On the 24 January 1982, more than 4,000 nurses converged on Trafalgar Square, London, to protest against the government’s 4 percent pay increase limit for public sector workers. Four politicians from the four major parties spoke briefly, but backbench Tory MP Tom Benyon was greeted with deafening shouts of ‘Off’ and ‘Maggie out’. Any mention of the health minister Dr Gerard Vaughan was met with cries of ‘string him up’, and eventually Benyon was booed off stage. In contrast, Gwyneth Dunwoody, Labour’s shadow health and social services spokesperson, was met with much less hostility. She told the gathered crowd, ‘You don’t want sympathy, you want justice.’

This incendiary moment was only the beginning of the 1982 pay dispute, the largest strike in the history of the NHS and one of the greatest shows of solidarity across the trade union movement since the 1926 General Strike. The year of sporadic and localised industrial action was in response to a decade of declining real-term wages. In 1974, the Halsbury Inquiry into nurses’ pay had recommended an average increase of 30 percent. But the severe inflation of the 1970s undercut these gains, and by 1982, continuing inflation and limited public sector pay rises meant that nurses’ income still lagged far behind that of other workers. 

Nurses and ancillary healthcare staff were overwhelmingly female. Their labour was routinely denigrated as ‘women’s work’, low-skilled, and more emotional than technical or professional. Gendered discrimination underscored nurses’ low pay compared to other members of the healthcare workforce like doctors, and compared to other public sector employees like police and civil servants. In addition, low wages were justified by narratives of nurses’ devotion and self-sacrifice. They were supposed to do their jobs not to earn money, but because they were driven by a powerful sense of vocation.

To redress the decline in real-terms pay for nurses, and low wages for other NHS workers, the unions argued for a 12 percent increase as part of the 1982 pay round. The three main unions that represented nurses and ancillary healthcare staff were the National Union of Public Employees (NUPE), the Confederation of Health Service Employees (COHSE), and the Royal College of Nursing (RCN). NUPE and COHSE also represented ancillary healthcare workers, and the RCN had only been registered as a trade union since 1977. Its members were also constitutionally barred from industrial action, but they frequently participated in public demonstrations.

Despite the Tory government announcing that the public sector pay increases for 1982 would be limited to 4 percent, in March, the Secretary of State for Health and Social Services Norman Fowler raised the offer to 6.4 percent, but only for some categories of healthcare staff, such as nurses. All other non-medical healthcare staff—porters, cleaners, clerical staff—were still to receive the 4 percent. 

Fowler’s plan was to drive a wedge between nurses and other healthcare workers by offering the former a better pay deal than ancillaries. Fowler was working with the assumption that hierarchies within healthcare would work in his favour. He gambled on the idea that nurses, in their efforts to professionalise and to counter some of the prevalent gendered assumptions about devotion and self-sacrifice, would seize on an opportunity to differentiate themselves from their supposedly lower-skilled colleagues. But Fowler underestimated the solidarity of the healthcare workforce and overestimated the nurses’ docility. 

The first days of industrial action took place in May. The size, duration, and style of strike varied across the country. In some places, the NHS only offered emergency services on strike days; in other hospitals staff worked by only performing limited duties. In early June, the 180,000 members of the RCN voted by a two-thirds majority to reject the government’s 6.4 percent offer, which meant that Fowler now faced a united front of one million nursing and non-nursing staff. In many places, like Great Ormond Street Hospital in London, RCN members not only refused to cover for striking union colleagues but joined porters and telephonists on the picket line. 

And this kind of solidarity was not confined to the healthcare sector. As Alan Fisher, the NUPE general secretary put it, ‘What is unique about this dispute is the support we are getting, for the first time, from all hospital unions, from the wider trade union movement, from the public and from the patients.’ In June, members of the biggest civil service union, the Civil and Public Services Association (CPSA), were urged to strike in support of the health service unions. The CPSA general secretary Alastair Graham said, ‘We must support NHS workers and forge the possibility of common action among all public service workers in the future.’

Throughout 1982, miners across the country participated in sympathy strikes. In June, 30,000 health workers in Wales staged a 24-hour stoppage and 33 pits in South Wales stopped production when 26,000 miners joined the strike in solidarity. As Tribune put it, when they reported on the story, ‘Support is growing in all quarters for the health service pay dispute.’

And yet Fowler continued his efforts to sow discord between different elements of the public sector. In July, he increased his offer to nurses to 7.5 percent, promising the RCN that a 1.5 percent differential would be maintained between their offer and any made to other health workers. But in August, the RCN chose again to reject the government’s pay offer. At the Western General Hospital in Edinburgh, ancillary workers staged a walk-out without emergency porter cover as soon as the RCN ballot was announced. In support of healthcare workers, firefighters in Strathclyde, Scotland’s biggest brigade, began a week-long programme of action, and 2,300 men refused to carry out station duties.

In response to continuing strike action, the government mounted a hostile media campaign, implying that nurses were abdicating their professional duties. Tory politicians repeatedly insisted that the strikes were endangering patient lives. In July, Fowler told the Commons that at a hospital in Cambridge, ‘elderly and incontinent patients were being forced to lie on paper sheets, with great discomfort and distress.’ ‘That is the reality of industrial action in the NHS’, he insisted; ‘people want hospitals out of the headlines’, and they want nurses to return to their ‘real job of caring for the sick.’

In response, nurses instead insisted that their commitment to strike action was evidence for their devotion to their parents. A student nurse at a large hospital in London wrote to the Guardian, saying, ‘Most of us feel we owe it to our patients to strike, to improve their conditions, to improve our morale and to increase the incentive so that more people join the profession.’

Despite the hostility, strike action continued. As part of a national day of action on 22 September, an estimated 2.25 million workers took part in one way or another. 120,000 demonstrated in London, 20,000 in Liverpool, 12,000 in Aberdeen, 10,000 in Edinburgh, 3,000 in Derry, and 2,000 in Norwich. 80 percent of mines were closed, as were 43 out of 65 docks. Fleet Street staff stopped the publication of national newspapers, and local journalists went on strike too. Local government services were also affected, and many schools were closed. Supporting strike action was also taken by car workers at Ford and Vauxhall, and Post Offices were shuttered. 

Regional strikes continued into October and became increasingly fractious. At Oldham General Hospital, thirty demonstrators were carried out of the hospital lodge they had occupied after administrators ordered crowbars to break open the doors. Officials broke up another occupation at the Chester Royal Infirmary, where catering staff had barricaded themselves in the kitchen and chained food trolleys to cookers in protest against management’s attitude. But support was waning. Jean Greaves, chairperson of the National Association of Theatre Nurses, said in the autumn that the NHS was in ‘disorder and disruption.’ 

By December, the government shifted its offer to 12.3 percent for nurses over two years, and the promise of a pay review board by 1984. 80 percent of RCN members accepted the offer. Ancillary staff received a 10.5 percent deal over 2 years. NUPE and COHSE were both furious, but it marked the end of the dispute.

Thatcher’s Conservative government won the 1983 general election and kept its promise to set up a pay review board. Nurses were awarded between 9 and 14 percent in 1985, and 8 percent in 1986. Work done by ancillary workers such as porters and cleaners was increasingly outsourced, with two-thirds of contracts awarded to private contractors by the end of 1984. By 1988, this section of the workforce had been reduced by 40,000. Secondary action—also known as sympathy strikes—was rendered unlawful in the UK in 1992. 

RCN members are now able to participate in industrial action, and earlier this month they voted to strike at most NHS employers across the UK. While much has changed since 1982, much also remains the same. Nurses are still underpaid and still underappreciated. Old stereotypes persist. Back in 2021, Nadine Dorries, then-health minister and former nurse, approved of the government’s proposed 1 percent pay rise, commenting that nurses ‘do their job because they love their job.’

The nurses going on strike today will again have to contend with a hostile Conservative government. Current Health Secretary Steve Barclay described the planned industrial action as ‘disappointing’. And, while sympathy strikes are no longer legal, nurses will still have to rely on the solidarity of other workers and offer their support to their colleagues in return. Hierarchies remain embedded within the NHS and some of the most vulnerable members of its workforce are not participating in industrial action. Ancillary healthcare workers remain more likely to be female, part-time, migrants, working class, people of colour, and employed on insecure or zero-hour contracts. Nurses need a pay rise, and so do their colleagues.