This week, trade unionists working in the NHS in various different unions failed to pass the fifty percent threshold on their ballot to take strike action. As trade unionists in the NHS reflect on this difficult defeat, we must analyse our ballot results seriously.

It’s important that lessons are drawn from this, because the scores of attacks on our NHS are not going away. There’s still much to protect and defend: the Health and Social Care Bill, now due to become law, will give private companies greater powers to take over core care services. Recognising that privatisation has an adverse impact on their own pay and conditions, GMB members have already taken successful strike action against being outsourced—and it won’t be long before this necessity will arise again.

There were factors that made winning this particular ballot very difficult. When the mood was high to struggle for a fifteen percent pay rise, the Conservatives deliberately delayed the 2021 NHS pay offer in order to kill momentum—and their strategy had some success. Delays in channelling anger into collective action poured further cold water over the prospect of successful strike action at this stage. Additionally, the lack of coordination across NHS unions, who were split on the question of going straight to a legal strike ballot, caused confusion and eroded confidence among workers.

Though many NHS workers were bitterly disappointed to learn that the three percent pay ‘rise’ was a pay cut, the union’s presence in workplaces was not visible enough. In many places, a clear factor in our weakness was only having a few isolated, overworked reps in each NHS Trust. This is simply unsustainable for effective organising—after all, it’s the reps who have the hundreds of face-to-face conversations that persuade members to vote in ballots and will always be more effective than regional officials. The lack of more reps was a key factor in our inability to convert this disappointment into action.

Failing to decisively get over the line set by draconian anti-union legislation has exposed weaknesses in union structures and highlighted the need to rectify this through honest discussion and hard work, if we are to ballot effectively in the future. It’s counterproductive to blame members for not voting in ballots. Campaigns need to be driven in workplaces, and messaging about the relevance of voting must be delivered via large networks of union representatives who have the trust and confidence of the workforce.

However, it would still be a mistake for the establishment to think they can forever rely on emotional blackmail to keep NHS staff in work, because most NHS unions have noted an upswing in member participation. The fantastic NHSPay15 campaign saw an influx of active members who will need to prioritise organising their own workplaces to gain the experience and confidence to lead future ballots and disputes. They will need support, training and further development to become the next cadre of workplace leaders—and withstand the anti-union bullying that is commonplace across the NHS.

Recruitment is important for strong campaigns, but a large membership level will also require seeking out many more competent and committed reps in every ward, unit, and community team base to support and lead members into action. It is this work—the identification of future committed members and genuine spokespeople for their colleagues—that will help us further properly organise the NHS.

These people will be found not just among clinical staff, but also among the most oppressed layers of NHS staff. These potential reps will encounter the biggest barriers to involvement—they will be workers on temporary contracts, migrant workers, young working mothers. But building networks of these people is not impossible, and they will be key to any future work towards coordinated industrial action. Recruiting members is one thing; the other half of the work is to ensure that many will be engaged and active in contributing to the success of their own union.

Launching and winning future NHS strike ballots will require a drive to engage members and to explain what trade unionism is about, and what is at stake if they don’t become active in them. It’s a mistake to think members are ‘not political’; they understand what’s going on around them. This means that in order to ensure that consciousness becomes action, unions must prioritise discussing the politics of the situation we, as the working class, are in.

Alongside this, we will require an unprecedented campaigning approach across all unions, communities, and campaign groups. There should be no walls between those with a genuine desire to defend the principle of high quality, universal healthcare, and the workers who provide it for us.

An uncompromising opposition to privatisation and cuts requires unity. This means involving union members and supporting them in struggle as a top priority; here, campaigners and trade unionists can utilise a range of tactics and methods to robustly challenge cuts and privatisation—up to and including direct action, protests, and industrial action.

In spite of decades of cuts and privatisation carried out under the rhetoric of ‘modernisation’, NHS staff are soldiering on, delivering incredible care and treatment to millions of people. Media stories of ambulances queuing outside hospitals fails to give the complete picture of the work staff are still doing against all odds and in spite of attacks on their pay and terms and conditions.

The struggle is far from over—in fact, it is really beginning in earnest. The NHS is not an archaic institution in need of being torn down, like many right-wing publications and politicians would have us think. It’s still one of the best institutions in this country; millions of people recognise that, and are willing to fight for its future.

It’s important for NHS trade unionists and campaigners not to become disheartened. If handled right, defeats do not have to demoralise: they can enable you to become sharper and better prepared for future struggles. There are lessons to take forward from ours—the biggest of which is to recognise the scale of the work ahead of us to protect our health service and its workers. Let’s stop just talking about protecting the NHS. Let’s do the groundwork necessary to take united, practical action to make words a reality.