While studying abroad in England and volunteering with the Radcliffe Hospital branch of the NHS, I have heard multiple opinions about the detrimental effects of NHS infrastructure on patient care. This article evaluates the roots of recent NHS protests, revealing complications that threaten the United Kingdom’s mammoth healthcare provider.

The best hospitals are not just businesses. Rather, the best hospitals have the dual function of discharging its patients as quickly as fit, and functioning as a home for their time under care. Hospital administrations also have the responsibility of sheltering its physicians, nurses, and workers from the human suffering medicine aims to combat. So wheredo we draw the line between practicality in hospital working conditions and hypocrisy in healthcare?

Wherever the line is, the major United Kingdom Hospital Systemappears to have crossed it, and is not fixing its mistakes. The National Health Services (NHS) is a multi-billion dollar hospital network aimed at delivering healthcare to all, regardless of financial status. Founded in 1948, the NHS gives free healthcare to 64.6 million UK residents per year, and is among the five largest employers in the world. However, the private contractors for the NHS domestic service staffs and the negative relationship the NHS has with the Royal College of Nursing are not helping the image or internal unity of this massive institution.

Figure 2

Serco group, a provider of public services, became the primary contractor for NHS cleaners this year after winning a£600 contract. The change led to one of the biggest strikes in UK history; approximately 700 hospital staff members (including security guards, cleaner, and porters) walked out on the Barts NHS trust for 7 days on July 11th, 2017 . There were several separate strikes, ranging from 48 hours to two weeks in length, staged at Serco’s presentation of fiscal results to investors and at the Royal Hospital in London. A strike ballot was arranged, and 99% of voters believed this was the appropriate course of action. Cleaners, who felt taken advantage of and physically deteriorated, chanted “we will not be bullied anymore” as they spearheaded a movement against unfair working conditions in the NHS.

The conditions that forced these workers to strike are appalling. The private sector has eliminated any time for physical rest, and has unreasonably maximized the daily tasks of every worker to a point where personal health sacrifices are being made. The commotion inside NHS hospitals has notably increased as fewer workers are forced to undertake more jobs. Margaret Acheampomaa, a Barts trust worker, elaborated upon her heightened physical and emotional stress following Serco’s changes. She has “Frequently seen colleagues, grown men and women, break down into tears as they simply cannot take the pressure any more”. A cleaner from the Royal London Hospital stated that “Since Serco came… We never have time for breaks, which has affected my health. They think domestic staff are invisible. But who is going to feed patients or keep the hospital clean?”.

These extra tasks have not been of any financial benefit to the workers. Cleaners work overtime and multiple extra jobs simply to stay afloat, and for a period directly after Serco’s contract some cleaners were paid under the London living wage of £9.75. Domestic staff, security guards, and porters submitted a 30 pence pay claim to Serco in March, which was rejected and only fueled the anger of hospital workers. Serco made an approximate profit of £82 million pounds in 2016 from its NHS contract, clearly benefiting from the exploitation of laborers. Rupert Soames, Sir Winston Churchill’s grandson and CEO of Serco has a £2 million salary. Clearly the Serco group and the NHS has financial leeway to improve the quality of patient care and worker well-being.

This is not the only incidence of severe payroll issues for the NHS this year. Following the NHS’ 14% wage cut and incomplete staffing, 270,000 nurses ran a strike ballot through the Royal College of Nursing in May. The votes called for a strike, and protests were held in 30 locations across the UK, leaving the NHS “on its knees”. This was the first incidence of industrial action in the history of the Royal College of Nursing, reflecting the deep anger members felt towards the maltreatment of trained professionals. Doctors’ pay has fallen approximately 17% in recent years, and nurses’ pay has fallen approximately 14%.

Figure 3

The pay gap has left nurses “worried about the future of the profession” and more worried about their health and their patients. Lauren Gray, a 22-year-old nurse, stated: “There have been times when I’ve left work and I’ve had a 20 minute break all day and I’ve done a 14-hour shift… Do you want someone who’s physically exhausted caring for you? It’s not right..  This is only one of the many concerning experiences nurses shared about the NHS, and their genuine fears for the patient’s well-being are apparent. While it is obvious that the patient is the priority of the hospital, prioritizing economic gain to the point of understaffing, underpaying, and exhausting workers in no way projects better outcomes for patients.

The figures exemplify what poor working conditions entails for the NHS, as well as medical professions in Britain. The Royal College of Nursing has stated that there are approximately 40,000 vacant nurse positions in the United Kingdom, and the percentage of nurses leaving surpasses the influx. Nurses are not losing their passion for medicine and public service, but are clearly losing loyalty for the NHS. Lana Cook, a nurse from Scotland, states that “A lot of my colleagues are planning on getting one of two years under their belt and then going to Australia, New Zealand, Dubai to save for a mortgage”. A medical institution’s foremost responsibility is to promote the wellbeing of everyone involved in its function. Stop caring about the health and safety of well-trained staff, and you will lose them to an institution that will; it’s that simple.

It is safe to assume that these changes are not positively affecting patient care. The NHS is notorious for taking large amounts of time to address the concerns of patients. Sure, a mammoth institution can be disorganized at times and credit can be given to the NHS’ selfless mission statement. However, this statement is becoming more hypocritical as the financial and physical toll being taken on caregivers increases, directly correlating to poor care on the floor. Gray describes the ward as “manic,” and changed her department so the number of patients she is responsible for is no longer “unsafe”. Anna, a nurse with seven months of qualification, discussed her horrific emergency ward experiences with Independent magazine. Anna was called in on a team of two (which should have been six) and had a severe amount of patients who all needed critical care. The “corridor was full of queuing ambulances” with “nowhere to put them,” and “the phone [was] ringing out as there [was] nobody to answer it.” She ended up losing two patients in one shift, which could have been prevented with more man-power and organization. . These experiences are devastatingly common, and patients are being neglected more than ever.

The concerns of nurses has translated into the “Scrap the Cap” campaign, which urges the Government to abolish the NHS’ 1% pay cap. About 3000 hospital workers and public members rallied in Parliament square to fight blatantly unfair wages on September 6th . It is evident that the movement is not losing momentum, and various public figures have expressed their support towards sufficient compensation for nursing staff.  This is no longer a matter of economic balances and private contracts, but it largely concerns human rights and dignity. It is a popular opinion that if the NHS does not begin to prioritize healthcare, it will continue to lose support and the institution will fall is disorganization, which will be detrimental to the economy and medical infrastructure of the United Kingdom.


Acheampomaa, M. (2017). One of the Biggest NHS Strikes in History is about to Happen-but You Won’t Hear About It.” The Independent: Independent Digital News and Media. Retrieved from

Forster, K. (2017) Nurses Vote on Strike Action after NHS Pay Cuts Leave Staff ‘Struggling to Make Ends Meet. The Independent: Independent Digital News and Media. Retrieved from www.independent.co.uk/news/health/urses-strike-vote-nhs-pay-cuts-royal-college-nursing-ballot-janet-davies-low-income-a7681441.html

Forster, K. (2017). NHS Nurses Protest Outside Health Department over low pay: ‘Without nurses, the NHS will fall’. The Independent, Independent Digital News and Media. Retrieved From http://www.independent.co.uk/news/health/nhs-nurse-health-department-protest-pay-london-rcn-royal-college-hospitals-jeremy-hunt-government-a7810526.html

Forster, K. (2017) ’The NHS is on Its Knees, and We are Too’: Nurse Describes 13-Hours A&E Shift That Left Her ‘Broken’. The Independent, Independent Digital News and Media. Retrieved From www.independent.co.uk/news/health/nhs-nurses-13-hour-shift-on-its-knees-broken-emergency-crisis-rachel-clarke-a7836851.html

Grafton-Green, P. (2017). Hundreds of London Hospital Workers are Protesting Outside JP Morgan Offices. Evening Standard. Retrieved Fromhttp://www.standard.co.uk/news/london/hundreds-of-london-hospital-workers-protest-sercos-low-pay-outside-offices-of-jp-morgan-a3603021.html

Jones, A. (2017). Nurses Vote Overwhelmingly to Strike for First Time Ever over 1% Pay Rises. The Independent, Independent Digital News and Media. Retrieved Fromhttp://www.independent.co.uk/news/uk/home-news/nurses-vote-overwhelmingly-to-strike-for-first-time-ever-over-1-pay-rises-a7735451.html

Siddique, H. (2017). Enough is Enough’: ‘Nurses Protest against Pay Cap Outside Westminster. The Guardian, Guardian News and Media. Retrieved fromhttp://www.theguardian.com/society/2017/sep/06/enough-is-enough-nurses-protest-against-pay-cap-outside-westminster

Whitehead, S. (2017). Cleaners at London Hospitals Stage Seven-Day Strike over Pay. The Guardian, Guardian News and Media. Retrieved From http://www.theguardian.com/society/2017/jul/11/cleaners-london-hospitals-barts-serco-seven-day-strike-pay


Header Image: (2017). Thousands Attend Scrap the Cap Rally. Royal College of Nursing. Retrieved Fromhttp://www.rcn.org.uk/news-and-events/news/thousands-attend-scrap-the-cap-rally

Figure 2: (2013). About the National Health Service (NHS) in England. NHS Choices, NHS. Retrieved fromhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

Figure 3: Getty Images. (2016). Junior Doctors and Supporters rally through the city centre during an all-out strike on April 26, 2016 in Bristol, England [Photograph]. Retrieved Fromhttp://www.independent.co.uk/life-style/health-and-families/health-news/nhs-doctors-morale-gmc-report-specialising-state-of-medicine-general-medical-council-working-a7382606.html

Posted by Ishu Sivakumar

Ishu is a Freshman pursuing a Molecular and Cellular Biology major and a Bioethics Minor. As a writer for HMR’s Global Health Team, she is passionate about reporting the international variables of healthcare and the impact of foreign affairs on healthcare policy effectiveness. Ishu’s interest in Global Health extends to her involvement with the Hopkins Model UN Team, her position on the MEDLIFE board, and her involvement with Cancer Metabolomics research at the Medical Institute. Ishu is excited to continue to explore global healthcare when she studies abroad at Oxford University her sophomore year, and she ultimately hopes to become a surgeon.