‘I just don’t think it’s fair,’ says Caroline*. ‘We’re doing the same job but for less.’

Caroline is describing her work for OCS, a private healthcare facilities firm that outsources domestic workers like cleaners, porters, and caterers to the NHS. She’s one of 50 of its employees working in eight NHS hospitals, mental health units, and clinics across Lancashire—specifically, in Blackburn, Blackpool, Ormskirk, and Preston—who are in the midst of a fight for the same pay and treatment as their in-house NHS colleagues.

As it stands, NHS-employed domestic workers—already often overworked and underpaid—receive time-and-a-half for overtime and weekends, with double pay on bank holidays. They also get enhanced pay on Christmas and New Year, seven more days of holiday pay, according to workers, and up to six months of fully paid sick pay depending on their length of service. OCS workers, on the other hand, get nothing but but £10.16 an hour in line with the Agenda for Change rate, and a paltry £96 a week in statutory sick pay.

In May 2021, Caroline and her colleagues began their call for parity in pay and treatment with their NHS counterparts, and earlier this year won an increase that took their standard hourly wages up to the level of NHS colleagues. But OCS still isn’t paying NHS rates for nights, weekends, or bank holidays, backdating the correct rate of pay, giving staff the same annual leave entitlement, or paying them in full when they’re sick. So this summer, along with workers in other companies and industries across the country, they’ve staged a series of strikes after 92.3 percent voted in favour: a 72-hour walkout at the end of June, two 48-hour walkouts in the final weeks of July, and nine days across the month of August.

Working in the conditions Caroline and her colleagues do, the lack of sick pay is a particular sticking point. ‘We don’t get any sick pay at all, so we’re forced to come into work when we’re poorly when we should be at home, but our NHS colleagues get six months full pay and six months half pay,’ Caroline explains. Britain’s terrible statutory sick pay has long been a problem, but Covid made it unavoidably clear just how bad the provision is—and as inflation spirals the things are only growing worse. ‘How are you supposed to live on that at the moment, with the cost of living going up?’

A single mother, Caroline says this crisis is hitting hard. ‘I struggle. It’s hard to say no when we can’t afford to buy anything. You just have to make sure you’ve got gas, electricity and food.’

Ian*, one of her colleagues, worked for 21 days on a Covid ward in a mental health facility during the pandemic—at one point, for seven days straight when the hospital was understaffed. ‘I was knackered,’ he says. ‘I felt terrible.’ Despite being over sixty and a smoker, he was considered one of the lowest-risk staff and expected to clean and sterilise the rooms of Covid patients, although he says that other hospitals were using ‘specialist teams’ to do the same thing.

Ian is not the only one: the OCS workers, who have been warned against speaking to the press, tell Tribune that they ‘risked their lives’ working on Covid wards like his. Even in the paltry ‘bonuses’ health workers got for those efforts, things were unequal: NHS workers got £50 or £100—meagre itself—where OCS workers got an ‘extra 10 minutes’ break and a chocolate bar’. ‘They tried to pass it off as National Cleaner’s Day, but we all knew it was for working through the pandemic,’ Caroline says. Ian adds: ‘I don’t even like orange chocolate.’

The worst days of the pandemic may now have passed, but the work remains tough. Both Caroline and Ian occasionally work on high-risk mental wards, and while luckily neither have been physically attacked, Ian says the job is ‘very emotionally distressing’. ‘You see people in bad emotional states and witness distressing events, but you have to try to detach yourself as much as you can,’ he explains.

Caroline is keen to point out that despite these challenges, she likes her job and gets on with her colleagues. ‘It’s just the company,’ she says. ‘To them we’re just a number, nothing else. They just care whether they have cover or not.’

For Ian, that lack of care is the inevitable result of outsourcing vital public services to for-profit companies, a problem rife across the NHS. ‘They just want to make money,’ says Ian. ‘And the way they do that is by taking it off the little people. Their main focus is not on the wellbeing of the services or the Trust; their focus is making profits for the shareholders, and it’s blatantly obvious.’

If profit is the goal, OCS is effective enough at it that they can afford to give their employees proper pay and conditions. ‘These are NHS workers contracted out to a company that makes millions each year,’ explains Unison Regional Organiser Dale Ollier. ‘What they are asking for is both affordable and fair. No-one wants to see services disrupted, but OCS needs to make sure workers doing the same job are treated the same. NHS Trusts should not be outsourcing services to avoid the pay and conditions that have been agreed nationally for all NHS staff.’ Similar problems have been raised with outsourcing elsewhere: earlier this year staff employed by Mitie at St George’s Hospital in South London were also out on strike, calling for decent terms and conditions and in-housing on NHS contracts.

As was made clear throughout the pandemic, the conditions in which our healthcare staff work are the same conditions in which the rest of us are treated and taken care of. Ahead of a crisis-wracked winter in which public health problems resulting from rationed heat or food look likely to spiral upwards, it’s time for employers and politicians to recognise that functioning health services depend on the workers who keep them running getting what they need and deserve. The OCS strikers, at least, know their worth, and are willing to fight for it. Caroline puts it succinctly: ‘We feel undervalued,’ she says. ‘That’s why we’re determined to strike until this gets resolved.’