This interview is cross-published with Vital Signs Magazine.

Hundreds of thousands of outsourced workers are indirectly employed by the NHS in the UK. Between privately provided clinical, administrative, and facilities services - everything from surgeries and maternity care through to HR and IT - a huge part of the NHS has already been privatised.

Some of these workers have their pay, terms and conditions determined according to the same framework as NHS workers - a national collective agreement called Agenda for Change. Most however do not, and as a result see significantly worse pay and conditions than their directly employed colleagues. To make matters worse, when the government announced a £1,655 to £3,789 bonus for NHS workers in 2023 in light of the pandemic, outsourced workers on non-Agenda for Change contracts wouldn’t see a penny. This is despite outsourced workers working in exactly the same hospitals, under the same conditions - and in the case of cleaners actually contracting the disease at higher rates than any other role.

The denial of the covid bonus set off a spate of industrial action. Outsourced workers at South London and Maudsley, East Kent, and Dudley Group Trust, North Devon District Hospital, Prospect Park Hospital, St. George’s Trust and Barts Trust have all won the lump-sum after waging industrial campaigns, while workers at Royal Liverpool and Broadgreen Trust, Great Western Hospital, and Homerton University Hospital are still taking action.

At Prospect Park, a small mental health hospital in Reading, outsourced workers not only won the covid bonus but a few years earlier won an uplift onto Agenda for Change contracts. A worker at one of the hospitals still fighting for the bonus conducted the following interview, to find out what exactly happened and what lessons can be learned for outsourced workers in other trusts.

CConnor Cameron

KKevin Jackson

CAre you happy to start off by introducing your role and sharing a bit of background on these disputes?

KI’m Kevin Jackson, I’m the branch secretary of the Berkshire Healthcare and Community Branch. I’m a bit of a one-off health branch secretary though because I don’t actually work in the health service at all. I actually work for a very small charity and ever since the Community Service Group in UNISON started I’ve been actively involved in that. I was chair of the National Service Group Exec for about six years and until last year I was the service group representative on the National Executive Council. So it’s a bit of a strange role. I only work part-time and I get no facility time, because I work for a very small charity. So the second part of my job is to run the branch, which I do in my own time.

As for ISS, Prospect Park Hospital was built in the mid-1990s with part of the building programme done under a PFI scheme.¹ That PFI contract was given to ISS, and they still have it to this day. The service was moved to the new-build at Prospect Park from a hospital near Didcot in Oxfordshire. The staff had originally been employed by the NHS but when the service relocated most left and ISS recruited brand new staff. Obviously a few TUPEd over, and until about five years ago we still had some staff left on the old contracts, but it was a small amount and bit by bit ISS got rid of them. Some quite ruthlessly. They didn’t want the TUPEd² staff there but couldn’t legally get rid of them all at once. Eventually they retired though and we don’t have anyone left on the old contracts now.

I got involved with ISS at Prospect Park because I used to work as a caseworker for the branch and covered all the areas where we didn’t have stewards in place. Until about five years ago we’d never had any stewards in ISS. There are around 100 ISS workers at the hospital out of about 4,000 workers as a whole. Up until about five or six years ago we had about half of the ISS workforce in UNISON. ISS have never been any good and the way they treat members has always been appalling, so there’s always been a lot of casework. But because we could never get any stewards it was always me or a previous convenor who did it.

So that was where we were. We kept our membership up to a certain level because of - and I hope this doesn’t sound boastful - good representation. We managed to get members off from being dismissed, but could never get a rep.

CIn February 2020 ISS workers at Prospect Park won Agenda for Change contracts. How did that come about?

KAbout six or seven years ago, our regional officer (RO) at the time had a relative who sadly got sectioned in Prospect Park for probably two or three months. He soon realised what kind of conditions people were working under there and started recruiting. He did a brilliant job. He’s the one mainly to thank for the movement forward we’ve had, because we ended up with virtually the whole workforce. And we still have virtually the whole workforce. There are a few who aren’t members, like technical staff who belong to Unite. They’re better paid but don’t have recognition and don’t get Agenda for Change pay increases - and they certainly didn’t get the bonus.

At some stage his relative got discharged and he wasn’t going there as much, but he’d built up a network of people who wanted to see change on the site. From there me and him went back onto site and organised a meeting with them all and said that if you want this place to change you have to elect stewards, you need to be more proactive. Don’t just let things happen to you. Work as a union. We recruited two stewards and went to the management, who didn’t want to engage with us. So we went higher and got senior people down from London. We basically said to them that we want recognition and we want our members on Agenda for Change. They were very understanding about recognition, they didn’t seem to mind that, but at that stage basically all the workers were on minimum wage. All of them. Porters, cleaners, catering, domestics. All of them. And obviously they weren’t too excited about that prospect, but we basically said, well, we’ll ballot for industrial action if we don’t get this.

The other thing we did is that we also approached Berkshire Healthcare where we have nearly 600 members, so we’re the biggest union in the Trust. We’re very strong there with a good network of stewards. We approached the head of HR and also the Chief Exec and basically said, look, we have a good relationship with you, we’ve had our difficulties but we work well together. Our members who work for ISS on your site should receive union recognition and they should get Agenda for Change. So the combination of that and having virtually 100% membership meant they agreed.

CAgenda for Change, just like that?

KYeah. We didn’t have to go on strike. We didn’t have to take industrial action. They knew we would though.

CHad you balloted?

KNo we hadn’t even got that far. I’m on record as saying our officer at the time is one of the best trade union organisers I’ve ever worked with. He’s very good. Him leaving’s already been a big loss. He basically just said we’ll go on strike and keep the members out until you agree. It didn’t change the attitude to our members sadly. ISS just don’t treat them like humans if I’m really honest.

CAnd with the increase to Agenda for Change, who absorbed the cost - the Trust or ISS?

KWell that’s an interesting question and it’s something that came out in the dispute [over the lump sum] this year. How the PFI works is that a certain amount of money is negotiated each year but it’s never clear exactly what it covers. I’m fairly convinced that ISS wouldn’t have done any of this unless it was covered. So in their annual upgrade some money goes into it to pay for their Agenda for Change increases. Once we get on to discussing the dispute that we had earlier this year you’ll see that that begins to get messy. But it gets messy for quite a few reasons

COkay so let’s move on to that: the dispute over the lump sum. How did that start?

KWell about a year ago now NHS workers obviously got this covid bonus thing and the ISS staff just assumed that they’d get it too. Eventually it came to a head in a meeting with ISS management and the RO asked when they were getting the bonus. ISS said they wouldn’t because they hadn’t been given the money by Berkshire Health Foundation Trust.

So initially we weren’t sure about that so we went off again to speak to senior people in Berkshire Healthcare, and they said that in their opinion it was part of the package for last year’s settlement. As we go on, that begins to get a bit messy. But we went back to ISS and said that from what we’re being told you have given you the money. We were getting nowhere though, because they were telling us that although it’s true that the Trust had given them more than usual, they had also been told to use that for a new kitchen and there wasn’t enough additional money for the bonus. So we were starting to lose a bit of patience. We had a mass meeting of the members and we basically said let’s stop messing about with going back and forwards to ISS and vote for industrial action.

As soon as we did that we started getting a very different approach from ISS. That would have been around November or December last year. They called the RO back in and said “look, we still haven’t got the money from Berkshire Healthcare but we’ve heard of a new scheme and we’ve applied and we’re confident we’ll get it. As soon as we get the money through your members will get it.” We gave them a month, or six weeks, and nothing.

The scheme was a fund set up by the government to finance the lump sum for non-NHS staff on Agenda for Change contracts. When the covid bonus was first announced as part of the Agenda for Change pay settlement it caused problems for a lot of non-NHS organisations providing NHS services. There were charities and social enterprises, for example, who had staff on Agenda for Change contracts and in theory wanted to pay it but weren’t given the money. They were going to the government and saying that under TUPE they should be paying it but they didn’t have the money to cover it. Eventually they started threatening to pull out of contracts since they couldn’t afford to meet their obligations. So the government set up a scheme with a pot of money that could be used to fund additional payments. I got heavily involved, mainly because I work in the voluntary sector with these kinds of organisations.

You’d have to say that, from what I’ve learned, the scheme was massively over-applied for. It became a good opportunity to get money back from the Department of Health and Social Care which these employers hadn’t been able to get through their local trust. So it was massively oversubscribed. But we still weren’t getting anywhere with ISS because they still weren’t getting any money out of the Department of Health and Social Care. So eventually we said we’re not going to wait anymore, we’re going to ballot. We’re very confident. We’ve had the meetings. You know that because you watch us. They knew what we were going through and they knew we had the support. But it didn’t really move them, because ISS are always conscious that if they give way in one area then the trade union network - not just UNISON but also GMB, and Unite - will work together and the message will go out.

CWe’ve heard that from them directly as well.

KThey’re clearly saying now that they only gave our members the money because they got it from the government. Nothing to do with the fact that we took six days of 100% strike action of course, where we virtually brought the place to a halt. 100% support. No one went in. They tried to get ISS workers from other places in to cover but we got that completely blocked.

CHow did you get that blocked?

KThrough UNISON circles.

CAnd so to talk in more detail about the strike action you took - the story was: you got tired of waiting, you balloted, and members went for it. Could you talk a bit more about what it was like taking facilities workers out on strike in a hospital? Was there any cover for those roles? What happened in terms of hygiene and infection control?

KWe gave them two initial strike dates. Even though they knew we had 100% membership and that we’d had big meetings and virtually everyone turned up, they didn’t think that on the day it would actually be that well supported. And I have to say, I’ve been a trade union activist for 45 years, and those 6 days were some of the real highlights of my trade union career. It was brilliant. Every single person. A few of them had jobs in other parts and they went and did their jobs in other parts but we didn’t mind that, they’re all low-paid staff. We ended up having to send people home because we didn’t need to picket, no one was crossing. Obviously our members in Berkshire Healthcare, who were very supportive, were passing it. There was very little solidarity from them, sadly, in the form of refusing to cross picket lines - but that’s the nature of our membership at that place and has been for years. But the support was there. And ISS were shocked. They tried to bring in domestics, caterers, cleaners from other sites; offered to put them up in hotels; offered to pay them bonuses - but it didn’t work.

CWere you out for two consecutive days?

KNo, we never did consecutive days. That was deliberate. We’d have a break and then go back. For two reasons. One, because our members preferred to do that. And two, because it’s very difficult for them to set things up for the strike, and then get everything back in place for people coming back into work, and then have to change things around for another day of strike action again. It had a much bigger impact because they were trying to pretend that they could still provide the service.

After those two days we asked whether they wanted us to come in for talks and it got very messy. Quite brutal to be honest. Besides spreading stories about members of staff, a process started which eventually led to the dismissal of our convenor. They tried to take action against other prominent members there. They sacked another very active member. He was a very loyal UNISON member and they’ve sacked him since.

So they started with intimidation thinking that that would get our members to go back. They tried very hard. They just kept saying that “you’re wasting your members’ money.” And then we gave them the shock news that we’ve got them strike pay to cover every day and we’d gotten the Industrial Action Committee to give us the full amount. So we knew that that money would keep going. That got the message across. This isn’t going to stop. Our members are committed, we’re giving them strike pay, so you need to do something. We took six days of action, and it got really messy towards the end.

There were two things that made it really messy. In the middle of all this the RO retired and the person who took over, no disrespect to him, just didn’t have the experience. They used that against him and just kept fobbing him off. The other was that towards the end we got a very strange message from Berkshire Health to say that they’d made a mistake and they actually hadn’t given the money to ISS for the lump sum. So we were suddenly being told that our major argument all the time, that they’d been given the money, wasn’t actually true - even though I still believe it was. Our convenor in Berkshire Healthcare had quite a serious meeting with the Head of Finance and was convinced we weren’t being told the truth. It would have been done for tactical reasons, to convince the government that ISS hadn’t had the money because they shouldn’t have gotten it twice. But then I think they did get it twice, to be honest. But it didn’t make any difference, because by that stage, about three weeks later, ISS received the money from the government and our members finally got it.

CDuring the strike itself, who was feeding people? Who was cleaning up inside the hospital? Who was that being covered by?

KBasically managers from other sites. They bussed in about 30 managers from other sites and put them up in hotels in Reading. It was a shambles to be honest. We started to put together a dossier about it for Berkshire Healthcare because we wanted them to tell them to settle. It was a very poor service. In the restaurant it was virtually sandwich only.

CWhat has the aftermath of the strike been like? What impact did it have on the ISS workers and the hospital more broadly?

KSadly we wanted to push forward from this but there have been a few reasons why that hasn’t happened. One, the RO retired. Two, they suspended our convenor. Three, our remaining steward is watched like a hawk, and they’re just looking for him to do something so they can sack him as well. The long term objective is for them to treat our members with respect. It’ll be difficult though because that just isn’t the way ISS operates. It’s all done on intimidation and setting one worker against another. So for now things are just ticking along. We’re about to elect another steward though, and once she’s on board we’ll go back in and start trying to build things up again. It’s going to be really good to have a female steward there because it’s a big female workforce but we’ve never previously had a female steward there.

CWhat do you think made it possible for you to win the things you have? Agenda for Change and then eventually the lump sum.

KThis isn’t easy. For us it was a mixture of circumstances. Our RO’s relative was in the hospital so we had someone on site, but as a branch we literally couldn’t do that. I have no release time. I do everything in my own time and I’m covering loads of other parts of the branch. Winning recognition feels key because it means that they’re taking you seriously and it gives you scope to organise. But some of this may also have just been the RO, because he’s such a knowledgeable and forceful organiser. When he says something people know he means it. His style suited ISS. He’s from an engineering background and was heavily involved in those unions. That was his style, and within an employer like ISS that style works.

Before he was on the site all the time the members never had the confidence. In the past ISS always used to think our membership was quite low because if a manager ever asked someone if they were a member they’d always say no. I’ve turned up there loads of times in the past and the managers would ask me what I was doing there because they didn’t think we had any members down there. It’s down to our two stewards, really, and the RO, and me, giving them that confidence, which only got stronger with the industrial action. Industrial action is very empowering. Some of them are different people now to who they were before the strike.

Beyond that there was the fact that we had basically 100% membership density. We had their workforce. We could tell them that they had to talk to us and they had to act. Because if they didn’t act then we would.

But it’s not easy. We’ve got another PFI in the west of Berkshire run by a company called Bellrock where we’re getting nowhere at all. We can’t recruit members, they don’t want to know, they’re just not interested. There’s a real good mix at Prospect Park. We worked out one Monday on a picket line that we had about 32 nationalities all working together. Over at the other site they work in little groups. Latvian staff, African staff; they don’t mix. The last time I looked we had barely any members left there.

So it isn’t easy. Never think it is. Anything you can achieve against companies like ISS will be a victory, and it can always slip away again.