On 10 December, United Voices of the World (UVW) – the trade union dedicated to representing low-paid, precarious, and migrant workers – announced their latest victory: domestic workers have been in-housed at Great Ormond Street Hospital (GOSH), making them official NHS staff. The victory marks an end to decades of outsourcing at the hospital, and an end to the £10 million-per-year contract with multinational contractor, OCS.

The campaign was initiated and led by the workers themselves, and prioritised the poor working conditions of outsourced cleaners, which were made all the worse in a global pandemic. Staff reported being overworked, bullied by managers, and not provided with adequate equipment. They were also only entitled to statutory sick pay—around £19 a day—rather than NHS levels which give employees at least a month’s full pay. Often, the low rate forced workers to continue to show up even when they felt unwell – the risks of which have been crystallised by the pandemic.

This wasn’t the first time UVW has pushed an NHS trust to end an outsourced contract. Back in April, UVW campaigned for outsourced staff to be given NHS contracts at Imperial College Healthcare NHS Trust. After strike action and a peaceful occupation of the hospital, that campaign also proved a success.

The outsourcing of NHS work is nothing new; it was introduced by the Thatcher government in the 1980s as a way to cut costs (and consequentially corners) in the public sector. But as UVW and other trade unions have proven time and time again, outsourcing workers benefits no-one except those at the head of the corporations who get to access public money.

Workers on outsourced contracts often experience poor working conditions and inequalities in the workplace; the workforce itself is fragmented under different bosses, too, which creates barriers to effective organising and collective bargaining. On the institutional level, outsourcing creates a false economy, saving NHS trusts money in the short term but incurring higher costs as the consequences of cheap contracts for both physical infrastructure and patient health slowly come to light.

UVW became involved with GOSH when one worker approached them about a separate issue relating to disciplinary representation. ‘After a number of wider conversations with this individual, we quickly realised there were issues at GOSH as well, and invited other workers and colleagues into the discussions,’ says Petros Elia, a UVW caseworker and organiser. ‘They really believed in the process and in our chances at victory.’ In a matter of weeks, over 100 members of outsourced GOSH staff joined the union; their consultative ballot for strike action was unanimous.

UVW and the workers collaborated on putting together a comprehensive and evidence-based report, highlighting their case against outsourcing. The report was presented to GOSH’s board in November, but responsibility for the outsourced workers was initially denied: it was, according to GOSH’s board, an issue for the OCS managers. As a result, steps towards strike action were taken. Organisers also attended a public GOSH board meeting to put forward their case, but the board responded by ejecting and blocking them.

UVW’s organising has exposed another problem connected with outsourcing, too: racial discrimination. In the case of GOSH, the union found that while only 29% of NHS-employed staff at the hospital were from a BAME background, outsourced workers were almost entirely BAME. Similar imbalances have come to light in other campaigns against outsourcing at St. George’s medical school, the Ministry of Justice, and the Royal Parks.

As part of its Public Sector Equality Duty, GOSH should have carried out an Equality Impact Assessment when it decided to outsource domestic services, and regularly updated it as the contract went on. But a Freedom of Information request by UVW revealed that GOSH held no records of these Assessments, and this fact, coupled with the poor working conditions already mentioned, built up a legal case on the grounds that outsourcing led to indirect race discrimination. So along with its submission of a 45-page report against outsourcing, UVW also threatened to take GOSH to court over a potential breach of the Equality Act 2010.

When asked about the negotiation process and if the obstacles faced were as expected, Elia explains that negotiations didn’t actually happen. The organisers put forward their report to GOSH and listed their terms: ‘Even if GOSH did want to negotiate on this,’ Elia says, ‘we would’ve rejected negotiations. Our demands and terms were set.’ Negotiating was a last resort; the demand for in-housing was backed by a mountain of evidence, and as such was simply non-negotiable.

Under growing public pressure, GOSH accepted the terms laid out in the report and agreed to in-house the workers once the current contract runs out in August 2021. While Elia believes the decision was evidence-based, he also acknowledges that the threat of industrial action, particularly at this time, was an important factor in securing the victory. After the events at Imperial College earlier in the year, GOSH were likely keen to avoid a strike.

Domestic workers at GOSH will now become NHS employees, and they’re overjoyed with the result. Genevieve, one of the cleaners, told Tribune: ‘Being in-house and an NHS staff member is the best thing that’s happened to me. We can now get all the fringe benefits that the NHS offers, and we will no longer have to come to work when we’re sick. There’s a possibility of excelling with the NHS.’

Victories like these help spread the burdens of Covid-19 more equitably, and are representative of the structural changes needed to ensure that BAME people and poor people do not suffer disproportionately from future pandemics. Related to this, the success also makes clear that labour organising is going to be key in the long fight to rebuild a strong NHS after decades of creeping privatisation. Drastic moments call for drastic measures: ‘This was not won through the power of argument,’ Elia says. ‘It was won through the power of collective action.’