The Conservative government has enforced a three percent “pay rise” for National Health Service (NHS) workers in England and Wales.

This twelfth below-inflation award over a decade of funding cuts and increased workloads was already an effective pay cut before the Consumer Price Index rate of inflation reached a 10-year high of 5.1 percent in November. It is forecast to top 6 percent next year. The Retail Price Index rate currently stands at 7.1 percent. Nurses will on average be £547 a year worse off as a result of the deal.

The government has been able to enforce this de facto pay cut because of the betrayal of the health unions, which deliberately suppressed mass opposition in the million-strong NHS workforce.

In July, the Socialist Equality Party’s NHS FightBack warned of their plan to “exhaust and demoralise health workers” by tying up the pay dispute in a string of non-binding consultative and indicative ballots, “in line with the historic record of the health unions in suppressing or betraying industrial action.”

This is not only what happened but what happened very quickly, because many health workers knew from bitter experience that the unions had no intention of waging a struggle.

Unison’s consultative ballot ultimately delivered a 77 percent vote for strike action, but on a turnout of just 24 percent. The Royal College of Nursing (RCN)’s latest indicative ballot gave a 54 percent majority for strike action, and 89 percent for action short of a strike, but on a 29 percent turnout in Wales and a 23 percent turnout in England.

Both unions have duly shelved any further action. The RCN pledged to enter a “formal dispute with employers… in an attempt to solve the dispute without further action.” Expressing the unbridled cynicism of the union bureaucracy, Unison’s head of health Sarah Gorton effectively declared the 3 percent offer a done deal by saying, “the focus now rightly turns to the next pay round” next year. NHS workers know very well that “the next pay round” will be no different.

Fully three quarters of the Unison and RCN membership did not vote in this year’s consultative and indicative ballots because they did not want to participate in the degrading pantomime of a struggle which would have been organised by the unions before forcing through a sellout. Unison has already urged acceptance of a 4 percent offer for NHS workers in Scotland.

Confronted with such a devastating debacle, the pseudo-left have launched a frantic rear-guard action to defend the trade union bureaucracy and their own crucial role in facilitating its betrayal.

The Socialist Workers Party (SWP) wrote that “low turnout will disappoint many union activists as it doesn’t reflect the anger on the wards.” They do not mention that this anger is directed just as much towards the unions as towards the offer itself and the Tory government who authored it.

The SWP say of the RCN that the union “wasted” the anger of NHS workers “instead of harnessing the mood”, creating a “long delay” that “sapped the energy of activists”. But it was the union activists, or more accurately “inactivists”, who enforced the official policy of the “long delay” and “sapped” the dispute which workers wanted to fight. And to be precise about who these “activists” are, they are for the most part members of the SWP and similar pseudo-left, Corbynite or Stalinist groups.

It is the same story with Unison, where the SWP scold the union for making threats “without delivering the action necessary to win a strike ballot.” The union delivered the defeat it always intended to, as the SWP know full well.

What alarms the pseudo-left is not the defeat itself but that the way the dispute collapsed, through the mass rejection of the unions’ leadership, that exposes their own fraudulent claim that the unions represent workers’ interests. Having specialised in portraying the sellouts and defeats of the union bureaucracy as “victories”, they are worried that this latest outrage is a step too far.

Moreover, defending the bureaucracy more and more takes on the character of an act of self-defence, given the prominent positions now occupied by the pseudo-lefts at all levels of the union hierarchy.

A succession of betrayals by the right-wing in recent years have helped elevate various left talkers in the SWP, Socialist Party (SP) and similar groups into leading positions. The SWP now has six members on Unison’s NEC and the SP has four.

In June, the SWP trumpeted, “The left has swept to control” of Unison’s NEC for the first time, calling this “a very big shift at the top of Britain’s biggest union.” The SP commented, “This is now the opportunity to show what a left leadership can do.”

What the “left leadership” has done is cover for a filthy sellout of health workers, who have suffered more than any other section of the workforce throughout the pandemic only to be kicked in the teeth by those they trusted.

The pseudo-left groups have worked to confine all opposition among workers to a perspective of pressurising the trade unions to the left. Even now the SWP concludes that the RCN should move to a formal strike ballot and “throw absolutely everything into winning it with a good turnout.” Excusing their own complicity, the SP admit, “The left now has a majority” on Unison’s NEC but writes that it “faces a battle with the right and a whole layer of the full-time officers for lay-member control of the union.”

Leading SWP member and Unison NEC representative Karen Reissmann gave full expression to the demoralisation sowed by the “activists”, who she urges “to fan any flicker of resistance… to support any small dispute, any mood of anger and drive it towards collective action.”

“Action” that is through the same unions which have proved themselves time and again to be instruments for suppressing the class struggle.

All talk of “activists” and “lay-member control” is a fraud. The only people active in the unions are the pseudo-left and other members or supporters of the bureaucracy. Workers play no part in the life of these hollowed out and discredited organisations, which they do not believe will fight for anything.

The last time workers were active in a meaningful sense in the RCN was in 2018, when 78 percent of its membership passed a “no confidence” motion forcing the leadership to resign—after its participation in that year’s infamous pay deal sellout.

Proving the impossibility of reforming the unions, the RCN bureaucracy closed ranks and half of these despised functionaries secured re-election shortly afterwards. A new betrayal has been orchestrated without breaking step.

This is a broader phenomenon. In the same year as the RCN no confidence vote, members of the University and College Union (UCU) sought to pass a similar motion at their annual congress against General Secretary Sally Hunt. She was being censured for her repeated efforts to sellout the national university strike over pensions. Hunt and the UCU leadership scuttled the motion by staging a walkout, citing the protection of their own union, Unite!

Hunt resigned in 2019 and was replaced by Jo Grady, which the SWP claimed signalled “a leap to the left” in the UCU. The organisation has six members on the union’s NEC. Three years later, Grady has seamlessly continued throttling the same dispute sabotaged by Hunt, with many of the UCU’s own recent ballots failing to pass turnout thresholds.

The lesson of these events is that no struggle can be carried forward except through a root-and-branch rebellion against the trade unions. Unison and the RCN’s calamitous pay dispute is another indication of a developing break by health workers with these moribund organisations. But having rejected the unions, they must now construct new organisations to lead a genuine fight for pay and, amid a worsening pandemic, safe working conditions.

NHS FightBack and the Socialist Equality Party have advanced the call for rank-and-file committees, independent of the trade unions, as the only means of providing that leadership. These committees will lead a struggle based on workers’ interests, not those of the bureaucracy and its relationship with the employers and the government. They will reach out to workers across and between sectors to mobilise a class offensive against Tory government and an equally right-wing Labour Party “opposition”. We call on all NHS workers who agree with this programme to contact us today.