A Strike to Save Lives, Not for Pay: A Manchester NHS Victory

After nine months on strike, Manchester’s Early Intervention in Psychosis team secured vital funding for safer staffing - but their victory reveals the deeper crisis hollowing out our NHS.

Dr. John Mulligan

After nine months of picketing through the chilly winter of 2024–25, our local healthcare leaders finally dipped into the family purse. In June 2025, we put down our placards, doused the bin fire, and went back to our day jobs in a busy NHS Early Intervention in Psychosis service.

We weren’t on strike for better pay. God knows the NHS has huge problems with unfilled posts, billions wasted on temporary staff, and too many new recruits leaving within months, all of which scream for fairer pay and more humane working conditions.

But hold on to your empathy hats. This isn’t an article about living in my shitty overdraft, driving my shitty Nissan Micra, or moaning about the shitty politicians who prioritise billionaire money hoarding games over keeping NHS wages in line with the price of rent and food.

I’d love to tell you what this article is, but I’m already a couple of meandering paragraphs in and don’t quite know how to say it. “Speaking truth to power” sounds lofty and self-indulgent. It’s not accurate, but, let’s just go with that. We fought power and won a rare victory.

I’ll give you an account of how we prevailed. You’ll be dazzled when I tell you how I got my face on telly a few times to draw attention to the unsafe and shameful lack of mental health services in Manchester. You might even grab a pen when I mention the international research evidence and local audit data our union members added to all those strongly worded emails we sent to powerful people. And those of you turned on by talk of “audit data” might get properly hot under the collar when I reveal our in-house figures: for every one extra staff member employed, our Manchester Early Intervention Service saves patients from spending 197 days in hospital.

Say what? A service where each extra staff member saves 197 hospital bed days? Are you calling bullshit? Well, it’s true. Let’s as politicians, commissioners and NHS execs often do, set aside the human suffering and focus on the finances. The cost of 197 hospital bed days is around £250,000 in NHS services and, wait for it, over £1 million when paid to those ever-popular political donors’ choice of private hospital providers.

So: a £38,682 annual NHS salary (paid to our sons and daughters as they embark on one of those increasingly rare careers that we should all be proud of), which gets taxed and spent locally, keeping shops, restaurants, and pubs alive. That sounds a whole lot sweeter than the alternative, paying yet another million quid to a big private American healthcare company, that’s legally obligated and unapologetic about making as much profit as possible, off the back of our most vulnerable. Tough call.

I over-promised and will now under-deliver on the “how to win a strike” tips. I’m not here to boast about collective action and make big claims about the mechanics of how it works. I’m here to beg you to join it. Because if you still think the system isn’t completely rigged in favour of a few pale male and stale oligarchs and their vast number of minions and financial interests, then you surely must be amongst a very small number of the last remaining eternal optimists on this dying planet.

After our “people are dying unnecessarily” campaign was dismissed as strike ‘banter’, our Unison and Unite members, non-striking colleagues, and local patient and carer groups screamed from the rooftops about Manchester’s community mental health crisis. No one listened. They still aren’t, if we judge this matter by action rather than feigned sincerity. We live in a country where structural neglect and systemic inequality within health and social care kills by the tens of thousands, every single year. We naïvely thought the media would expose the Manchester scandal and see it for what it is: a national disgrace. If government inaction predictably leads to tens of thousands of preventable deaths each year, how far is that from democide in effect, if not intent?

Our system is so layered with ambition, greed, and incompetence that it’s a miracle the NHS and the wider running of the country has managed to survive this long.
If you’re not angry about government and NHS leaders ignoring our data on preventable deaths, maybe our strike action victory will do it for you. We weren’t greedy. Our “safer staffing” strike demanded what the NHS England workforce calculator said we needed, hardly a generous algorithm that lavishes services with unnecessary staff.

We won £1 million per year in funding for 21 extra staff. Not bad, until you realise those same senior leaders who wrote that cheque were the same folk identified by NHS England as having taken £1 million from our supposedly ring-fenced budget in 2022 and spent it elsewhere. So our “win” was really just getting back what was taken from our 14-35 year old Manchester patients over five years ago and every year since. But hey - no bitterness here - lemons into lemonade.

That £10 million over the next decade will help our four small teams do some, though not nearly enough, good. As a preventative service, every £1 invested in our service saves £15. So across ten years, we’ll save £72.5 million for the NHS and wider economy. Net. But if we’d have been funded for the 54 staff that we actually need, the impact would be £217.5 million in net savings over the coming ten years. We could have transformed early psychosis mental health prevention across Manchester and saved a couple of hundred million in the process. Instead, we’re still several levels below the national basement, buried by Tory-era and now Labour devolution settlements that continue to leave our city’s mental health services chronically underfunded.

So we would have been able to help far more patients, more quickly. And did I mention that our four tiny teams would have saved society £217.5 million over 10 years? Net? Now I know what you’re thinking. This fella lives in his shitty overdraft and drives his shitty Nissan Micra, he knows nothing about money (despite technically still being a qualified financial advisor, if the financial services authority can forgive 20 years of ‘the dog ate my CPD homework’ excuses). No, definitely don’t believe me about anything to do with maths or finance. But our sums are supported by a large international evidence base and organisations like the London School of Economics, so go us. The people holding the purse strings seem to think front line clinicians and patients don’t care about value for money and financial prudence. That’s a little rich coming from those people who seem to think the correct answer to most maths equations or sensible financial decisions is “maybe next year.”

Meanwhile, thousands of mental health patients die unnecessarily every year. Forty-three thousand, eight hundred across England each year, 120 funerals every single day. Maybe that’s just an abstract figure if it’s not your family member, but these are real people we are talking about and real preventable reasons why they are dying. Where’s the urgency? Like those long-known stats showing people with severe mental health problems die 15–20 years younger than everyone else, the urgency to address this national shame just isn’t there. The shame of this national shame just isn’t there either. I don’t think most of the people in power have the capacity or strength to feel shame.

I should probably shut up and celebrate our big win. But I can’t. Our service is still understaffed, and we’re now back at the rear of a decade-long queue of hungry services, fighting for scraps in the impoverished workhouse of Manchester mental health care.

Manchester’s adult community mental health teams should be at the front of that queue now. They are so broken, that most people with ‘severe and enduring’ mental health difficulties receive either no or an appalling service in the community. And this, despite the best efforts of the small number of dedicated and skilled staff who heroically battle on, without light at the end of this long dark tunnel. Let’s hope you and yours never need these services because currently they are just not there when you and 12,000 others need them each year across the city.

I don’t have a neat, hopeful takeaway. “We’re all fucked” doesn’t look good on a banner, so I’ll substitute a message of hope with a self-indulgent rant. Unless we demand change and get off our arses to make it happen, the rich will keep getting richer, the poor poorer, and the vulnerable will keep getting blamed, abused, or shat on from a great height, while the rest of us are just grateful most of the splash-back missed our clothes.

Collective action works, but only when enough of us join in. If a few thousand of us fight, the odds improve. We need to tear down this greed-is-good system and rebuild a democracy with real public voice and power in the boardrooms. So search out local campaigns, get more involved with your union if you have one, internet search and then join local groups like Stand Up To Racism or Disabled People Against Cuts (DPAC) or the People’s Assembly or shameless plug but join your local ‘We Demand Change’ group — https://wedemandchange.uk — which is a great way of keeping up to date on all the opportunities to get involved in collective action both locally and nationally.

Without you and your kind supporting our picket, we might well have shut up shop early and believed that bullshit narrative that there’s no money for anything that matters to most of us. You came out and joined us, made it a party atmosphere, helped us push through and kept us warm on those cold winter days (metaphorically speaking, although hugs did occur). If you hate what’s happening, show up in body as well as in spirit. I’ll hopefully see you there.

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Our coverage of Manchester’s Mental Health Care Crisis:

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