent, Durham and York.19 Emergency 999 calls were covered and the strikes were solid. The mood was for all-out stoppages, but the NUPE officials argued strongly for providing emergency cover. In Kent, the branch secretary of NUPE reported:

We took control of the garage to prevent any possibility of volunteers getting access to vehicles. The back door was locked with a barricade of ambulances sideways on behind it. At the other end we had an ambulance as a mobile barricade to let vehicles in and out.20

As well as low pay, ambulance workers were reacting to an increasing ­professionalisation of their service. They were changing from simply being taxi drivers who drove patients to hospital to becoming increasingly skilled workers. However, they were frustrated by ham-fisted management, and their skills were not recognised in their pay. A one-day national strike in December was well supported, but an argument for a national stoppage of work, conducted within the union structures of the National Ambulance Council, was lost. The unions instead favoured lightning strikes and only responding to 999 calls. In some areas managers sent workers home for working to rule and only answering emergency calls, but hasty all-out strikes very often forced management to back down.21 Wage increases were won in most parts of the country, although the unions withdrew official support for the action before all areas had settled their disputes, exposing some workers to victimisation.

1974: nurses go into action

Between 1970 and 1973, nurses pay fell in real terms by 11 percent as a result of the government’s pay policy.22 This policy was split into a number of phases, with a national pay board limiting wage increases. Nonetheless, the action that broke out among nurses in 1973 was never simply about pay. Nursing in Britain had been shaped by Florence Nightingale’s belief in clean and healthy environments for the sick, and flowing from this was a requirement that nurses do the sort of “domestic” work within hospitals that were traditionally regarded as part of women’s “proper sphere”. Author, activist and nurse Jane Salvage explains how the hierarchical nature of domestic work in the early 20th century was transplanted into hospitals:

The skills required by books such as Mrs Beeton’s Household Management…were numerous, varied and involved directing a staff of servants; the Victorian patriarch did not interfere (although he established the parameters). The matrons built a formidable power base by creating a similar sphere in major hospitals. They did not challenge male authority, and they exerted a tight control over the working-class women who did much of the basic work.23

Nurses were certainly kept strictly controlled. Although living away from home and having their own money, they were corralled into nurses’ residences that lay under the discipline and control of the matrons. This, however, was now beginning to break down. Moreover, by the 1970s, nursing was becoming more skilled, with degree courses being set up for a minority of “state registered nurses”. This increasingly skilled workforce was also becoming aware of being paid too little for their skills. Race and class played their part. Disgracefully, “state enrolled nurses” had less training and no promotion possibilities; Irish and Filipino migrants, as well as other socially disadvantaged groups, were forced into second-class jobs. Below this grade were the “nursing auxiliaries”, who were trained and paid even less.

Nonetheless, nurses’ newfound militancy was strengthened by two crucial factors. First, there was a rejection of the idea that “women’s work” should mean low pay; second, there was a realisation that nurses’ widening skill set was unrecognised by their wages. Undoubtedly, the militancy was fed into by other struggles such the 1968 strike by women sewing machinists at the Ford factory in Dagenham, East London, which won regrading to a skilled pay rate and prompted Barbara Castle, Labour’s employment secretary, to pass equal pay legislation in 1970 (though this did not come into force until 1975). Amid this context, and having witnessed the militancy of the ancillaries’ strike, it was now the nurses’ turn. The mood had altered for good.

The Royal College of Nursing (RCN) was steeped in Nightingale’s tradition and anxious to uphold the professional status of nurses, demonstrating they were more than simply menials who made beds. Although the RCN took up the issue of falling pay, it did not become a trade union until 1976. Moreover, Rule 12 of its constitution, which precluded it taking industrial action, was not abolished until 1995, and it refused to recruit auxiliaries. Neither the RCN nor NUPE were at the forefront of things at the beginning of the dispute, even though the RCN had a large number of stewards who would become active during the fight. The RCN leadership were wrongfooted when they accepted a massively inadequate and below-inflation pay offer from the new Labour government in March 1974. The officials then counselled silent marches and mass resignations, which would have laid nurses open to victimisation. NUPE seemed scarcely aware of what was coming and was eager to avoid upsetting new Labour prime minister Harold Wilson. Steve Ludlam, the NUPE branch secretary at Moorfields Eye Hospital and editor of Hospital Worker, wrote:

The February 1974 Hospital Worker (issue 7) gave no hint of the explosion about to occur. A front page article by a nurse in National and Local Government Officers’ Association outlined the recruitment crisis of the time, the 30 percent dropout rate, the RCN’s stranglehold on the negotiating machinery and the pay delay. The article called for unionisation and pointed to recent ­successful ­canteen price campaigns by nurses. It concluded,
“Our only way out is to ­organise ourselves locally into the existing trade unions and use them to force changes. If we build up our muscle over small issues, we’ll be in a ­position to take on national issues.”

The same Hospital Worker gave an account of the pay position: the gradual abandonment of 1971’s 25 percent plus revaluation claim and the RCN’s subsequent welcoming of phrase three of Heath’s pay code in 1973, when the original claim was lodged with the pay board.24

However, a month later, a “nurses’ special” of Hospital Worker was able to report a wave of industrial action over pay:

From Hammersmith, Edinburgh, Norwich, Ipswich, Mappley, Leeds, Darlington, Balham, Merton, Glasgow, Cumbernauld, Liverpool, Birmingham, Croydon, Bristol, Salford, Manchester, Maidstone, York and Romford came reports of countless rallies, marches, pickets, short strikes, solidarity meetings, work to rules, canteen boycotts, and bans on paperwork, routine admissions, agency nursing on private patients and outpatients… Even motorcades! All the big towns had set up joint nurses’ action committees linking dozens of smaller groups in hospitals. In South West London this widened into a multi-union solidarity campaign led by Wandsworth busmen, who struck in support. Hospital Worker, together with the big metropolitan committees, called a national action groups conference to try and unite the movement and its demands.25

Meetings were often massive. Socialist Worker reported a 900-strong rally at Holdsworth Hall in Manchester, with many unable to get in. There were messages of support from 800 Manchester dockers and a petition from engineering workers. Amid a lack of leadership both from the RCN and the unions affiliated to the Trades Union Congress, Hospital Worker and the National Rank and File Organising Committee called a national conference of nurses on 1 June 197426. By this time, solidarity strike action had started. The Manchester dockers struck for 24 hours. More than 4,000 manual workers at the C A Parsons and Company engineering factory in Tyneside came out on a one-hour strike, and 100 nurses in uniform led a march through Newcastle, followed by the striking workers.27 Over the next few weeks, Socialist Worker was full of reports of nurses taking action and organising joint marches with other trade unionists. A march of 1,000 nurses in Nottingham was led by the Calverton Colliery band. The Swansea Nurses Action Committee, which was started by trade union members of the International Socialists and nurses in the two biggest local hospitals, leafleted the pits, and coal miners immediately agreed to strike for 24 hours. This was repeated at other pits throughout the country. More than 1,000 miners were on strike in Swansea for the national day of action for the nurses, and there were marches across the country.28 The International Socialists’ industrial department issued an instruction to all of the organisation’s factory branches to get nurses to come and speak at their workplaces and argue for token strike action.29

Unfortunately, however, the strike solidarity movement was held back by union officials and failed to spread further. In Bristol, bus drivers, having voted to ­support the nurses’ protest march with solidarity strike action, decided to reverse the ­decision. The movement started to run out of steam and was not quite strong enough to overcome the RCN’s hostility to militancy and the failure of the NUPE and COHSE leaderships to go beyond tokenistic actions. A poor interim pay award was agreed, with the promise of an enquiry, to be led by Tony Giffard, the Earl of Halsbury, on the condition that industrial action ended. When Lord Halsbury’s enquiry finally reported, 30 percent average pay awards were announced, which did represent a real terms pay increase for nurses, although this was less than could have been achieved.

The lessons of 1974 were crucial. Events had shown it was possible to build industrial action based on mass action groups, uniting nurses from different unions, together with other NHS workers, and calling for solidarity action from industrial workers. Arguments were had in the action committees about whether to reject the unions altogether, because it seemed such a hopeless task to get the leaders to fully back the action. Yet, it was far from hopeless; at points, limited backing from NUPE and COHSE was won due to the strength of the rank and file. Health workers learned that they would get support from other trade unionists and that that needed a network of rank and file militants across their workplaces.

The battle against NHS pay beds

When we think of private medicine today, we might think of large corporations running private hospitals and insurance schemes in the United States and of the subcontracting of parts of the NHS. We might also think of the Private Finance Initiatives, whereby hospital facilities are owned by private companies, utilising ­leveraged finance, and leased back to the NHS at rip off prices. However, this was not how the private sector operated within the NHS when it was first founded. Instead, many consultants were on part-time NHS contracts that allowed them time during the working week to see and treat their private patients, often using “pay beds”. These were beds in NHS hospitals that were made available to the ­consultants to treat their private patients. These patients would pay a small hotel charge to the NHS as well as a fee to the consultant. This had the potential to become a political issue, not least because waiting lists for routine surgery were very long: perhaps four years for a hip replacement operation. When pointing this out to their NHS patients, surgeons would ­commonly say, “But if you were to come and see me privately, I could get you in next week.” Private practice was originally a small industry, albeit one that boosted consultants’ earnings considerably. However, by the 1970s, an increasing proportion of the population (maybe 4 percent) had private insurance cover. The right of NHS consultants to work for the NHS’s competitors was part of the compromise Labour health minister Aneurin Bevan made when establishing the service. The money taken by the NHS for this private work was often below the true cost to the service, since no allowance was made for the capital costs to the hospital of equipment, surgical supplies and so on.

An enormous amount of resentment built up among hospital workers as they watched private gain being built on the back of NHS labour and resources. As Widgery wrote, “It seems unfair that a hungry nurse can be reprimanded for eating a patient’s meal, and a domestic can be fired for taking home a loaf that otherwise would go mouldy, but, when consultants help themselves to NHS facilities, they are somehow seen as defending clinical freedom”.30

When the Labour Party regained office in 1974, its manifesto included a promise to phase out NHS pay beds. Nonetheless, little would probably have been done without pressure from hospital workers. In the strikes of the ­preceding few years, workers had found that refusing to service pay beds elicited an unprecedentedly hostile response from management. A lot of the workers’ action had hit the general public, but not servicing pay beds put ­pressure on managers and the government while only hurting those consultants with private patients.

So, after the pay strikes in the early 1970s, workers chose to target pay beds again. This was done partly as a way of maintaining union organisation, which had become very strong, and partly because pay beds were simply unfair and undermined the NHS. Rosa Luxembourg’s 1906 book The Mass Strike describes the interplay between economic and political struggles in periods of high class struggle. While many socialists can be demoralised by “the apparently fruitless ebb of the storm flood of the general strike”, Luxembourg wrote that such despondency would be a “great mistake”, ignoring how directly economic struggles can prepare the ground for wider political battles. She wrote of the massive economic struggles as, “for the first time, awakening class feeling and class consciousness in millions upon millions as if by electric shock”:

This awakening of class feeling expressed itself in the circumstances that the proletarian mass, counted by millions, quite suddenly and sharply came to realise how intolerable was the social and economic existence that they had painfully endured for decades in the chains of capitalism… Here, the eight-hour day was fought for; there, piecework was resisted; there, the brutal foremen were “driven off” in a sack on a handcar; at another place, infamous systems of fines were fought against; everywhere, better wages were striven for; and here and there, the abolition of homework.31

On a smaller scale than described by Luxemburg, but following a similar dynamic, hospital workers took action on pay beds, shifting their fight from the economic to the political. The struggle kicked off at Morriston Hospital in Cwmrhydyceirw, South Wales, in 1975, when 400 NUPE members—­ancillaries, nurses, theatre technicians, kitchen staff and ward receptionists—issued an ­ultimatum to management demanding they remove a private patient. There was already a union ban on private patients, but the hospital management was trying to circumvent it. When the managers refused, they went on strike. The strike was successful.32 This was followed up by similar action in Mount Pleasant Hospital in Swansea and other hospitals in South Wales. A branch secretary explained, “As soon as a private patient moves in here, a mass ­meeting will ­boycott any unit in which a bed is occupied by a private patient.”33 The action soon spread to Moorfields Eye Hospital, Hammersmith Hospital and Westminster Hospital (­situated just next to the House of Commons at that time) as well as to Manchester.34

Geddes, who was still at Hammersmith Hospital at this point, describes the feeling of the time in a way that gestures towards the self-confidence of the humble hospital ancillaries:

We got very rich patients coming in from all over the world to use our facilities. Hammersmith was a world centre and very famous. The porters knew who those patients were. So, we started a campaign, saying that we didn’t want them in our hospital. We wanted our hospital beds to be kept for normal NHS patients. It was a long campaign that was really a lot of fun. As an example, Hammersmith Hospital was a series of old Victorian buildings, and patients had to be moved around outside the buildings. Sometimes patients used to just have raincoats over them as they moved from one block to another. So, sometimes the porters would discover halfway through the journey that the patient they were wheeling was a private patient, so they’d just leave them in the rain. The most cataclysmic thing was what one shop steward in the kitchens did. I don’t know how he did it, but he printed on the back of one of the menus a message to patients saying that we didn’t want any private patients in our hospital. The management were absolutely furious because obviously these people were paying a lot to stay there, and they received this menu with stuff on the back slagging them off. I didn’t stop laughing for days.35

The issue dropped out of sight for a few months, but then it blew up again in July 1974 when Esther Brookstone, the NUPE branch secretary at the new Charing Cross Hospital, threatened a strike unless pay beds were closed there. Castle, who was now secretary of state for health in the Labour government, was in the middle of introducing legislation to regulate private practice more closely and ban it within NHS hospitals. The consultants responded by ­themselves threatening strike action if they lost their right to private practice. Castle backed down and the unions refused to sanction further action, opening up rank and file militants to victimisation if the militancy continued. Labour did later move to phase out pay beds from the NHS, but this involved watered down proposals that resulted in a new consultant contract, allowing them to continue private practice but not in NHS facilities. Even to achieve this compromised position, James Callaghan, who became prime minister when Wilson resigned in 1976, had to sack Barbara Castle. As the Financial Times put it, “Castle wanted to scrap the pay beds overnight, a move that might have dealt the private sector a lethal blow. However, the outcome of two years of bitter dispute was a plan—never really implemented—to phase them out slowly”.36

The end result was an increased opportunity for large private companies to build substantial numbers of private hospitals. Nonetheless, the whole story ­illustrated the balance of power between the union leadership and the rank and file. The rank and file had the power and confidence to go far beyond what the union leaderships were happy to countenance, but unless they won swiftly, the leaders could still snatch defeat from the jaws of victory.

As a postscript, in May 1979, after the election of Margaret Thatcher’s government, Geddes had one last attempt at confronting the issue of private practice. After the Tories reintroduced private practice into the NHS, he successfully passed a motion for a campaign (including industrial action) against it at the NUPE national conference, though sadly this resolution was never really implemented. Geddes appeared on the front page of the Daily Mail for his “rich bastard speech” at NUPE conference, when he railed against private practice:

This is a motion with teeth that will succeed if the union begins a campaign from today. It is saying that from 1 January next year, 1980, all NUPE members will refuse to provide any services to private patients. This is something we’ve done in the past, but haven’t been very well organised in doing. It gives us seven months to prepare: seven months for the executive committee to educate the membership on what private practice is and the need to abolish it. On that day, every single rich bastard who comes into the hospital will only be treated on the basis of being a NHS patient and not because he’s got a bit of extra money to pay the consultant.37

The 1975 junior doctors dispute

In 1975, the British Medical Association (BMA) sanctioned the first ever official strike in its history. If we want to understand why, it is instructive to look at the figures on the growing numbers of junior doctors. Today, there are some 75,000 juniors, but there were only 6,000 when the NHS was set up, less than a tenth of the current number.38 By the 1970s, junior doctor numbers had doubled to over 13,000.39 In contrast to consultants, who were relatively well paid and could supplement their incomes through private practice, junior doctors were paid very little when the NHS began. Their contract failed to stipulate the number of hours they worked, and most juniors worked in the hospital between 80 and 120 hours a week. They tolerated this because their on-call work was usually not very arduous; there were few effective medical treatments that needed to be administered in the middle of the night, so doctors on-call in hospitals at night could often sleep. Indeed, beds were provided. Moreover, many junior doctors came from well-off families and displaced whatever discomfort they experienced by looking forward to the rewards they hoped to attain when achieving the rank of consultant.

However, by the mid-1970s, all this was changing. The work had become much more intensive due to scientific advancements and the development of a rising number of effective medical interventions. The lack of extra pay for working at night increasingly became a source of resentment. Just as today, many junior ­doctors chose to emigrate. The 1974 NHS reorganisation also meant that hospitals were no longer run by doctors, but rather by professional managers, who exerted their influence through a much more bureaucratic and controlling structure. In their pamphlet about the 1975 junior doctors’ dispute, Harvey Gordon and Steve Iliffe explain why, out of all the doctors, it was the juniors who took action:

It was no accident that it turned out to be junior hospital doctors who eventually broke with the traditional apathy. They were the group most in contact with the other people working in the hospital, making contact daily with the laboratory technicians, nurses, theatre technicians, porters and switchboard operators. These workers would do overtime and be paid premium rates for it, but not so with the junior doctors. These workers would go home from their work, while all too often the junior doctor would live at the hospital—in accommodation which left a lot to be desired. These workers would get a night’s sleep, while the junior doctor would be available for duty at night and then would have to work the next day.40

The job was increasingly proletarianised, and the junior doctors responded. The convulsions that followed showed (even more clearly than with the ambulance workers and nurses) that being in a highly skilled profession would not preclude sections of the workforce from participating in the class struggle that had engulfed much of the rest of the NHS. Indeed, as with other health professionals, junior doctors’ growing skill sets and professionalisation went side by side with being treated increasingly as the same as the waged labour of any other workers, and this helped precipitated the dispute.

As Labour health secretary, Castle claimed sympathy with the dispute. In early 1975, she agreed to pay overtime to junior doctors who worked over 40 hours. Yet, she delayed implementation until a £6 pay limit had been announced in July, which clearly meant that the settlement could not be ­implemented ­without ­substantially cutting their core-hours wages. The BMA then cobbled together a deal that agreed a core 40-hour week and a reduced wage rate for overtime—junior doctors would receive just 30 percent of their normal hourly wage after 44 hours. Those on call from home would get only 10 percent of their normal pay for overtime. The BMA were inexperienced negotiators and, unlike other unions, failed to anticipate the pay freeze and was caught out. It had no plans to resist it.

Nonetheless, widespread unofficial action began after the BMA “reluctantly accepted” the deal. Two smaller unions, the Junior Hospital Doctors Association and the Medical Practitioners’ Union took the lead. As Gordon and Iliffe document:

By 9 October 1975, The Times was able to report, “Leaders of 19,000 junior doctors were faced yesterday with a rebellion by their members over a contract that came into force on Monday.” Among the rebellious hospitals listed were Plymouth, Sheffield, Scunthorpe, Leicester and Norwich. London hospitals and King’s Lynn Hospital were reported to be preparing to join in, and the Manchester region had announced its intention to meet to discuss action.41

Mary Edmondson, who was a junior doctor at the time, describes the dispute in Manchester.

We were three months into our house jobs when it all started, and we were all sleep-deprived zombies, but we knew there were junior doctor meetings going on for North West England. These were meant to have representatives from each hospital, and because I was quite vocal, I got chosen to go—chosen rather than elected. So, me and another junior doctor from my hospital went to the ­committee meetings. We were on an overtime ban, not striking. Some hospitals were doing 24-hour strikes, but we didn’t. Our contract was for 40 hours, so we started just doing a 40-hour week. We did shift work, so the wards were covered. The hospital was staffed by a whole lot of overseas doctors, especially from India, but there were Greek, Ghanaian, Indian, Pakistani and Iraqi doctors too. They completely understood and supported us, because they’d been politically active in their own countries. So, we talked a lot about politics.42

The dispute was hopelessly muddled. The consultants tried to link the junior doctors’ fight to their own dispute about private practice (with some success). Many junior doctors agreed to this alliance, thinking they would be stronger if everyone was fighting together, which is, of course, usually true but was not so in this case.

Nonetheless, by 16 October, junior doctors in all the major cities were involved. Those in Manchester were working emergencies only. The BMA reversed its decision to support the settlement, and it managed to regain control of the action by making it official—some 6 weeks after it began. By November, over half of junior doctors were participating in action.

Unfortunately, the final settlement fell far short of what could have been achieved by the action. Rather than the paltry 30 percent overtime payments being made after 44 hours work, they would instead be paid after 40 hours. However, when the settlement was implemented, it turned out to be a substantial breach of the government’s own pay policy, costing an extra £30.5 million in the first year (equivalent to around £200 million in today’s money), which was much higher than the anticipated £14 million.43 This fact was, nonetheless, kept in obscurity.

The junior doctors had demonstrated they were far ahead of their union ­leaders and were willing and able to take action independently, though not strong enough to win a complete victory. Nonetheless, a dam had been broken, and today’s junior doctors have been able to step through this breach. Moreover, in the context of the campaigns by nurses and ambulance workers, industrial action, including strikes, had become a permanent part of the armoury of weapons wielded by healthcare professionals.

Fighting cuts and hospital closures

The heady days of the early 1970s, with its explosion of workers’ militancy across the economy, saw large numbers of workers get real wage increases. However, by the mid-1970s, high inflation had set in and was cutting into workers’ pay. Inflation peaked at over 20 percent with the 1973 oil price crisis. Indeed, it remained above 5 percent until the mid-1980s. With stark similarities to today, the pressure on wages was accompanied by austerity, including cuts to the NHS. There was a new social philosophy in the air; Widgery described a reactionary social revolution “towards a harsher, meaner, less caring Britain, with a return of the Poor Law mentality”.44 This was presided over by the Labour government elected in 1974. From 1955 until 1975, NHS spending as a percentage of GDP had been rising year on year; under Wilson and Callaghan’s Labour governments, it fell from its peak of 4.5 percent down to 4 percent by 1979.45 This amounted to a cut of over 10 percent in real terms. Faced with economic crisis, Labour cut into the real wages and the social wage of those workers who had elected them.

The response of workers both inside and outside the NHS was much more self-confident than it is today—a self-confidence built up in the struggles described above and that fed into a powerful fightback. This failed to stop the cuts, but it did considerably slow down and soften them. A story will give a flavour of this. In October 1975, John Clark, NUPE’s branch secretary at the Queen Elizabeth children’s hospital in Hackney, East London, caught sight of a letter from the “house governor” (hospital manager) saying cuts were being considered. The document requested “firm proposals for making savings, even if, in so doing, the level and quality of service to patients is affected”.46 The cuts were as yet unannounced, unimplemented and, indeed, not even scoped, but the NUPE branch still went on indefinite strike until the letter was withdrawn. Furthermore, the branch refused to go back to work until an agreement was made that no wages would be docked for the strike days. These victories were publicised to other hospitals through various networks, including the rank and file Hospital Worker newspaper, which was distributed and sold through shop steward networks across the country.

Many of the fights were over hospital closures. In particular, a large number of small hospitals were being closed, many of which were much loved, having provided vital services to their local community for generations. Often, they could not be fitted with the latest technology and lacked the full range of ­specialists needed by a modern hospital. Some of these problems, such as the absence of a scanner, could have been fixed with more resources, but very often the old buildings were unfit for purpose in the world of modern medicine. The main problem was thus the failure to build new hospitals to replace them. Local people understood that something they needed was being taken away, and ­activists could see that technical arguments were being used to justify cutting resources. Hospital campaigns generally combined some level of action by hospital workers, right up to full occupation of a hospital, with support from outside trade unionists and the local community. Some were short-lived and achieved little, but others were successful in delaying and mitigating closures.

Successful campaigns generally involved hospital worker ­stewards and ­activists calling a meeting inside the hospital as soon as a closure was announced.47 A committee would be elected to represent all staff. Management would be stopped from removing equipment, staff and patients. There would be a union recruitment drive, and very often there would be a ­work-in, whereby workers would continue to work and resist attempts to wind down the facilities. Doctors would come on board to provide ­medical cover. GPs would be canvassed to keep sending patients there, and the ­ambulance ­workers would be asked to keep bringing them. Picketing would take place to gain publicity in the press. Mass meetings of local residents would be held, often involving the local MP as one of the speakers.

In the middle of 1976, the Department of Health announced plans to close the Elizabeth Garrett Anderson Hospital (EGA) in Central London. This was the only ­hospital where women were guaranteed to be treated by women, so there was strong ­feminist support for the campaign to save it. The EGA had been run down, with no maintenance being allowed, but the plans to close it were met with a ­one-day strike in July 1976, which involved some 2,000 workers at the ­hospital itself as well as the nearby University College Hospital and Royal Free Hospital. Management used the fact that a lift was out of action as an excuse to close the ­hospital, but a work-in started in October 1976, ­coinciding with a national march for the NHS. Pickets were on the gates 24 hours a day to stop equipment being taken out and to ensure only authorised visitors were allowed to enter. Staff from the EGA joined the national march that kickstarted their campaign. In December, a solidarity ­conference was held, giving confidence to the medical staff, who then decided to put their support behind the occupation. The occupation was run by the joint shop stewards committee, but a wider “action committee” included the doctors and representatives from each department within the ­hospital and the wider community outside. This type of organisation was a sort of dual power in miniature, existing in parallel to hospital management. Whereas most hospital occupations were worn down and eventually demoralised and defeated, the ­campaign at the EGA won a partial victory. The original proposals would have seen it closed and amalgamated into the Whittington Hospital. Instead, it was kept open, and the campaign ended in 1979. The EGA was finally amalgamated into the modern facilities at University College Hospital in 2008.

Most hospital occupations failed to gain the same level of success. In April 1977, a work-in began at Hounslow Hospital in West London, which provided much needed long-stay beds for the elderly. The work-in proceeded according to careful planning by hospital unions, a Trades Union Congress council of action and the Hounslow Hospital Defence Committee. The ambulance workers passed a motion banning the transfer of any patient from the threatened hospital. The work-in succeeded in keeping the hospital open for some months after the official closure date, securing support from GPs. Finally, the health authority forced the hospital to close, cutting telephone lines and using police and a private ambulance service to cart away distressed patients. Beds were wrecked and furniture was damaged to prevent the hospital being reopened by workers. There was outrage after the eviction, and 2,000 workers held an unofficial strike to protest their disgust. Some patients died shortly after their forced transfer, and the authorities were blamed. Still, even after the patients had been removed, the hospital occupation continued, with the building used as a campaign office for the Fightback bulletin, which supported other occupations and anti-cuts struggles around the country. In 1976-8, there were work-ins and occupations in at least ten hospitals, including at Aberdare Hospital in South Wales and Plaistow Maternity Hospital and Bethnal Green Hospital in East L0ndon.48

Not all fights against the cuts involved occupations. For example, 4,000 hospital workers went on strike against closures of hospitals in East London in October 1976. In town after town local anti-cuts committees were set up, organising marches, meetings and small unofficial strikes, and some 230 delegates attended a “Save Our Hospitals” conference in London.49 Yet, with a few exceptions, most of these struggles only won stays of execution. They were worn down because, most of the time, the hospital workers lacked sufficient confidence to strike and call on solidarity action from other hospitals. However, these fights did illustrate that hospital workers were confident enough to take on broader political issues about the running down of NHS services and facilities. Workers were showing they were prepared to campaign on questions that went far beyond their own pay and conditions.

The Winter of Discontent 1978-9

The the recession bottomed out in 1976; after that, levels of ­employment, and thus the confidence to engage in more offensive struggles, generally picked up. In June, Socialist Worker reported that a mass meeting of workers demanded NUPE put in for a large catch-up pay demand at St James’s Hospital in Leeds.50 However, it was only in January 1979 that any serious attempt was made to mount a big, cross-sector, national fightback on pay and to break through the “social contract”, a policy of voluntary wage restraint agreed between trade union leaders and the Labour government. Trade union branches up and down the country were building for a large demonstration and lobby of parliament for a catch-up wage rise. Hundreds of thousands went on strike, and tens of thousands attended the demonstration in London. Hundreds of schools were closed because they had no caretakers, crossing patrols and meals staff; hospitals were without ­cleaners, cooks, porters and theatre orderlies; airports had to operate without many of their manual workers. Ambulance workers also took part in the action, although in some areas, such as London, they still provided emergency cover. In other areas, army ambulances were on standby.51 Tony Ventham, an ambulance worker at the time, described how they organised the action.

It was abundantly clear that, if we were going to win this dispute, or get anywhere near a victory, we would have to organise ourselves. Immediately, a meeting was called for all London stewards and convenors. From there, an action committee was set up with three stewards and two convenors from each division. Depot meetings were called. From these came the decision, ratified by the action committee, for an all-out 24-hour stoppage. A week later, we started a work to rule, followed by an overtime ban and refusal of non-urgent work.52

The strike was very much controlled by the rank and file, but the campaign led by the union leadership was half-hearted. Ventham continues:

I would hold station meetings every morning where we would have a further vote on whether to carry on our strike. However, lack of support from the top meant the meetings got a bit ragged, and we got very isolated, so there was the danger that management could come back, and we might get victimised. So, we decided to go back to work.53

By March, there was a two to one vote against accepting a bad offer. An emergency issue of Hospital Worker tried to organise further action, but the RCN leadership ruled out any action by nurses. With no real call by the union leaders for further action, rank and file militancy was sporadic. When Callaghan was forced to call a general election (which Thatcher’s Tories won) due to a parliamentary vote of no confidence, the NUPE executive committee decided to call off the action. The years of the social contract between Labour and the unions had weakened rank and file organisation and the shop steward networks, and they lacked the strength to oppose the settlement. Paradoxically, the 1979 Standing Commission on Pay Comparability, set up by Labour and led by academic Hugh Clegg, was part of this settlement and yet resulted in a 17 percent pay increase, despite the pay limit having been set at 5 percent. Nonetheless, workers did not feel as victorious they had after the 1972 strike, when self-confidence rocketed. As Jonathan Neale writes:

On the wards and in the mess rooms, it often felt like a defeat. Partly, there was no obvious victory because Clegg took so long to report. Partly, the actions had been sectional. Those who did take action experienced a gradual erosion of their strength. Those who did not take action did not experience a victory. Moreover, of course, the full claim was nowhere near won.54

The end of that dispute and the so-called Winter of Discontent led to a big debate in the Socialist Workers Party (SWP) about what lay ahead. The SWP had been founded as the successor organisation to the International Socialists in 1977. Steve Jeffries, the party’s industrial organiser at the time, took an optimistic view. Despite anticipating the forthcoming attack on workers from the incoming Thatcher government, he felt that the growth of rank and file organisation would continue to strengthen. Jeffries set out his position in the International Socialism journal:

Ten years ago, the building of a rank and file movement, clearly speaking and struggling for workers’ interests against the “national interest”, was merely the dream of a handful of revolutionaries. Today, it is the property of a few thousand revolutionary trade unionists. As British trade unionism strikes into the 1980s, our task is to make it a political alternative for tens of thousands of workers.55

In the following issue of International Socialism, Tony Cliff pointed towards a larger retreat by the working class, which came to be characterised as the “downturn”. He described the role of the Communist Party in drawing rank and file activists into the union bureaucracies and supporting the left-wing officials. He also pointed to the reformist ideological trap involved in accepting the need for “profitability” and “viability”, which was compounded by “a loyalty to Labour even when Labour attacked workers’ living standards” as well as by “the impact of the economic crisis—cuts, sackings and so on”.56 He argued for a strategic shift away from a pure rank and file strategy to a more political approach, linking the industrial struggle with a more political and ideological critique of capitalism.

My outstanding memory of that whole period was how, in an era of industrial militancy, a relatively small number of revolutionary socialists were able to help to build a rank and file network of militants. That network went far wider than the revolutionary socialists. Through selling Socialist Worker at work and operating in that larger rank and file network, helped by the Hospital Worker newspaper, revolutionaries were able to relate to large numbers of workers and call mass action that always threatened to go beyond what the union leaders were willing to countenance.

Conclusion

There was a sharp contrast between the industrial action in the early 1970s and the later strikes against hospital cuts and during the Winter of Discontent. The early action was full of confidence. Geddes describes the mood in these earlier struggles:

The ancillaries took action for the first time in 1973. Looking back, I think there will never again be an atmosphere in the NHS when circumstances were so favourable for a victory. The sheer enthusiasm of the strikers was fantastic. The picket lines were a riot of fun and laughter.

The management were panicking like hens when a cat gets into the yard. They had no idea how to handle strikes; their industrial relations experience was zero. The union leaders’ decision to use selective action in 1973 not only lost us the battle on that occasion—it also throttled the new born militancy of hospital workers to such an extent that the effect is still obvious today.57

The stewards were new, which meant they were not yet incorporated into national and regional union bureaucracies. Equally, however, they had little experience of how union leaderships could hold back action and settle for less than what was possible. In those hospitals where rank and file organisation and newspapers were most prominent, there was a greater distrust of the union leaders and a greater readiness to challenge. Unfortunately, though, the reach of rank and file organisation was limited. Geddes outlines the situation after 1975:

Management have now become confident enough to take on the rank and file leaders; my own sacking, together with a number of other militants in London, has been the latest development in this tendency. The fight to stop the cuts has taken place in the same piecemeal way as the wages campaigns of 1973 and 1979, and the result has been defeat after defeat, resulting in a great deal of ­demoralisation. Very few of the rank and file leaders from 1973 are still around… In an industry with a very high turnover of staff, the experience of the past is being lost forever.

The strikes in 1973 and those in 1979 were very similar in terms of tactics. The vital ingredient missing in 1979 was confidence, despite the fact that council workers were also out. In the hospitals there was an air of pessimism that was not there in 1973.58

The lack of confidence was in part due to many workers buying into the idea of a national interest. Supposedly, wages had to be held down to get the economy on its feet. This weakness was magnified by the deep connections between the trade union bureaucracy, especially the left-wing union leaders, and the Labour Party. Thus, in 1979, strikes were called off so as to avoid embarrassing the Callaghan government as it went into an election campaign.

Until the early 1970s, the capitalist economy had been expanding, and industrial militancy and a rank and file strategy achieved a lot. In the late 1970s, however, as capitalism went into crisis, a higher level of politics was required.

Today, the situation has more similarities with the struggles in the late 1970s than those earlier in that decade. We are faced with major crises at the level of the world economy, international relations, ecology, global public health and climate change. For workers to have the confidence to fight, the political debates created by issues such as the war in Ukraine, the Covid-19 pandemic and the economic crisis must be addressed by the left, otherwise workers will be made to pay for these crises. There is a contradiction though. Union leaders might agree with their members on many of these key political issues, but that does not mean they will guide disputes towards victory. Mick Lynch, the general secretary of the RMT transport workers’ union, spoke well at a recent pay rally held by NHS consultants, making good points about many of these issues; yet, generally, the role of the union bureaucracies in the recent resurgence of strikes in Britain remains similar to the part it played in the late 1970s. Union leaders have sought to keep tight control over strikes and refused to escalate, and workers have often lacked the confidence to act independently.

One driver of action in the 1970s was the changing degree of ­professionalism within the health sector. The roles of doctors, nurses, ambulance workers, ­technicians and other NHS staff have become more skilled and complex as ­healthcare has advanced. Yet, professionalisation has taken place alongside a decline in workers’ control over the work process, which is more and more guided by a new managerial layer that has taken over control of hospitals from the senior consultants and matrons who used to run them. As a consequence, the barrier to industrial action that professionalism once constituted has continued to crumble. Increasingly, of course, it is the government’s ­failure to respect the skills of the workforce through adequate pay settlements that is driving the anger of doctors, nurses and other healthcare professionals, especially as inflation continues to bite. Yet, at this year’s BMA conference, many delegates spoke not just about falling pay but also about lack of adequate office space to write up their notes and speak confidentially to relatives of patients. Similarly, many complained that they no longer have secretaries to help manage their workload, because these workers have been withdrawn in favour of poorly ­functioning voice dictation systems. Healthcare professionals can see themselves being proletarianised, even if they are not using this technical term for the process.

Participants in the recent wave of NHS strikes view themselves as in for the long haul. Failure to reach the statutory threshold for striking in union ballots has not been interpreted as a permanent obstacle to strike action, but rather as an impetus to fight harder and maximise turnout in the next round of votes. The tasks for socialists in the current strike wave should include learning from the strengths and weaknesses of the strikes in the 1970s, as part of trying to nurture the green shoots of rank and file organisation and speed their development. We must also bring to the movement a political analysis that explains why workers need not pay for capitalist crises. The fights in the 1970s were held back by each section—ancillaries, nurses, doctors, ambulance workers—­fighting one at a time. In the rounds of struggles to come, we need to work hard to ­overcome sectionalism, rebuilding and strengthening joint ­committees of union reps in the hospitals and unionising all the different parts of the ­workforce as well as developing the sectional disputes that do break out. Fighting for the survival of the NHS against privatisation is clearly central today, and there are many other political struggles that reps committees should take up. These encompass racism (including the health charges levied on migrants), sexism, the environment and pandemic unpreparedness. However, by fighting back on pay, as in the 1970s, we can also gain the necessary confidence to struggle on all these different ­political axes of the generalised crisis of capitalism.

Kambiz Boomla is a retired Senior Lecturer at Queen Mary University of London and a retired GP. His took his master’s degree in Public Health at the London School of Hygiene and Tropical Medicine. He is a long-standing member of the Socialist Workers Party (SWP).

Notes