In May 2025, following 6 months of industrial action, workers in the Manchester Early Intervention in Psychosis Service (EIS) won a dramatic victory – securing over £1 million investment into the service.

This strike, which was coordinated action by UNISON and Unite members, was different from many disputes in that it was a fight for investment. We were demanding an increase in funding to go directly towards employing new staff in chronically under-resourced mental health services.

Background to the strike

Early intervention services support people experiencing a psychotic episode for the first time. The service is intended to offer intensive support in a whole range of areas in order to prevent chronic illness, and all of the consequences that can be associated with that – from family and relationship break down, loss of education or employment opportunities, homelessness, repeated hospital admissions, or the need for long term care. A first episode psychosis is a high-risk time for suicide. But when properly funded, early intervention services reduce that risk by half compared to other mental health services. There is extensive evidence that, when properly resourced, we work well at supporting people to recover and live their lives. Unfortunately, we’ve been chronically underfunded for decades.

As with other public services, years of austerity have resulted in a gradual decline in the quality of provision, which is then coupled with increasing demand to put lives at risk and workers under enormous strain.

Every year in the UK 43,800 people with severe mental health problems die prematurely from preventable illnesses. The life expectancy of this group is 15-20 years lower than the general population. And things have been getting worse. In Manchester in particular the situation has been extremely dire. The city has some of the highest mental health need in the country, yet some of the lowest per capita spending on mental health services, and money that should have come to this service had been spent elsewhere.

We first entered into dispute to try to address this situation as far back as 2021. A successful strike ballot back then won us concessions at ACAS negotiations and averted industrial action that time. We involved ACAS shortly after the successful strike ballot and before taking any industrial action, with a view to a positive negotiated outcome. The agreement we won through these negotiations, was to employ an additional assessment worker, a carers support worker (to complete carers assessments and ensure better provision for the needs of carers) and a welfare rights adviser, as well as a commitment to complete a capacity and demand analysis to determine the level of investment that was needed to ensure we were properly staffed.

As time went by, it became increasingly clear that this latter part of our agreement had been reneged on. We re-submitted our grievance and in the face of further extensive delays we returned to the ballot. Turnout was 88% with 96% voting in favour of both strike action and action short of a strike. Once again, we had a strong strike mandate, and this time we were going to exercise it.

The result

The strike won £1million to be spent directly on front line staffing. We won 21 new permanent workers in the service, increasing the size of the workforce by a third. This included: a CBT therapist, 3 family intervention workers, 2.5 occupational therapists, 2.6 physical health workers, 2 nurse associates, 5 support time recovery workers, 3 peer mentors, an assessment worker, and an administrator.

This success has resulted in real improvements to the care we are able to offer to service users and families. It will improve people’s prospects of recovery and we believe this investment will save lives by alleviating distress, reducing suicides, enabling recovery focussed interventions and ensuring we can better respond to physical health needs that are associated with antipsychotic medications.

Not only that, because we can better help people recover, this £1million investment results in a net saving of £72.5 million for the NHS and wider economy over the next 10 years, money which can be reinvested back into services. Investment in services saves both lives and money.

How we did it

We began organising the strike with combinations of 1:1 conversations, all staff meetings, and regular joint union members meetings across the workplace. We made every decision collectively; what action we would take, for what period, how we would go about it, when to escalate. We were supported by other unions up and down the country, we spoke at branch meetings, public meetings and events. We were supported by and collaborated with service user and community groups.

We framed the dispute clearly in terms of under-investment, workload pressures, and patient safety.¹ Our demands were for immediate financial investment into the service in line with the NHS England workforce calculations around what patient to staff ratios we needed to operate safely and effectively. We were knowledgeable about the extent of chronic underfunding and had evidence about the impact of this. Psychology assistants in the teams completed audits which showed that a small increase in caseloads was directly linked to increases in relapse rates and hospital admissions. We found evidence of the number of unnecessary admissions and the costs per night in out of area private hospitals, relative to the much lower costs of investing in the community which would prevent the need for the admissions in the first place.

We used the NHS England workforce calculator to demonstrate what NHSE deemed to be the minimum number of staff needed to run the service safely and effectively.

We had a strike WhatsApp group and formed a strike organising committee made up of front-line workers, supported by other experienced activists.

We continued to negotiate with management throughout but declined requests to stand the actions down during the negotiations, instead escalating following each unsuccessful negotiation meeting.

We noticed a marked shift in the position of management from the early days of the original grievance to their attitude following the ballot outcome. Their reasoning changed from “there is no problem” to one of “we agree with you, but it’s out of our hands – there’s no money”. Both the Trust and the Integrated Care Board (ICB), who plan, fund and commission services, were in special measures with restrictions on and monitoring of their spending. We understood that we needed to identify who the real decision makers were, and to apply pressure not only on the Trust, but also on the ICB, NHS England, local politicians and, to what extent we could, on the government itself.

We met with and lobbied the senior leadership of the Trust, MPs, the ICB, and the Mayor. We contacted key people within central government and within NHS England. We considered refusing to accept new referrals during the dispute, but this was controversial and difficult to implement. Instead, we notified senior managers that we were accepting referrals under duress and were reporting each allocation to NHSE as a patient safety incident, thus sustaining pressure via various avenues.

We appeared in the news, on print, radio and on TV, and we did this alongside service users and carers who shared their experiences of failing services.

We joined up and exchanged solidarity with other striking workers across the city including Unite and UNISON transport workers, and Unite Capita workers who were fighting for improvements in their pay, terms and conditions.

Striking in an NHS service, or any public sector area for that matter, comes with particular complications due to consideration of the needs of the service users. To succeed the action has to be disruptive, but there is a way of doing that that still balances the safety of those we care for. We agreed on derogations² for some members in exceptional circumstances.

We knew that in order to win, we had to create a situation in which the ‘disruption cost’ to the decision makers was greater than the costs of them conceding, and that it was therefore in their interests to meet our demands. The greatest disruption and expression of collective power was the withdrawal of our labour, but we intensified the pressure in a range of ways. Community services across the city were in special measures, and the reputational damage to them of a high-profile public campaign exposing the realities as experienced by staff, service users, and carers together no doubt provided a powerful incentive for the employer to seek a resolution. From the initial complacency and disregard of the issues, the Trust leadership pivoted to actively participating in making the case to the ICB to help them settle the dispute by providing the required investment.

We made picket lines welcoming, fun and varied, with different themes. Some of these themes caused controversy but had been fuelled by the bad behaviour of senior people within the Trust themselves, including for example our response to the Chair comparing service users to angry crows.

Our picket lines were a visible demonstration of solidarity between workers, service users, and carers that was genuinely moving. They were a demonstration of working-class solidarity and power with broad support from across the labour movement and other community groups, tenants unions, campaigns, socialist organisations, and more. They were often attended by several generations, children, parents and grandchildren – the whole community all united for social justice and a recalibration of power and resources which was at the heart of the campaign.

Working closely with service user and carer groups meant our combined efforts, and resources strengthened one another. To give just one example, research carried out by local campaign and carers group CHARM mental health, showed that Manchester services have one of the highest numbers of Prevention of Future Deaths coroners reports in the country, outside of the Home Office. The case for investment was irrefutable.

Ultimately, however, you can present all the evidence you like – it will be ignored unless the decision makers know you are organised and are prepared to do something about it. None of what we did could have been possible without pre-existing base organising. We started out with a well unionised workplace. Between the four unions, we estimate that the density was over 90%. UNISON and Unite members made up 62% of the workforce. This meant when the dispute came to a head for the second time, we were in a position to hit the ground running with strategic organising for the strike.

Throughout the dispute, Unite and UNISON acted as one, timing every vote and action together and this strengthened us immensely. There was a high level of cross union cooperation and organisation at a rank and file level, and between regional organisers, and a strong sense of solidarity and cooperation with service user and carer groups.

We took intermittent strike action, starting with a one day strike and gradually escalating in the number of consecutive days over the next six months. We sustained action short of a strike from day one and throughout. In the lead up to our mandate expiring, we had two consecutive weeks of strike action planned. If that didn’t succeed we would have had to re-ballot for a new mandate. We projected to management that our resolve had only strengthened during this period, and informed them that if forced to re-ballot we intended to implement an all out indefinite strike in event our demands had not been met. We projected complete confidence in this action and our determination to win throughout, though truth be told we never really knew what the outcome might be until it was won.

How the dispute changed the workforce

Strikes inevitably raise the political consciousness of the workforce. They bring us face to face with questions about why things are as they are, how services and society are run and in whose interests, why is the NHS underfunded, why are things getting worse, how are power and resources distributed, and what needs to be done to redress the imbalance. It also makes clear in a very real way that the masses hold the power provided they recognise this and are prepared to exercise it collectively.

With the success of our strike, one thing remained clear for many of us – that although the battle is won and gains have been made, in order to overcome the source of the problem there is a need for a much more profound change. We need to overturn a system organised around profit and for it to be replaced with one organised around what is needed.

The workforce are empowered and some have since become more actively engaged in their unions or other left-wing organisations. We believe our success has influenced other harder to organise areas including the Community Mental Health Teams who are now organising collectively over the same issues. Everyone is to one degree or another more politicised as a result.

We feel that this success is reflective of a wider shift that is going on. An end to the era of low expectations in which we have accepted a gradual deterioration in services, working conditions, and living standards (an approach that demoralises workers and weakens us all), towards its replacement by an era of renewed trade union militancy.

The biggest challenges and what did we did about them

Like any dispute, we were not without challenges. The first relates to regressive trade union laws dictating that a dispute must be directly with the employer rather than the government or another body. This meant when the employer said they agreed with us about the need for investment but that they could not do anything about it due to the lack of central government funding, there was potential for our dispute to be viewed as political rather than industrial and therefore illegal. We overcame this easily on three fronts. Firstly, the Trust had reneged on a previous ACAS agreement that committed them to carry out a capacity and demand analysis and endeavour to invest what was needed. Secondly, we were aware that ringfenced government spending that should have come to us had never been received by the teams. Thirdly, we fought on the grounds of patient safety. Our respective local branches, regions, and national disputes teams agreed.

There had been a missed opportunity earlier on for a broader strike involving Early Intervention and CMHT workers. In 2020 Manchester EIS and the 6 Community Mental Health Teams were all part of a city-wide collective grievance on the same issues. At that time, the management were in complete denial about the severity of the problems in the services and the outcome of the grievance and appeals were negative. The internal processes were dragged out by the organisation to such an extent that coupled with the severity of the situation in the CMHTs, workers in those teams were so exhausted and distressed that it became impossible to organise a fight back - they left en-masse. This was catastrophic and led to the complete collapse of those teams. Some teams were left with only one care coordinator and a manager for hundreds of service users. It was an extremely dangerous situation for the population we serve, and from an organising perspective there were no staff, no union members, and no power to change things. It meant we were unable to foment any kind of collective challenge for a number of years. Only the Early Intervention Team remained stable enough in terms of workforce and union membership to continue to mount a challenge.

One lesson from this is that whilst striking is usually thought of as a last resort, perhaps sometimes it is the only option with a chance of success and should be organised for much sooner. It has taken years for the Community Mental Health Teams to subsequently begin to recover – and this was only after the CQC placed them in special measures and capped caseloads at 25, initially filling vacancies with agency staff at much higher than usual pay in order to try and stabilise the teams. This of course came with its own problems, and since then new ones have arisen (like community transformation plans) which have only gotten worse. Exhausting every single internal process where this is intentionally being drawn out by management results in long delays, high staff turnover, and loss of union density. The key is about choosing the opportune moment to act as waiting too long in the hope of a solution or in adherence to formal processes can backfire. Of course every scenario is different and determining the best approach will be dependent on the specific conditions of each workplace, but this is something to consider. In retrospect, our own success could also have been realised much sooner i.e. in the 2021 negotiations if we hadn’t taken strike action off the table until all our demands had been met. We did so in good faith, but we could easily have retained a valid strike mandate to ensure the agreement was honoured and without delay. It’s all a learning curve.

We faced one problem that may be common in many strikes - some of the team unfortunately took the decision to cross the picket line. Fortunately these were very few in numbers, but it could have been a disaster if these numbers had grown. These workers stated they supported the strike but felt they were letting service users down and, unfortunately, they could not be convinced otherwise. The vast majority saw the bigger picture – that doing nothing means the harm to service users will only continue and worsen. It is possible that this was linked to flaws in our way of organising e.g. should we have been more careful in identifying the influential workers or those best placed to speak to them about their reservations? Certainly, a range of approaches didn’t win them back. It’s possible that this was a part of a persistent hangover from decades of the servicing model promoted by every union at national level, from which a perception of “the union” solving problems without the workers themselves taking action remains for many. Even the most organised of branches continue to feel the effects of this era. Our strike ballot showed overwhelming support for the strike, however not every staff member voted for it and as such, perhaps those breaking the strike were the ones that never supported it in the first place. Whatever the reasons, the best way to overcome this challenge and how it should be dealt with may best be the subject of another article.

Fears about the welfare of service users were a valid concern to be considered. As discussed, we mitigated against this with derogations where required, and also sought to shift mindsets by comparing the harm of doing nothing, to the short term disruption that can fundamentally change things for the better.

There were fears about pay. We overcame this by ensuring every worker was paid in full via our branch and national strike fund. The support of other unions who recognised the importance of the dispute and donated to our fund was invaluable.

There were challenges around communications and engagement with the media. We had good support from our respective regions and disputes teams who backed the strike and negotiated fiercely with us. But they are naturally more cautious than the rank and file when it comes to this element. For example – we were asked to put all communications out via press releases from the union communications team. This would have meant lengthy delays, a degree of censoring or simplification of the complex issues, and loss of control over what we communicate. This was a source of tension at times, but ultimately there was acceptance from higher up that we would not be managed in this respect. We spoke to multiple news sources in our capacity as union reps and workers, and members also spoke about things that were already in the public domain, sometimes framing it in the broader context of austerity rather than the fault of the Trust itself. We were reminded several times by the employer that we were in breach of our terms and conditions by speaking to the media. But we were aware that the Trust had already reckoned with the consequences of sacking outspoken members many years ago. I refer here to the case of Karen Riessman who was sacked for “bringing the trust into disrepute” after speaking out about cuts to services – an episode that will have stayed in the collective memory of the organisation. Her sacking sparked off an all-out strike and widespread campaign to reinstate her. We anticipated that it would have been reputationally more damaging for the current Trust leadership to instigate disciplinary proceedings against any of us, especially given we were united with service users and carers about the state of services. The Trust was under a lot of scrutiny following the Edenfield scandal in which they had been slammed for ignoring the concerns of front-line workers. The last thing they wanted was a reputation for victimisation of whistle-blowers on top of all the other failures. Of course, this was all a risk as we had no way of really knowing which way they would respond. But it was a risk that paid off. To mitigate, we set up a collective team email and social media accounts which made it hard to identify any one worker as the source of communications, and we ensured a no detriment clause was integrated into our settlement meaning no one could face disciplinary action for anything they did during the course of the dispute.

Another challenge we encountered relates to working to rule. We found this to put quite a bit of pressure on us. Once you are at work in a mental health service, you have to respond to what is needed. We worked together to find ways to make this work more effectively, which included taking our lunch breaks together in the office, and a general slowing down of what we did for the dispute period. This resulted in managers having to accept that non urgent tasks and elements of paperwork would be delayed.

There are four unions in the workplace; UNISON, Unite, Royal College of Nursing (RCN) and the British Medical Association (BMA). At the outset of the collective grievance, workers from all four unions signed up, and it was signed by workers from every profession in the service. However only UNISON and Unite went on to ballot for industrial action. Had all four unions taken strike action, we would have had significantly more leverage – a supermajority that would no doubt have forced a much quicker resolution. There was scope then for improved joint union collaboration. Nevertheless, the cooperation between UNISON and Unite ultimately proved to be effective.

What it was like striking in context of cuts and how that influenced the dispute

At the time of balloting, we were aware that both the Trust and the ICB were in deficit and under scrutiny from NHS England over spending. It did feel that the odds were stacked against us. It was around the time of the general election, and although many of us were not optimistic about the Labour government, there was a sense that it could result in some additional money for the NHS. In reality, things turned out to be even worse. Rather than investing, we were being told that the organisation had to make millions in “efficiency savings”.

We were not put off from our goal. But we did discuss from the outset what our exit strategy would be in the event that the worst happened. It was an anxiety provoking prospect – the fear that we go on strike, give our all, and it doesn’t succeed. And what the implications of the defeat would be for our service users, for our morale, and for the belief in the power of collective action.

We resolved from early on that even if we were able to shine a light on the reality of mental health services, to expose the reality of what is needed, this would in itself be an achievement. Still, we weren’t about to accept the status quo without a fight and were prepared to do what was needed to at least try to bring about material improvements, whatever the outcome may be.

One of our worries was that if we won, any money directed to us would be money diverted from another underfunded service. All of these were legitimate and genuine concerns. This isn’t something we could reassure members about with any certainty - the decision-making in relation to funding is so opaque that all we can be sure of is that the ICB ultimately approved the business case for investment in our service. And that this results in a massive net gain financially as it prevents much more expensive crisis care, hospital admissions and onwards referrals for longer term services. This is also likely to be true for other situations as well - where services are short staffed and dysfunctional nothing runs smoothly and this ends up being significantly more costly (on both financial and human levels), either to the NHS or other public services, but most importantly, to the people in terms of their suffering vs prospects of full recovery. One thing we do know for sure, is that to succumb to this way of thinking has only one outcome. It leads us straight into a dead end, and then to further decline. It is true that to really overcome the root of the problem, wider systemic change is needed. However, we can still do what we can in the here and now. We have to fight where we are strong, where there is a will to fight and where workers are prepared for confrontation. It is only by exerting pressure upwards where we can that things change. On the one hand, the context of cuts made it feel like the odds were against us, on the other, it provided the conditions for the dispute - we were not prepared to continue as we were and do nothing.

How service users and others related to it

We explained the reasons for the strike to service users and families and kept them informed about strike dates. We were overwhelmingly supported by them. We spoke at events where service users told us that they had never felt solidarity like this from staff. We spoke at others where nurses of 20 years’ experience told us they had never seen anything like it, and that it was exactly what we needed more of. Service users and carers were at the forefront of the battle with us. Some of these were individuals who despite having severe and enduring mental health problems had been deemed ineligible for help because thresholds have become so high. With the support of a retired nurse, they were part of a peer support network called Community Works. Instead of a strike fundraiser, we held a celebration of solidarity in which the proceeds were donated to them.

The solidarity we received was overwhelming. For any workers considering strike action, know that you will be supported too. And when striking in an era of cuts, remember that the first battle is the one in the mind that tells you nothing can be done, when the truth is it can. Once this is overcome, the rest becomes possible.