As the calendar turns to late October, health workers across Northern Ireland and Alberta, Canada, find themselves at a crossroads, locked in tense negotiations over pay and working conditions. The air is thick with anticipation—and, for many, frustration—as unions prepare for potential strike action in both regions. The stakes are high, not just for the workers themselves but for the future of healthcare delivery in these communities.
In Northern Ireland, talks between health unions and the Department of Health resumed on Monday, October 27, 2025, after health staff unions rejected a renewed pay offer. The Royal College of Nursing (RCN) has warned that it has "no choice but to continue preparations to ballot members for strike action in the coming weeks," according to statements reported by BBC News NI. This comes after months of mounting frustration among nurses, who have been denied a 3.6% pay award already granted to colleagues in other parts of the UK.
Professor Rita Devlin, Executive Director of the RCN in Northern Ireland, voiced the growing discontent: "Despite recent negotiations on pay, there is still no settlement in sight. As a result, the RCN in Northern Ireland has no choice but to continue preparations to ballot members for strike action in the coming weeks. This situation is beyond disappointing but going out of pay parity is not an option we’re willing to accept. We remain committed to ongoing negotiations with the Department of Health and the Executive to find a way forward, but it’s clear that our members are running out of patience as this stalemate continues."
The heart of the dispute lies in pay parity. While the UK government confirmed a 3.6% rise for England and Wales in May, and the Scottish Government agreed to a separate 4.25% deal as part of an 8% two-year offer, Northern Ireland’s health workers have not seen similar backdated increases. Talks in Northern Ireland are taking place months after settlements were reached elsewhere under the NHS Agenda for Change framework, which was designed to ensure fair and consistent pay across the UK’s health service. Traditionally, new pay awards take effect from April 1, but the Department of Health in Northern Ireland has proposed a 3.6% uplift effective only from October 1, 2025, without backdating—an offer unions have called insufficient.
John Patrick Clayton from Unison told BBC Radio Ulster’s Good Morning Ulster program: "This is about a commitment to pay parity and that is the absolute minimum that we are looking to have achieved here. Our members don't want to be in a position where they have to take industrial action in order to secure something that they are entitled to. Pay parity is absolutely fundamental to recruit and retain the staff that the health service needs so we need to see commitments that have been made being realised."
The Department of Health also floated a two-year award deal, including a 2.5% increase for 2026-27 and a 1.74% short-term uplift intended to compensate for the lack of backdating this year. However, none of these options have been finalized, and unions remain steadfast in their demand for full pay parity.
Patrick Mulholland from Nipsa, speaking on the Nolan Show, didn’t mince words: "What's on the table at the minute is a real terms pay cut for health workers. They want parity, they're entitled to parity, it's what they're supposed to get every year and surely when they're working out the funding of the health service they would start with the most essential component which is the staff in it. If we do not receive the pay rise that our members need to ensure the future of our health service and ensure the staff are in place – have no doubt about it we will fight."
Health Minister Mike Nesbitt has maintained a public posture of optimism and constructive engagement. In a recent interview with Downtown Radio & Cool FM, he said he was "highly optimistic" that the pay dispute would be resolved. Nesbitt told BBC News NI in a statement: "My department continues to work in good faith with health unions and professional bodies. Talks are continuing as we acknowledge and respond to their concerns within the regrettable financial constraints we face. I very much value the ongoing constructive engagement with the health unions, particularly in terms of identifying and exploring any potential options and common ground, as we seek to work through these difficult issues together. We anticipate further discussions in the coming week."
Yet, the financial realities are sobering. In May, Nesbitt signed off £200 million for this year’s pay deal, but only half of the funds needed to resolve the pay award shortfall have been found. This has led to public disagreements with First Minister Michelle O’Neill over how much money has actually been secured and where it will come from. The health pay issue remains a devolved matter in Northern Ireland, and the recent history is marked by previous strikes as workers campaigned for pay parity with the rest of the UK.
Meanwhile, a similar drama is playing out across the Atlantic in Alberta, Canada. From October 30 to November 3, 2025, approximately 15,000 healthcare workers represented by the Alberta Union of Provincial Employees (AUPE) are set to vote on potential strike action. The AHS Nursing Care sector, which includes Licensed Practical Nurses, Health Care Aides, Orthopaedic Technicians, and Surgical Processors, is pushing for wage increases that reflect an expanded scope of practice for its members.
Alberta Health Services has proposed a 12% pay increase over four years, but the offer is complicated by suggestions to roll back wages for certain positions. The union argues that only a strong strike mandate will demonstrate their determination to secure fair raises, benefits, and working conditions. The Alberta government, for its part, has acknowledged the ongoing negotiations but has refrained from commenting further, expressing trust that both sides will seek fair solutions, as reported by Trending 55.
The challenges facing healthcare workers in both Northern Ireland and Alberta are strikingly similar: wage stagnation, rising living costs, and the feeling that their essential contributions are undervalued. Both regions are grappling with the need to recruit and retain skilled staff, a goal that union leaders argue is simply impossible without competitive, fair pay. The specter of industrial action looms large, threatening to disrupt services and test the resilience of already stretched health systems.
As the clock ticks down to potential strike ballots, all eyes are on the negotiators. Will governments and health authorities find a way to bridge the gap, or will the coming weeks see picket lines and further unrest? For now, health workers on both sides of the Atlantic are standing firm, insisting that fair compensation is not just a matter of justice, but a prerequisite for the future health of their communities.
