Draft plan for London & Eastern High Cost Area Supplement Campaign

Draft plan for London & Eastern High Cost Area Supplement Campaign

This plan was presented to the London & Eastern Health Combine and RISC in January and February. Guys and St Thomas Hospitals Branch proposed the motion for a HCAS campaign that was passed at the RISC.

Introduction

What is the High Cost Area Supplement?

The High Cost Area Supplement (HCAS), sometimes referred to as “London Weighting” is additional payment made to NHS workers who work in London and the surrounding areas. It was implemented as part of Agenda for Change, and was aimed to establish equity among the various forms of additional pay that were implemented across London hospitals.

HCAS is divided in to three areas:

Area	2025/26 pay rate
Inner London	20% subject to a minimum payment of £5,609 and a maximum of £8,466 per annum
Outer London	15% subject to a minimum payment of £4,714 and a maximum of £5,941 per annum.
Fringe	5% subject to a minimum payment of £1,303 and a maximum payment of £2,198 per annum.

The areas it covered are based on the boundaries of old Primary Care Trusts and Strategic Health Authorities, organisations which no longer exist and have been replaced by Integrated Care Boards (ICBs).

Problems with HCAS

Boundaries no longer reflect NHS organisation

HCAS was implemented in 2004, and has not been updated since. It has not been updated to reflect the fact that organisations which its areas applied, to no longer exist. A two decade of NHS cuts, privatisations, mergers and regional and national reorganisations have reshaped the NHS, and meant the boundaries do not reflect the current lay out of services and workplaces.

Barts Trust includes staff at The Royal London Hospital, and Newham Hospital. Royal London is in inner London, while Newham is in Outer London, creating pay inequalities within one NHS organisation.

Does not match rising cost of living

Nor has it not been updated to reflect the rising cost of living, which has risen hugely in London over the past two decades. While 20 years ago there may have been some difference in living costs to justify the different pay areas, now all of London is expensive to live in, and NHS workers either have to pay extortionate rents and struggle to pay their bills, or live on the outskirts of London, with long commutes to work on top of long shifts.

Regions around London have similar cost of living, but are not in HCAS

Surrounding towns and cities have also seen huge rises in the cost of living, and they are completely exempt from HCAS. The rising cost of living necessitates additional pay arrangements for those areas being created to compensate NHS workers for the rising costs there. NHS workers in these towns and cities in London & Eastern, and South Eastern regions have the highest cost of living in the country, but no compensation.

What are Unite’s demands?

Campaigning around the issue of HCAS can mobilise a large swathe of NHS workers, if we have demands which give them something to fight for. 

This necessitates demands to expand coverage of HCAS to surrounding regions, giving those outside its catchment area a reason to join the campaign, and demands to eliminate the inequality present in the current arrangements so workers across London’s boroughs will mobilise.

Draft demands

1. Renew HCAS - raise the HCAS rate, and expand its coverage
2. Redraw the boundaries - One rate for all the London Boroughs
3. Raise the rate, remove the cap - raise the London rate by 10%, remove the salary cap so workers receive all of the additional pay.
4. HCAS for Eastern and South Eastern regions - towns and cities surrounding London and in those regions to have their own HCAS rates

How shall we campaign?

The campaign should be organised through the LE combine, with all branches asked to send delegates to LE Combine meetings so that they are included in campaign planning and can report back on developments and local progress.

The Combines work can be reported back to the RISC, and oversight provided there.

1. Petition

Unite L&E should launch a petition asking NHS workers if they support the demands of the campaign, and if they are willing to take strike action to win these demands.

This can be an online and paper petition. The aim will be to secure 5000 signatures across Unite’s London & Eastern membership over the next two months, and present these signatures to the DOH in an action in March/April.

2. Leafleting

L&E to produce a model leaflet two-sided leaflet containing information about campaign, with space for branches to add their own specific local issues. Branches to be responsible for leafleting and petitioning their members.

3. Meetings

Branches to organise local meetings about the HCAS campaign in February, and L&E to hold a London wide meeting for reps and members in March, to prepare members for balloting on the issue as part of the national pay campaign.

4. Protests

L&E Reps to organise a protest march for HCAS renewal in March. Reps to book the day off, and take part in protest march from a hospital to DOH to deliver signatures and dispute letter. Propose we use St Thomas Hospital as starting point for march. Aim to mobilise 40-50 reps to protest, plus any members who can attend.

Rallies can be organised locally at NHS Trusts to build support for the campaign

Further protests can be held as the campaign develops; other targets could be:

• Meetings where Wes Streeting is attending
• Labour Party HQ
• NHS Trust offices

5. Ballot

L&E Region to formally open dispute with DOH in March, so that issue can be included on consultative ballots alongside national pay and cuts, and so we can proceed with ballot if other regions do not want to campaign.

Map of HCAS areas:

 

Motions to the L&E RISC - Creating Caseworkers for Unite, timeframe for the 2026/27 Pay award

These were motions proposed to the London & Eastern RISC in September 2025. They were amended and submitted to the Regional Committee, and Health National Industrial Sector Committee respectively.

The first motion proposes creating a case worker system for Unite to support members and regional officers with the increased load of casework, due to the decline in workplace reps in some sectors.

The second motion proposes a timeline for this years NHS pay campaign. Too often the union has waited months for the outcome of the PRB report, rather than taking the initiative and starting ballots as soon as a pay award is not granted in April, as the BMA has succesfully done.

Motion: Invest in caseworkers to support Unite members

Motion on creating Caseworkers for Unite

This RISC notes:

1. Unite has a duty to support its members both collectively through industrial action and campaigns, and individually through supporting their individual employee relations cases.

2. At present there is no system to support members with individual case work; if there is no active branch in a workplace the burden of case work falls entirely on Regional Officers.

3. In a situation where branch organisation is in decline across many sectors, and where Unite offers membership in completely unorganised workplaces, this places a huge burden of work on Regional Officers.

4. This workload prevents RO’s from being able to support members in the workplace and organise campaigns and industrial action, and leads to a poor service for members needing individual support.

This RISC believes:

1. To rectify the situation the union needs to invest in case workers to handle individual cases from workplaces where Unite is recognised, but without functioning branches, or from the unorganised workplaces where it offers individuals membership.

2. By investing in professional caseworkers, Unite will provide a better, more consistent service to members, resulting in member retention and increased subscriptions.

3. This investment will free up officer time which can be better spent supporting branches and taking forward industrial organising campaigns which will grow and strengthen the union, recruiting more members and increasing our strength in areas where the union has declining membership and organisation

This RISC calls on the Unite Executive to:

1. Urgently develop a plan for creating a caseworker department in every Region which can takeover the responsibility for individual casework from Regional Officers

2. Commit to invest the necessary resource to recruit and staff caseworker offices in every region, in proportion to the need for casework support.

3. Contact our sister unions which have caseworkers for advice and guidance on how to organise and structure this new function to provide the best service to members.

Motion: A timeframe for the 2026/27 NHS Pay campaign

The L&E RISC notes:

1. NHS members are set to ballot in September/October over the 2025/26 pay award. Strike action will not be able to take place till November or December.

2. This time frame has been forced upon us by the long delay in initiating the consultative ballot over pay, and the failure to submit a pay claim earlier in the year.

3. Unite Health needs to avoid falling into this situation again for future pay awards as it creates delay and an unnecessarily lengthy pay campaign, putting extra stress on reps energy and resources to maintain the momentum of the campaign.

The L&E RISC believes:

1. Unite Health should initiate a consultative ballot over pay as soon as the government has failed to agree a pay award on April 1st.

2. We cannot keep allowing the government to dictate the time frame and timescale of our pay campaign.

3. Drawn out pay campaigns waste precious time and energy, while the crisis in the NHS and the cuts and privatisations worsen with each month.

4. The BMA has show you can undertake a consultative ballot, and industrial action ballot prior to August, if you begin consulting members in April.

5. There is nothing to stop the union initiating a consultative ballot in April, regardless of the government having issued its formal pay award. Continuing the practice of waiting for the government pay award allows the government to delay our pay campaign, and leads to us wasting precious time.

The L&E RISC calls for:

1. All RISCs to undertake discussions at their Winter/Spring RISC, with the aim of submitting proposals for a 2026/27 pay claim to the Spring 2026 NISC.

2. The Spring 2026 NISC should discuss and agree a pay claim and submit to the government prior to March 2026. This pay claim should be communicated to members in advance of April 1st, and form the basis for our consultative pay ballot.

3. If the government does not agree a pay deal for April 1st which meets the demands of Unite Health members, the union should immediately commence a consultative ballot of members for strike action, with the aim of concluding this consultative ballot by the end of May.

4. Once the consultative ballot is concluded, Unite Health should initiate industrial action ballots, with the aim of concluding these by the end of July 2026.

Appeal to the Unite Health NISC and National Health Officers - Let us ballot!

This appeal to the National Industrial Sector Committee (NISC) is on behalf of the 1500 Unite members at Guys and St Thomas NHS Foundation Trust, who voted overwhelmingly to reject the government pay award, and to ballot for strike action over pay and ongoing job cuts.

Last Saturday 13th September, over 100,000 racists and fascists marched passed St Thomas hospital in an anti-immigrant, anti-refugee, anti-Muslim demonstration. While the march went past, elements of this mob tried to force their way in to the hospital and our security officers, - the majority of them Unite members from migrant backgrounds -  had to barricade the doors of our hospital to stop this racist mob getting inside and threatening staff and patients.

This massive display of support for racist, anti-immigrant, anti-refugee views has created fear and anxiety among our multi-national, multi-cultural workforce, many of whom felt too intimidated to attend work on Saturday, or stayed after work for hours in the hospital until the racist crowd had dispersed and they felt safe to leave.

These events are terrifying, and foreshadow worse to come in the future as racist scapegoating increases and attacks on migrants worsen.

As Unite members in the NHS, we represent this diverse, multi-national, multi-cultural workforce and are best placed to fight back against both the damaging effects of austerity on our public services, and challenge the racist ideas which divert blame on to migrants and refugees.

Now though we are being told our union will not ballot us for strike action to fight for better pay or to fight back against the job cuts and closures which are devastating the NHS.

Despite our branch, and many others in London & Eastern Region and around the country voting in favour of strike action in our consultative ballot, and spending the last five months preparing for a ballot, we have been told we may not be given a strike ballot. The reasons we were given; because other health unions have decided not to ballot for strike action, and some Unite Health branches do not want to strike without them.

Making the decision on this basis is wholly wrong and should be rejected. Our members will expect our union to be willing to fight. The issues they want to fight over have not gone away, and members should have the say on that through a strike ballot.

Our members have voted for strike action in a consultative ballot, and over 30 branches and workplaces, representing 20% of our membership indicated they wanted to ballot for industrial action. These members should be given the ability to do so. 

The issues our members voted to strike over; low pay, the cost of living crisis, understaffing, job cuts, down banding - have not gone away, and the situation worsens with each passing month. We need to use  this opportunity to allow our members to have their say and show their willingness to fight back.

Our members must be given the ability to make their choice through the ballot, not through a decision at the NISC. Its removing our members 

 In this time of great national crisis, where our public services are collapsing, the economy is stagnant, and racist mobs are roaming the streets, we must take action wherever we can to fight back. Our strengthen lies in demonstrating how the working-class uniting in the workplace can win victories for working people. Ducking the fight because it is challenging now, will only make it more difficult the next time.

If a strike ballot is denied to those branches which wish to fight, it will undermine our credibility with our members. We have spent months promising a strike ballot to members across workplaces in L&E Region, to not deliver would break trust in the union, and undermine any future attempts to organise strike action.

In L&E we have been building branches which can take strike action, ending years if stagnation in the Health sector. We have secured important local victories, and are recruiting reps and strengthening Unite's organisation in health in the capital.

By taking forward these disputes to strike action, we will build organisation, and be in a better position to fight disputes in the future. With Labour continuing to undermine the NHS, we must take forward every fight we can.

Report from the 3rd annual Berlin-Brandenburg Hospital workers Movement (Berliner-Brandenburg Krankenhaus Bewegung)

The Berlin Hospital Workers Movement was started during the height of the Covid pandemic in 2021. A group of hospital workers inspired by Jane McAllevey’s Organising for Power training course set out to radicalise their hospital unions and led a fight for higher pay, safe staffing and insourcing of outsourced workers.

The movement organised across twelve hospitals and led a strike that lasted over 30 days and won significant improvements in staffing including mandatory staffing ratios, extra pay for overtime shifts, and extra holidays for staff who have to work understaffed shifts.

The movement filmed a documentary which provides a good account of their organising work, and the strike:

How the movement built itself holds many lessons for trade union activists trying to organise and inspire NHS workers to resist the running down and collapse of NHS services.

The Berlin health workers organised with the support of their union ver.di, using the formula that the movement was “powered by ver.di”, but not run by it. They emphasised workers organising themselves and leading the movement themselves and set about developing innovative ways to organise.

To build the movement they formed campaign groups in hospitals and worked to recruit activists on as many wards and departments as possible. These activists were given the task of surveying and organising their ward or department to find out what staffing levels and improvements they wanted, and of electing a representative to represent that ward at the movements mass meetings. 

The motivation for surveying the whole workplace was that if they managed to survey all the workers, then the specific demands that came out of their departments surveys would be incorporated in to the movements demands to management.

They worked for many months to recruit and build across the twelve hospitals in Berlin, until they had sufficient survey results and elected representatives to show the movement was well implanted.

Activists used many innovative methods to engage union members; one time they asked for photos from everyone who signed a petition, and used the images to make a banner showing how many people had signed it. 

Once the movement had enough elected representatives, a mass meeting was held at an open air sports stadium. Over 500 representatives from across the 12 hospitals attended. They debated and discussed the list of demands that came out of their organising work, agreed a set of demands, and voted to strike to win them.

In the German system, rather than a national contract that all staff follow, contracts are made between employees and their specific employer and negotiated by the union. The union can open a dispute and ask for a new contract with new conditions, and that is what they did. Through Ver.di the movement went in to dispute with the employers demanding a new contract with specific staffing ratios, increased pay, and penalties for the employer if staff had to work in understaffed areas.

They staged a “protest strike”, followed by an indefinite strike which lasted over 30 days. Most of their demands were won including improved pay, specific staffing ratios and penalties such as staff receiing and extra days annual leave for every understaffed shift they work. They did not win all their demands; the outsourced workers remained outsourced after their strike, although pay and conditions were improved.

3rd Hospital Workers Conference

I was invited to attend the conference having met some of the movement activists when they visited London in February. The Rosa Luxembourg Foundation brought several activists over during the early days of the NHS strikes to talk about their experiences, and meet with striking NHS workers.

The conference was attended by over 200 hospital workers and took place over two days. The union Verdi had encouraged all union members to take the time off work as union training so they could attend. Union members are entitled to ten days a year of under their employment laws/collective agreements.

For union reps and member struggling to get time off work to organise, it was a simple example of  successfully using existing laws/collective agreements to free up members to organise.

"More of us is better for everyone"

The conference had a number of themes; Health Policy, Unions, Union Practice, Stronger Together and Youth. They covered issues like staff shortages, fighting for democratic hospital systems, organising against extra shifts and forced overtime, uniting health struggles with struggles over rent. It was inspiring seeing a union conference hosting such discussions, trying to build unity with other struggles and project a better future for the health service than the one at present under capitalism.

I attended "Outage Management - How do we protect us; overtime, on-call, extra shifts"  The discussion looked at the ways hospitals organised overtime and extra shift work. There is a practice in hospitals of staff regularly being asked to work extra shifts to cover for understaffing. However it had the added layer that staff were having their rota’s changed and new shifts inputted after the rota had been planned and issued to staff. Hospital workers were being called by their managers and were told they had to come in to work the shifts, and they felt they could not disagree because the shifts were part of their rota.

The sessions aimed to educate union members on their rights to refuse extra shifts, and how the system could be turned around on management.

The issue came down to managers abusing the system which exist in many large companies in Germany. The workers council is made up of staff members elected by the employees, who represent the workers to management and have some powers or oversight function within the organisation. The workers council is separate from the trade unions. Trade union members do stand for election to some councils, but not all and many of the councils are not very active in using their powers to support staff.

In the hospitals the workers councils have the authority to approve or reject planned rota’s for staff, they are meant to check them to ensure staff are not being made to work too many shifts and have adequate rest days. However the reality in many hospitals is the councils are not checking the rota and the sign off is perfunctory. This sign off is all the management need to impose the shifts on staff, even if they have added more shifts to the rota and made the rota unsafe or unmanageable for that staff member. As well, managers would avoid paying the proper overtime rates to staff which they should get for extra shifts, instead just paying the normal rate.

A key message from the meeting was for staff to feel empowered to say no to their managers, and to ask for the rota to be checked by workers council representatives. This stopped the managers imposing the shifts, and forced the council representatives to review the rota’s.

The situation reminded me of the issues with claiming overtime pay within the NHS. Under Agenda For Change terms and conditions, any staff staff have the right to claim overtime pay, or Time Off In Lieu (TOIL) for any hours they work beyond 37.5 hours per week. Most hospitals avoid paying this by not giving managers the right to authorise overtime shifts, and not having any systems for recording overtime that is done.

"We are indispensible - now its your turn!"

On the afternoon of the first day, Ina Cyzborra, the Health minister or the Social Democratic Party which runs the Berin Federal region attended the conference to speak with the staff. The minister was confronted by outsourced hospital workers who demanded that she keeps to the promises the SPD made to invest in the health system, and bring outsourced workers in house. The minister carefully avoided making any commitments during the talk, explaining and excusing their inaction as due to factors outside their control.

The movement had prepared a protest and during the ministers talk, outsourced hospital workers came out with banner a banner, chanting and making speeches about the SPDs failure to bring them back in-house.

There was then a back and forth with the minister as workers demanded to know when the SPD would act to support them, and the minister making excuses for the delay.

The fact that the health minister felt they should visit the conference, despite knowing the pressure and opposition they would face showed the power and influence the movement has.

Relaying the state of the NHS strike wave 

I gave a talk on the state of the NHS after a decade of austerity, and how this was causing the deterioration of the health service, and driving the wave of strike action.

A copy of the slides can be downloaded here.

The talk was well received and was followed by many questions and lively discussion of the situation. Several of the Berlin health workers remarked that the NHS situation looked like their future, and pointed out the politicians in Germany were discussing centralising their health service in the name of greater efficiency, foreshadowing job cuts and workplace closures. 

In contrast with the NHS which has over 200 hospitals across the U.K., the German health system has over 1000 hospitals across the country.

There were questions about the situation of activists in the health service, how much co-ordination there was and whether there were attempts by groups of workers to support each others strikes.

In the German health system, there are only two unions; ver.di for hospital workers, and the Marburger Bund for doctors. I contrasted this with the U.K where we have 14 unions in the NHS, a complex mix of general unions and smaller craft unions representing specific professions. This makes finding unity across the workforce much harder, and means there is greater effort needed to co-ordinate across a workforce divided in to many different union organisations.