Kerala HC Questions Why Nursing Not Declared Essential Service Amid Statewide Strike

The Kerala High Court has raised a critical question regarding the classification of nursing services under essential services legislation, observing that the absence of such a declaration leaves public health infrastructure vulnerable during industrial action. The remarks came during hearings related to a statewide nursing strike that paralysed hospital operations across government and private healthcare facilities in Kerala during May 2026.

Background of the Nursing Strike

The United Nurses Association (UNA) and allied nursing unions called an indefinite strike demanding revised pay scales, better working conditions, and implementation of the minimum wage notification issued by the Kerala government. The strike affected thousands of nurses across the state, forcing hospitals to operate with skeletal staff and defer non-emergency procedures. Emergency departments and intensive care units faced acute manpower shortages, prompting the state government to approach the High Court for urgent intervention.

The Essential Services Question

The Kerala High Court, while hearing a writ petition filed by hospital management associations, questioned the state government on why nursing had not been declared an essential service under the Kerala Essential Services Maintenance Act, 1994 (KESMA) or under the central Essential Services Maintenance Act, 1968 (ESMA). The Court observed that while doctors and certain categories of hospital staff have periodically been brought under essential services declarations, nursing staff have remained outside such notifications despite being indispensable to patient care.

The Industrial Disputes Act, 1947 lists hospitals and dispensaries under the First Schedule as a public utility service. However, the declaration of a particular category of workers as providing an essential service requires a separate executive notification. The Court noted that this gap in the regulatory framework created a situation where nursing strikes could legally continue without attracting the penal consequences that would apply to strikes in declared essential services.

Legal Framework and the Right to Strike

The right to strike is not a fundamental right under the Constitution of India but has been recognised as a statutory right under labour legislation, subject to reasonable restrictions. The Supreme Court in T.K. Rangarajan v. Government of Tamil Nadu (2003) held that government employees have no legal or moral right to go on strike, and that strikes in essential services can be prohibited in the interest of public order and public health. The Industrial Disputes Act requires workers in public utility services to give fourteen days' notice before commencing a strike under Section 22, and Section 10(3) empowers the government to prohibit strikes during pendency of conciliation proceedings.

Under ESMA, once a service is declared essential, participation in a strike becomes a criminal offence punishable with imprisonment up to one year or fine or both. The Kerala Essential Services Maintenance Act similarly empowers the state government to declare any service as essential if its cessation would prejudicially affect the maintenance of public order, or the supply of essential commodities, or the delivery of services necessary for community life.

The Court's Observations

The Division Bench observed that the right to protest and collective bargaining must be balanced against the right to life under Article 21 of the Constitution, which encompasses the right to health and access to medical care. The Court noted that patients in critical care, post-operative recovery, and emergency departments are entirely dependent on nursing care, and any disruption to nursing services directly endangers lives. The Bench directed the state government to file a detailed affidavit explaining the reasons for not invoking KESMA and to consider issuing a notification declaring nursing an essential service for the duration of the crisis.

The Court also directed the striking nurses to maintain a minimum service level in emergency and critical care departments, relying on the principle that the right to life of patients cannot be subordinated to the economic demands of any professional group, however legitimate those demands may be.

Implications for Healthcare Labour Relations

The Kerala High Court's observations carry significance beyond the immediate dispute. If nursing is declared an essential service, future strikes would require compliance with stringent procedural requirements, and participating workers could face criminal prosecution. This would fundamentally alter the bargaining dynamics between nursing unions and healthcare employers. Critics of such a classification argue that it would deprive an already underpaid and overworked workforce of their most effective tool for securing fair wages and working conditions. The Indian Nursing Council's own data has shown that nursing salaries in private hospitals often fall below minimum wage thresholds, making industrial action a necessary recourse.

The matter remains pending before the Kerala High Court, and the state government's response to the Court's query regarding essential services classification is awaited. The outcome of this case could set a precedent for how states across India regulate nursing strikes and balance workers' rights against public health imperatives under the existing labour law framework.