Healthcare assistants (HCAs) are some of the lowest paid workers in the NHS. As roles have evolved and hospitals have struggled with staffing, they have taken on more clinical responsibilities without the pay and recognition to match. So UNISON is organising healthcare workers to claim the reward and respect they’ve earned.
The campaign saw its first landmark victory in August 2022, when after a six-year battle, thousands of workers in Manchester were re-banded and received up to £5,000 in backdated earnings. Since then, over 70 similar campaigns have sprung up across the country.
One of the biggest successes has been at UNISON’s Northern Care Alliance branch, which unites four hospitals in Salford, Oldham, Bury and Rochdale. Through strategic organising and a campaign that has recruited over a thousand new members and 40 new reps, activists have secured re-banding and five years’ back pay for over 2,000 workers.
“UNISON is an organising union”
UNISON Northern Care Alliance branch secretary Jacqui Lewis said: “The foundations were there to build on. We used the same tactics as Manchester and launched a survey of workers to see whether people on band two were doing clinical duties that would fall within the remit of band three. We received thousands of responses that showed there was widespread practice of people working above their band. So we set up WhatsApp groups, started organising meetings and formalised a negotiating committee.”
Lisa Royle, a band two theatre assistant, became more active in the union through the campaign, which inspired her to become a UNISON rep: “Support workers are worth so much more than what they’re paid. Life’s short, you can’t make time up. We’d lost any kind of work-life balance. Nobody should have to come in on their day off to work an extra shift just to put food on the table.”
Jacqui, Lisa and other union activists put together a formal collective grievance which was signed by over 900 UNISON members.
Ms Royle describes the day in September 2022 when members met with the NHS trust’s CEO to deliver the grievance. On the day that the CEO was due to meet with governors in a meeting room at the Salford Royal Hospital, union reps booked the room next door to host an organising meeting for members. Workers marched across the hospital car park with whistles, drums and banners to get the attention of the trust’s CEO, Dr Owen Williams.
“When he arrived for the governor’s meeting next door, I stood outside and said: “Can you come and meet with us? There are 150 clinical support workers in this room who won’t be happy if you don’t.” So he came in, and I read a statement, and another worker read a powerful speech about how she wakes up at 5:30 in the morning to cycle to work.”
“We handed our grievance letter to the CEO and we asked him to sign a pledge that would say he’d negotiate with us. At first, he was resistant. Then, someone started chanting ‘Sign it! Sign it!’ and it caught on. The whole room of 150 workers were chanting at the CEO to sign it, and he knew at that point he had to. So he did. It felt fantastic.”
Northern Care Alliance management have since agreed to five years’ back pay, which will include workers who have since retired or left the trust. The union is still in discussions about how re-banding will be implemented.
“UNISON is an organising union”, Ms Lewis said, “and this campaign has really activated people.”
“A&E ground to a halt. That’s when they realised our worth”
Healthcare assistants in Leeds took a different approach. Amy Lee has been a healthcare assistant and UNISON member for 15 years and, two years ago, she noticed that she and her colleagues were doing far more work than was required: “We didn’t feel appreciated. We found it all very unfair, so we decided to file a collective grievance with UNISON’s support.”
Amy and five of her colleagues filed the grievance and after two years were re-banded, which prompted the trust to review the job roles of all healthcare assistants. While doing so, Ms Lee describes how “the trust instructed all people on band two to stop doing the extra jobs they were doing, which put a stop to HCAs doing bladder scans, ECGs, catheters, bloods and cannulas.
“The consequence was that A and E ground to a halt. That’s when they realised our worth.”
The trust immediately paid band two healthcare assistants ‘responsibility allowance’, a temporary extra payment in recognition of the additional duties they were undertaking and committed to review staffing. The union won.
“After two years of fighting, the trust told us we could apply for band three jobs, but we refused, because we were already doing the work. Eventually, we got put to the top of band three and given two years’ back pay. Then, we got other band two’s moved up to band three. Those who don’t get re-banded will receive the equivalent of 16 months’ responsibility allowance.”
Healthcare assistants in Leeds
Ms Lee continued: “It feels amazing to know you’re respected for the work you do, and you’re appreciated. You can’t do that job if you don’t care, but we were tired and being taken advantage of.”
Branch secretary for Leeds Teaching Hospitals Trust Denise Carr said: “Healthcare assistants are predominantly low-paid women workers, juggling shifts around, working part-time hours and bank shifts. They go above and beyond, and the trust have proactively worked with us in partnership to finally recognise that.”
Ms Carr continued: “It’s been brilliant. Hard work, but brilliant. It’s about people using their own voice and encouraging them to stand up for what’s right.”
Pay Fair for Patient Care: 76 campaigns
Retention and recruitment
In Newcastle, UNISON secured re-banding and a year’s back pay for around 1,000 workers. This is the campaign’s first victory in the Northern region – and according to Newcastle Hospitals branch secretary Linda Hobson, it was fairly straightforward:
“We wrote to the trust in 2021 asking them to look at healthcare assistants’ job descriptions to make sure that they match with the new profile. The role went to job matching and came out at a band three. There were a number of options put to the trust execs, but the easiest option was just to uplift everyone, so that’s what the trust did.”
Ms Hobson, a nurse herself, said: “I know how valued healthcare assistants are, they’re such an integral part of the nursing team. In negotiations, we knew one of the options would be for the trust to tell all band two’s not to do clinical duties, but we knew there’d be kickback from nursing colleagues because they can’t do all of that work.”
“We’ve had problems with retention and recruitment, which is why it’s so important for HCAs to be rewarded. The trust recognises this and, with good partnership working, we’ve been able to deliver for our HCAs.”
The union are now looking at how this can be extended to other band two workers, including physiotherapy assistants.
“Without healthcare assistants, hospitals would fall apart”
Bev Findlay is one of the healthcare assistants leading the new Pay Fair for Patient Care campaign at Bedford hospital. She said: “I’ve always thought it was wrong that we were doing way above our job description and not being paid for it. Honestly, without healthcare assistants, hospitals would fall apart.”
The campaign in Bedford started in March this year, and Ms Findlay has already managed to get 50 colleagues to complete surveys on what duties they’re undertaking. The next step will be coordinating organising meetings among healthcare assistants with support from UNISON organisers on the ground at Bedford.
“I feel really encouraged that other trusts have won on this. There’s no reason we shouldn’t either, as long as we’ve got the numbers behind us. I know that if healthcare assistants stick together, we’ll get this over the line.”
UNISON national officer Louise Chinnery said: “The Pay Fair for Patient Care campaign has seen some huge wins, with thousands of pounds being put into members’ pocket and HCAs finally seeing the reward, respect and recognition they deserve”
“Now we want to go even further, spreading this campaign to more workplaces and for more roles in our NHS. Keep an eye out for news on this in the coming months.”