“Striking is breaking my heart, but I’m £8k worse off – we have to fight back”
On the all-women picket line in South Wales, it’s clear health visitor Jo Hyde desperately wants to get back to the families she gives vital support to, in Merthyr Tydfil.
“In 36 years, I’ve never been on strike,” says Jo, 55, who lives in Ogmore, in the Vale of Glamorgan. “We never thought this would happen. But we have to – we’ve tried every other option. We just want to go back to supporting families. We’re all really struggling, we’re carrying a lot of guilt about the people we support – but the aim is to make sure they remain supported in future, by maintaining a good service where people feel valued and respected, and where we can recruit and retain the best people.”
While headlines have been dominated by the national strike by resident doctors – formerly known as junior doctors – who returned to work on Monday, Jo and her colleagues, who work for the Cwm Taf Morgannwg University Health Board (CTMUHB), have been out for seven long weeks.
Over 100 health visitors who cover some of the poorest parts of Wales – Merthyr Tydfil, Rhondda Cynon Taf, and Bridgend – have been striking over a banding decision they say has left them £8000 to £9000 per year worse off. “We work in areas of high deprivation,” Jo says. “We are the gateway to so many services. But it’s become very fragmented and unfair. Health visitors aren’t being paid the same across the UK for delivering the same service.”
The health visitors say criteria which is part of the Agenda for Change grading and pay system for NHS staff, has been differently interpreted in different parts of the country. In Scotland, health visitors are Band 7, acknowledging their specialist skills and masters’ level qualifications. Yet in parts of Wales and England they are Band 6 – a vast difference in pay.
The reluctant strikers are all women. “If you put our skills into the NHS job evaluation process, we should be Band 7,” health visitor Melani Smith, says. “Specialist paramedics are Band 7. They are mostly men.”
Unite general secretary Sharon Graham has backed the health visitors’ struggle. “This is an outrageous ploy from a health board to try and avoid paying its essential staff the money they are worth,” she says. This is a significant pay difference that has left our members undervalued and underpaid. They have been left with little choice but to take strike action and have the full support of Unite in this dispute.”
A former midwife from Aberdare, Jenna Terry retrained so she could be a health visitor – a job she loves. With two young children herself, she says she hates the thought of being on strike and is worried sick about the 200 families she works with – but says she and her colleagues have been left with no choice, after being denied parity with their peers in Scotland.
“We can’t believe this is happening,” Jenna, 36, says. “I want to be in this profession for the long-term – I love it – but we have to stand up for ourselves. I want to be able to tell my children, ‘we fought for this’. We need to be treated with respect, and pay does play a part. We’re looking after children, parents, it’s important to society. This is a vocation. I find it hard to speak up but, my gosh, I have to now. We feel so undervalued and ignored.
“It makes my heart break because I know there are all those people struggling, people I help to support.” Like her health visitor colleagues, Jenna is highly qualified. “You now need a Masters-level qualification to be a health visitor,” she says. “I spent five years studying – first to be a midwife, then one year on specialist community nursing then another year, so we’re all highly experienced, qualified specialists.
“We look after big caseloads – mine is 150-200 families, from ante-natal to five years. We are a Jack of all trades. We are the people who make decisions, referrals across education, health, nutrition, mental health. It’s a lot of responsibility, especially around safeguarding, but the banding isn’t reflecting that.
“In Scotland health visitors are band 7 automatically. We’re doing the same job here in Wales and England, so why are we being treated differently?”
A spokesperson for CTM Health Board said: “The health board has been in discussion with Unite and health visiting staff since a formal dispute was lodged in February 2024. The dispute, at that time, asked for the Band 6 health visitor job description to be updated to reflect the duties of the role, and to re-evaluate the job. A process to review and agree the revised job description took place, facilitated by NHS Wales Employers.
“The job description, which was agreed in social partnership, was re-evaluated, and came out at the same band, Band 6. The job description was issued to health visiting staff and remains in effect. It is important to recognise that the pay banding for health visitors in Cwm Taf Morgannwg University Health Board is the same the banding for health visitors across England and Wales.”
Melani Smith has worked for the health service for 42 years – as a nurse, then a midwife and now a health visitor for 25 years. “My salary has regressed,” the 59-year-old from Bridgend says. “I should be earning more now than I was as a midwife 25 years ago. During my time, health visitors’ responsibilities have increased. We have a lot of responsibilities, a lot of formal expertise, we work in a lot of different areas, and so much of what we do comes from building trust.
“If someone is experiencing domestic violence, is unable to heat their home or doesn’t have enough food they won’t always tell you that outright – we can observe and hear.”
After weeks of taking action in South Wales, next Wednesday, 50 to 100 of the Cwm Taf health visitors will join hundreds of other Unite healthworkers to protest against NHS cuts to jobs and services outside Parliament. It will be a national moment of solidarity for women strikers who have often felt out on a limb.
“I’ve been with the NHS 42 years,” Melani says. “I don’t want to be on strike. But we have no choice. As health visitors we have been undervalued, and we want it put right.”
