More than 350 theatre staff at four Greater Manchester hospitals walked out for a second day this week in an ongoing dispute about overtime pay with Northern Care Alliance Foundation Trust (NCA).
The strike action took place on Monday (August 24) and Wednesday (August 26), with another walkout planned for Friday (August 28). Staff on the picket line included nurses, clinical support workers and housekeepers from Salford Royal Hospital, Royal Oldham Hospital, Rochdale Infirmary and Fairfield Hospital in Bury.
Union says staff pushed to work extra shifts for less pay
At the heart of the dispute is the NCA's use of NHS Professionals (NHSP) to manage additional shifts. Members of the trade union Unison say years of staff shortages have left colleagues routinely picking up additional shifts to keep services running, but claim changes to how overtime shifts are managed mean some now have to work several extra shifts to earn what they previously made from one.
Unison says staff working beyond their contracted 37.5 hours are entitled to time-and-a-half under their existing terms and conditions. But the union claims the trust has increasingly directed staff towards NHSP to cover additional shifts, meaning workers can end up earning less per hour than they would have done by working overtime directly for the trust.
Unison North West regional organiser Kevin Dolan accused the trust of "choosing to get nurses and care on the cheap". "Our members are really angry," he said. "The disdain [the NCA] are showing to their staff by walking away from negotiations has shown."
Staff say they are struggling to make ends meet
One union representative said staff had been left struggling to make ends meet. "We haven't been given a choice. The choice is NHS Professionals or nothing. There is no choice," they said. "We've got staff accessing food banks and staff that can't make the money last the month.
"The cost of living is going up for everybody. Gas, electric, car insurance - everything is going up, but our pay isn't going up to match it." They added: "People are living hand to mouth, month to month because they haven't got any additional money."
Speaking anonymously on the picket line, one worker claimed changes over the past year pushed workers towards NHSP, before enhanced pay rates for overtime were removed altogether in January. The result, they say, was that staff were still needed to fill the same gaps - but were being paid less for doing so.
Staffing pressures and patient safety concerns
The worker said some colleagues were now working five or six shifts a week - two or three more than usual - just to get the same pay as they did picking up only one extra shift a week. This, they say, creates a vicious circle: staffing pressure leads to exhausted workers taking time off, which leaves fewer people available to work, putting even more pressure on those who remain.
Unison's Mr Dolan said there is a "high level of sickness rate in the theatre area", which he attributed to staff working excessive hours. The anonymous staff member also said long-term sickness has become an increasingly serious problem. "Our sickness is horrendous," they said. "We've always had sickness levels, that's the nature of the job. When we're around poorly patients we catch a lot of it. But now this is long-term sickness - stress, anxiety, depression. The amount of cases of burnout has increased rapidly because of it."
The industrial action comes amid wider patient safety concerns at the NCA, including findings contained in the Trust's own reports. Reports found lengthy delays were linked with "28 deaths" and 56 issues of "severe harm", while problems diagnosing illness led to ten deaths last year. There were also 10 "never events" recorded at the NCA across 2025 and 2026, which the NHS describes as patient safety incidents which were "wholly preventable," according to the reports.
One union representative said so-called "never events" are happening "on a regular basis". Another representative also claimed staff had repeatedly raised concerns through the NHS's Freedom to Speak Up process, and some of these remain unresolved. The union rep said: "That colleague said patients were going to come to harm and that we were currently harming patients. That was submitted two years ago - still no response.
"There's been some back and forth between the colleague and the 'Freedom to Speak Up' guardian, but that is still not resolved. Somebody has said we are harming patients and we're going to kill somebody, and nothing has been done about it."
Trust response and impact on patients
NCA Chief Nursing Officer Juliette Cosgrove said: "Our teams have worked incredibly hard to keep as many operating theatres open as possible and to ensure that patients requiring urgent or emergency procedures continue to receive the care they need.
"For the several hundred patients whose procedures we've been unable to carry out this week, we are sorry and will do everything we can to reschedule treatment as quickly as possible.
"We recognise that this disruption will have caused anxiety and uncertainty for patients and their families, and we are genuinely saddened by this.
"This industrial action stems from a dispute about pay. It is important to be clear that we do pay theatre colleagues overtime when procedures overrun their scheduled finish times. For any additional shifts, colleagues can choose to work these through bank arrangements, which is the same approach taken across the rest of the NCA."
Commenting as theatre staff walked out on Monday, Gertie Nic Philib, chief people and strategy officer at the Northern Care Alliance, said: "First and foremost, we are sorry for the impact this situation will have on our patients.
"Theatre colleagues at NCA have been receiving a higher rate of pay for additional work than other people at the same level across the trust. We want everyone to be treated fairly and paid consistently for any extra hours they work, in line with arrangements across Greater Manchester and nationally.
"Our senior doctors have reviewed the patients who need emergency, urgent or time-critical care next week, including cancer care. We want to make sure these operations can still go ahead. We asked UNISON colleagues to support the staffing arrangements needed for those patients, but this has not been agreed.
"We have declared a critical incident so we can get extra support and make sure patients who need urgent surgery can get to theatre.
"We are prioritising urgent, emergency and time-critical care. This means some less urgent operations and procedures will need to be postponed or rearranged. We know this will be difficult for the people affected.
"We are contacting affected patients directly about any changes to their surgery, treatment or appointment. Patients do not need to call us to check."
In a video posted on social media on Wednesday, chief nursing officer Juliette Cosgrove said the trust had cancelled "several hundred" patients' operations, although some theatres remained open for emergency operations. She said: "We do pay our staff in theatres overtime when shifts overrun and for everything else, as across the rest of the Northern Care Alliance, we ask staff to work bank shifts for additional work. We've got very few vacancies at the Northern Care Alliance and we're always recruiting, so welcome anybody who wants to come and work here.
"We are really sorry for the inconvenience and we are working really hard and are committed to making sure our staff are cared for."
