We won’t strike in vein

Phlebotomists on the picket line. Images: Phil Loadwick

“Everything starts and ends with a blood test,” says Caroline Hayhurst, a UNISON rep and phlebotomist who has spent over three months on strike with her colleagues at Gloucestershire Hospitals NHS trust.

Phlebotomists are specialist health workers who take and handle patient blood samples. They are paid at band 2 of the NHS’s Agenda for Change pay scale, but UNISON believes that their knowledge, skills and training equate to those of a band 3 worker. This is why Caroline and her colleagues have been striking since March to demand their roles are re-banded, and that they’re paid six years’ worth of back pay to correct the historic underpayment of the work they have done.

“If someone’s unwell, the first thing a doctor will say is, ‘Alright, let’s get your bloods done.’ A blood test is the beginning of a diagnosis, it’s the monitoring of every ailment,” Caroline explains. “And whether it’s for a six-year-old child who has never had a blood test before, a needle-phobic adult, or an elderly person with dementia, we have the skills to get it right.”

Caroline has been a phlebotomist for the last 10 years, but has worked in the NHS for over 40 years. In other words, she’s spent her entire working life with patients. She says that phlebotomists, or as she calls them, ‘phleebos’, hold a specialist role within the health service that combines technical dexterity with good people skills.

“When somebody’s tense, the body’s normal response is to go into fight-or-flight, which shuts down peripheral veins and keeps the blood in the core. So you need good people skills to get people to relax and be compliant.”

Phlebotomists are regularly drafted in when another health care worker has been unable to take a sample. “There are lots of patients who’ve had multiple attempts from our colleagues in the hospital. This can include patients on chemotherapy who are very poorly and dehydrated, which makes it difficult. But getting blood samples is our area of expertise, and we’ll always be able to get it done.

“If you’re taking blood from a child who is nervous, for example, you try and turn it into a science lesson, or a bit of fun. You tell them that the blood is driving around the body like a little car that picks up messages from the bones that they need more calcium.”

There are over 300 different type of blood tests and phlebotomists know each of the correct sample tubes and techniques they need to use for each one.

“You also have to decipher consultants’ handwriting on forms, so a degree in hieroglyphics is usually helpful too,” she laughs.

Pay fair for patient care

Caroline (pictured below) and her colleagues had long suspected they were on the wrong pay band. Then, in 2023, when healthcare assistants (HCAs) across the country joined UNISON’s ‘pay fair for patient care’ campaign and won a correction from band 2 to band 3, plus thousands of pounds’ worth of backpay, the phlebotomists realised that to secure the pay they were entitled to, they needed to build their collective strength by joining together in a union.

In 2024, when all HCAs at the trust were re-banded to band 3, Caroline’s colleague Dawny joined UNISON and started to talk to her colleagues about joining too. They initiated a collective grievance from phlebotomists, and in September 2024 they marched together to deliver it in person to the trust’s CEO, Kevin McNamara.

“We asked people: ‘Do you feel valued? Do you feel you’re paid appropriately? If not, sign here, let’s do something about it.’”

Mr McNamara initially pretended not to be in, but Dawny, Caroline and their colleagues coaxed him out of his office and told him straight: it’s not right for bosses on six figure salaries to be underpaying their workers. Initially, the CEO’s only response was to offer to visit the phlebotomy department in March the following year, which would have been six months later. “It was the final insult,” says Caroline.

By this point, every single phlebotomist, and their supervisors, had joined together in UNISON and they elected three among their number as their union reps. Next, they ran a consultative ballot in October, which returned a 100% vote for an industrial action ballot if their pay wasn’t corrected by the end of 2024.

“By the time we walked out, we had 100% on our side.”

Re-banding

“We know that our skills align to band 3,” Caroline says. “When we tell other staff we’re on band 2, they can’t believe it – a lot of them thought we were on band 4.

“We didn’t join the NHS to earn lots of money, but now with the pay falling so far behind the cost of living, we’re facing the choice of whether to turn our back on our skills and work in a supermarket just so we can make ends meet.”

The NHS process for re-banding a role involves a job evaluation panel, where union and management representatives jointly assess the skills, responsibilities and effort required for a role and follow a national scheme to determine what the appropriate band is. The trust initially set up a job evaluation panel to assess phlebotomists’ roles, but when the panel met in March this year, senior managers panicked and pulled the plug.

The trust’s management then falsified the outcome to the press, claiming the panel had made a band 2 decision. Only after internal documents were released did the truth come out.

After two more months of strike action, the CEO finally agreed to allow the job evaluation panel to reconvene and review the roles the phlebotomists have been carrying out.

However, just days before the panel was finally due to meet on 9^th July, the trust announced that they were delaying the meeting again, and wanted to change the panel’s membership by adding another management representative.

According to UNISON head of health, Helga Pile, the behaviour of the CEO and other senior managers is making Gloucestershire Hospitals NHS trust look like a ‘rogue employer’. She says they seem determined ‘to go to any length to avoid paying staff fairly.’

“NHS trusts up and down the country are doing the right thing by paying their staff properly for the work they do and giving them compensation for when they weren’t on the correct rate,” says Ms Pile.

“The bizarre and counterproductive approach adopted by senior executives at Gloucestershire is not only out of step with the rest of the NHS, but it clearly isn’t working either.”

‘We’ve got to stand up for ourselves’

Most of the phlebotomists on strike are mothers or care for other relatives, working part-time to balance their shifts around caring responsibilities. For almost all, this is their first time taking industrial action. Many are out of their comfort zone.

“When you spend your life caring for people and working in a profession like this, you have this great feeling of self-worth about what you do,” says Caroline. “Now, we’re all away from that, we feel like fish out of water. But we’ve got to stand up for ourselves.”

The close-knit team of 37 (36 women and one ‘token bloke’) have been picketing Monday to Thursday, alternating between the two hospital sites in Cheltenham and Gloucester. Every now and then on a Friday they host ‘motivational movie mornings’ in a room upstairs in a local pub.

The films started off being strike-themed (Pride, Made in Dagenham, Suffragette) but have moved on to sports (Cool Runnings, Eddie the Eagle). The common theme, according to Caroline, is “don’t give up your dreams, stand your ground, believe in yourself.”

And their campaign activities away from the picket line don’t stop there. In June the phlebotomists went to Parliament, with all seven MPs in Gloucestershire writing to Wes Streeting, the health secretary, to raise concerns that the trust has not followed the NHS pay rules.

Two weeks later, the phlebotomists received a standing ovation before speaking at UNISON national delegate conference, and on Friday 4 July, the 100^th day of their strike, they held a rally in Gloucester with new friends and supporters from around the country.

The ‘magnificent 37’, as they’re known locally, are committed to staying on indefinite strike until their roles are re-banded. UNISON members across the country are on their side, donating thousands to their strike hardship fund so they can keep fighting until victory. Caroline says the support from hospital patients and colleagues has been particularly special.

“We’ve had patients, the people who we feel the most bad about turning our backs on, come out to the picket line and say ‘stick with it girls, you stand your ground.’”

And that’s what they’ve done. At the time of writing, the strike has run for 80 consecutive days, 106 days in total.

UNISON South West regional organiser Chris Roche said: “The phlebotomists in Gloucestershire hospitals are an inspiration for us all. There’s so much going on in the world – bullying bosses, the wealth inequality crisis, climate chaos and the horrors of genocide in Gaza – so it’s easy to feel overwhelmed. But these NHS workers remind us that we’re not powerless, and by acting together we can start to make things better.”

For Caroline, the fight is much bigger than herself and the rest of the magnificent 37. “It’s not just for us,” she says. “It’s for the people who want to come into this job for their future. It’s for underpaid, undervalued people everywhere.”