Client spotlight: UNISON – Holding the government to account over NHS reforms

In March 2025, as the UK government unveiled its plans to abolish NHS England and implement sweeping changes to the healthcare system, UNISON, one of the country’s largest and most influential trade unions, was quick to raise alarm. The union has been a tireless defender of NHS workers and the principles of a publicly funded and universally accessible healthcare service. UNISON’s recent statements and actions underscore their role as a critical voice in the ongoing debate over the future of the NHS, particularly as the government’s proposed reforms have raised significant concerns about the potential for increased bureaucracy, diminished care, and further strain on an already overburdened workforce.

A Plan That Leaves More Questions Than Answers

The announcement from Prime Minister Keir Starmer to abolish NHS England was met with immediate opposition from UNISON. The union’s leadership has expressed serious doubts about the government’s ability to enact reforms that truly benefit patients and NHS staff. In a recent press release, UNISON’s head of health, Sara Gorton, described the move as “shambolic” and raised concerns that it could lead to even more administrative hurdles, further complicating an already complex system.

For UNISON, the issue is not simply about opposition to change but about ensuring that any reform actually improves patient care and supports those working on the frontline of the NHS. The union has consistently pointed out that the government has yet to present a coherent and detailed plan explaining how this restructuring will alleviate the pressure on NHS staff, let alone enhance the quality of care.

Rather than streamlining services, UNISON fears that these proposed changes could result in the opposite—more confusion and greater fragmentation of services that would make it harder for local health services to meet the needs of patients. With NHS staff already overwhelmed by rising demand, long hours, and persistent understaffing, the union has stressed that the government’s focus should be on providing more support to workers rather than creating new layers of bureaucracy.

Protecting the Workforce

At the heart of UNISON’s opposition is its commitment to protecting the NHS workforce. With over 1.3 million members, many of whom work in healthcare, the union has long advocated for better pay, working conditions, and a fairer deal for NHS staff. UNISON’s response to the government’s proposals has been focused on the potential impact on workers who are already facing burnout, exhaustion, and low morale as they continue to grapple with the aftereffects of the pandemic.

A significant concern for UNISON is the widening gap between the government’s rhetoric about NHS reform and the reality on the ground for those working within the service. Despite promises of efficiency and better service delivery, the reality for NHS staff is one of stretched resources, increasing workloads, and, according to UNISON, an ongoing failure to address the staffing crisis that continues to plague the health service.

With over 100,000 vacancies across the NHS, and staff retention a growing issue, UNISON is adamant that any meaningful reform must focus on providing tangible support for NHS workers. This includes increasing wages, improving working conditions, and ensuring that staff have the necessary training and mental health support to carry out their roles effectively. Without this focus on the workforce, UNISON warns, the NHS could become increasingly unable to meet the needs of the public.

The Call for a Clear, Transparent Plan

UNISON’s call for a more comprehensive, transparent plan for NHS reform is grounded in its desire to ensure that any changes to the healthcare system are driven by evidence and clear objectives. The union has called on the government to demonstrate exactly how the abolition of NHS England will improve the quality of care, ease the pressures on NHS staff, and ensure better patient outcomes. Without such assurances, UNISON has stated, they will continue to oppose any changes that risk undermining the principles of the NHS.

The union has also highlighted the risk that the government’s proposals could open the door to further privatisation of NHS services. The ongoing concern over the creeping marketisation of healthcare has been a key issue for UNISON, which remains committed to defending a publicly funded and publicly run health service. While the government has repeatedly assured the public that the NHS will remain free at the point of use, there are growing fears within the union that this may no longer be the case in the long-term. UNISON has vowed to fight any measures that could lead to further privatisation or reduced access to essential services.

A Voice for NHS Workers and Patients

As the debate over NHS reform continues to unfold, UNISON’s commitment to representing the voices of NHS workers and patients is more important than ever. The union has long been a powerful advocate for workers’ rights, and its role in holding the government to account for the future of the NHS cannot be overstated. By consistently raising the concerns of its members, and by pushing for a clear and transparent plan, UNISON is ensuring that the voices of those who provide care are not drowned out by political manoeuvring.

The union’s focus is not just on opposing change, but on making sure that any reform is in the best interests of both the workforce and the patients who rely on the NHS for their health and wellbeing. As UNISON’s head of health, Sara Gorton, has pointed out, "If the government is serious about improving the NHS, it must start by protecting those who deliver the care."

Looking Ahead

The proposed reforms to the NHS may be just the beginning of a wider conversation about the future of public services in the UK. As the government seeks to navigate the complex landscape of healthcare policy, UNISON remains a vital voice in ensuring that the NHS stays true to its founding principles. For the union, this means advocating for a system that is not only publicly funded but publicly accountable and accessible to all.

UNISON’s work in March 2025 is a powerful reminder that, as the government pushes ahead with ambitious reforms, it must never lose sight of the people who make the NHS work. The future of the NHS, according to UNISON, must be one that prioritises care, supports the workforce, and remains rooted in the values of fairness, equity, and accessibility. As the union continues to hold the government to account, its commitment to these principles will be crucial in shaping the future of the NHS.

At Movement, we’re proud to support UNISON in their ongoing fight to protect the NHS and ensure it remains a service that works for everyone—patients and healthcare workers alike. As debates continue and the government moves forward with its proposals, UNISON will remain a vital force in ensuring the NHS stays focused on what matters most: providing the best possible care for all.