We’re heading into a winter of crisis. People across the country struggle to keep themselves warm and fed as the NHS faces with record backlogs and the workers who run it grapple with low pay, burnout, and a staffing nightmare. Each of these crises feeds into another, and the government seems set on not providing solutions.

In this context, healthcare workers fighting for proper pay and conditions are also fighting for the future of the NHS. Like many others, growing numbers of outsourced workers are pushing back against the injustice of their situation. One group of these workers—cleaners, porters, and caterers employed by healthcare facilities firm OCS at Lancashire and South Cumbria Trust—have recently spent months in dispute fighting for parity with their insourced NHS colleagues, including the same number of paid holidays, enhanced pay for bank holidays and unsociable hours and, perhaps most importantly, the same sick pay, instead of the punitive statutory minimum they were originally entitled to. And last month, they won.

50 Unison members took part in 26 days of strike action over five months, culminating in an inflation-beating 14% pay rise, an extra week of annual leave, and the same sick pay as their NHS counterparts. ‘It took a long time,’ says Caroline*, who spoke to Tribune about the dispute earlier this year while out on strike. ‘But, finally, we got what we wanted.’

The sick pay victory alone, says regional organiser Dale Ollier, was backed by a ‘really strong moral case’ that made it clear that workers should never have to choose between falling behind on rent or bills and risking patients’ wellbeing by going into a hospital while sick. At just over £95 a week, Britain has one of the lowest levels of statutory sick pay in Europe—a problem made unavoidable by the pandemic, when staying off work while sick became an issue of life or death.

But the victory isn’t just about those concrete wins, either. The dispute saw Unison members at OCS make strides in building worker power within their organisation; there are now two official union reps, who have signed up since the dispute ended, and membership grew remarkably during the dispute period. ‘That means we’ve got some lasting organisation now that will stand that workforce in [good stead],’ adds Ollier, ‘and make them stronger and better equipped to deal with things in the future.’ Caroline, a mother, described her cost of living crisis fears to Tribune earlier in the year, and says she’s not only in a better financial situation now, as a tight winter sets in, but that she feels she and her colleagues are going to be ‘a lot more valued than [we] were last year’.

It all started in May 2021, when a group of workers including Caroline filed a collective grievance about their unjust contracts. But it wasn’t until the following year that year when a formal dispute was opened up. In the intervening time, Ollier says, there had been little progress and workers were feeling ‘a lot of frustration’. It seemed, according to some, like OCS weren’t taking the grievance seriously. ‘They told Unison to get lost, basically,’ Caroline says. In January 2022, OCS responded to the grievance—with a flat-out no.

OCS workers were angry, but they were far from strike-ready. As a mental health trust, explains Ollier, Lancashire and South Cumbria is ‘very fragmented and spread out across lots of different and small sites’. That meant hard organisational work to unite workers in sites where there might be only three, two, or even fewer OCS employees. But for the workers, it paid off: union membership in this time grew by more than 50%, and in a consultative ballot held in April, 98% voted in favour of strike action.

After Unison got their first mandate, the Trust intervened, pushing OCS to uplift wages by 69p to £10.19 an hour—the same wage the workers’ NHS colleagues were paid. But with no sick pay and no extra pay for unsociable hours like nights, weekends, and bank holidays, it was clear real parity still lay ahead. The dispute remained live, and the workers remained angry—anger made clear by the ensuing formal ballot, in which workers voted 92.3% in favour of strike action.

Because of the outsourced nature of the work, the negotiations that took place alongside strike action had a triangular structure, involving not only members and OCS, but the Trust, too. ‘After all, it was the outsourcing of this service to a private company [by the Trust] that brought about this dispute,’ adds Ollier. ‘We simply wouldn’t have achieved it without involving them.’

Caroline and around 30 of her colleagues, meanwhile, stood out on their picket line come wind and rain. For her, she says, the sense of strength and solidarity among the workers made it easy: ‘It was a good atmosphere, and we got a lot of support from people all around the country.’ These demonstrations of support came alongside wider publicity in the media and on social sites like Twitter. And there was solidarity, too, from Unison members from other sectors—in the NHS and in local government, for example—many of whom also showed up for a march and a rally.

Growing pressure for one side, Ollier points out, came alongside growing morale for the other. ‘[They were striking] sometimes under difficult circumstances, wondering how people felt about the fact they’d withdrawn their labour,’ he adds. But in the wake of the pandemic, the working conditions of healthcare staff—which have crumbled over a decade of austerity, or simply been outsourced to private companies willing to pay them lower wages with worse conditions—have been more in the spotlight than ever, as have the consequences of that outsourcing for patient wellbeing. As a result, ‘Members were overwhelmed by the constant support from the public,’ Ollier adds. Or, as Caroline puts it, ‘I just don’t think they wanted the publicity anymore; that’s why they gave us an offer.’

OCS is just one example of a growing reaction against outsourcing unfairness taking place in NHS Trusts across the country. GMB members employed by Mitie at St George’s joined the strike wave this summer fighting for parity, while cleaners, porters, security guards and domestic staff and members of Unite employed by Serco at St Bart’s recently won a victory that will see them brought in-house, as did members of United Voices of the World employed by Sodexo at St Mary’s last year.

As Caroline pointed out to Tribune in the summer, there is little sense in a model that sees some workers doing the exact same job for less money. At OCS specifically, though, the number one factor in the victory—‘beyond any doubt’, says Ollier—was the strength of the workers who continued to strike. ‘It became really clear to all parties that these members were not going to give up,’ he says.

Their victory, and their improved sense of security as the winter sets in, proves what that kind of resolve combined with collective action can do—a resolve workers will need plenty of in the coming months, if we want to pull the NHS and the country that depends on it back from the brink.