For the third time in as many months, workers struggling to recover from the impact of Covid, cuts and crisis in NHS Scotland have been presented with a ‘final’ pay offer by the SNP Health Secretary Humza Yousaf – Socialist Alternative Scotland explain why workers should vote to reject it, despite the recommendation of Unison’s right-wing Scotland Health Committee.
In a consultative vote announced in August 91% of Unison members rejected NHS Scotland’s latest 5% pay offer and 83% voted to take industrial action. The other health unions delivered similar, or larger, votes for strike action and all unions smashed through the undemocratic thresholds required under Tory anti-union legislation.
In the absence of an acceptable pay new offer agreed by the membership, the obvious next step for the union’s Scotland Health Committee, dominated by the right wing, was to hold a strike ballot in order to put this mandate into action. Three months later, they have totally failed to do this. Instead members have had to put up with a succession of evasions, derelictions and delays amounting to a complete abandonment of following the members’ mandate.
Bosses and government play ‘divide and rule’
Whilst other unions went ahead with their ballots and delivered massive majorities for action, the Health Committee delayed starting a ballot until mid October. On 21 October, SNP Health Secretary Humza Yousaf, clearly spooked by the growing determination of health workers to end poverty pay in the NHS (and the massive support they were getting from the public) momentarily climbed down.
Yousaf temporarily abandoned his campaign of blaming health workers’ pay for waiting lists and the scandalous state of cancer treatment and mental health care on his watch. Yousaf, having insisted that there was no more money for salaries, suddenly produced a second “final” pay offer out of his back pocket.
Based on a minimal increase to the overall sum on offer, his principal change was to convert a 5% offer into a £2,205 flat rate increase. For workers on the lowest grades, this represented a significant improvement on the previous package – from 5% to 10.8%. However, most health workers immediately grasped that this was in reality a cynical ploy designed to sabotage the pay campaign by ‘divide and rule’.
The improved offer to the lowest paid workers (which with CPI inflation running at 11.5% still represented a real terms pay cut) was to be paid for from even more swinging cuts to the living standards of workers further up the pay scale. Socialist Alternative demonstrated this in this graph, which was widely circulated in NHS Scotland.

Most unions, correctly, recommended rejection of this divisive poverty pay offer. Some, recognising how far it fell short of their members’ wishes, did not even bother putting it out to consultation. Scandalously, Unison’s Scotland Health Committee not only decided to put it to a vote but, in a move which played directly into the hands of Yousaf and the NHS management, suspended the industrial action ballot pending the outcome of the consultative vote on this offer. Angry members questioned this move and demanded that the union at least recommend rejection of the offer as clearly inconsistent with the stated wishes of members as expressed in their August vote. In response, the Health Committee insisted that they could not make a recommendation because that would breach the principle that Unison is a “member-led union”!
When shop stewards in the Scottish Ambulance Service branch (which is in the front line of NHS Scotland’s funding crisis, and was widely expected to be amongst the first groups called on to take industrial action) unanimously agreed to recommend that the their members reject the deal and opposed the decision to suspend the Industrial Relations Act ballot, full time officers attempted to obstruct the branch writing to their own members!
Fortunately, the divisive nature of Yousaf’s deal was far better understood by rank-and-file Unison members who, in a vote announced on 14 November rejected it by a margin of two to one. Any sensible person would have thought that, with their members having voted (not once but twice) for action to end poverty pay in NHS Scotland, the Health Committee would roll up their sleeves and get on with the task of organising a ballot to give effect to these mandates. But this would be to underestimate the deviousness of Mr Yousaf and the Health Committee’s unwillingness to confront this
Another “final offer”
On 24 November, Yousaf made yet another “final offer” to NHS workers. This increases the overall package to 7.5%, but still leaves a newly qualified nurse, for instance, taking a real term pay cut of 5.47%. It would leave front-line staff in higher grades such as midwifery and health visitors lagging even further behind RPI inflation which now tops 12%. The SNP government’s strategy, despite Yousaf’s honeyed words about making the ‘best offer possible to get money into the pockets of hard working staff’ remains a vicious one of divide and rule.
This revised version of our graph shows the impact of the new offer on workers’ pay packets in the face of a cost of living crisis which is forcing more and more health staff to depend on food banks.

All other unions have suspended industrial action planned to begin in the next ten days, whilst consulting members. Unite and GMB are both recommending rejection and the Royal College of Nursing are consulting their shop stewards before making any recommendation. All these unions would, moreover, be in a position to re-launch strikes and other industrial action immediately their members rejected this offer.
Outrageously, however, Unison’s Scotland Health Committee have doubled down on their previous position, leaving their members even further out of step with their siblings in the other unions. Not only have they failed to recommence the strike ballot, but they are actively recommending acceptance of this divisive offer which does nothing to remove the burden of the cost of living crisis for NHS workers. This also leaves Unison health members in Scotland out of step with Unison health members in England and Wales, where the union has been united in rejecting and balloting for action over a pay award worth only slightly less than that offered by the Scottish government.
Wilma Brown, Chair of the Committee has said: “We have decided to recommend this offer to our members, as we believe it’s the best that can be achieved through negotiations. It will go some way to helping NHS members with the cost of living crisis.’ Rank-and-file Unison members have two questions for Ms Brown:
Firstly: given a clear, and renewed, three month-old mandate to ballot for industrial action, why is she restricting herself to considering the “the best which can be achieved through negotiations” alone? Members have said that they are prepared to take industrial action. What kind of “member-led union” conducts its affairs in this way?
Secondly: if being a “member-led union” prevented Brown from making a recommendation in October, why is she now prepared to breach this “inviolable principle”?
For a campaigning member-led union!
Brown and the rest of the right-wing majority on the Health Committee give every impression of running scared from a fight to defend their members’ pay and conditions. Their cowardice can only serve to assist Yousaf in his attempts to fragment the united struggle of health workers to defend NHS Scotland. Unison members must reject his latest divisive and insulting pay offer and demand that the Health Comittee act on the mandate they have repeatedly been given to organise industrial action.
Unison members and activists in Scotland urgently need to prepare to replace the current membership of the Health Committee at the next elections, working together with Time for Real Change activists across the union to transform Unison into the kind of campaigning, genuinely member-led, trade union which health workers need and deserve.
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