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Pay spine for nurses could break AfC and divide the NHS workforce

Unions and nurses speak out against RCN’s ambition to see an NHS pay scale designed solely for nursing staff, claiming it would breed tension between staff and make Agenda for Change unviable
RCN members outside the Royal Marsden Hospital in London during the nurses' pay strike

Unions and nurses speak out against RCN’s ambition to see an NHS pay scale designed solely for nursing staff, claiming it would breed tension between staff and make Agenda for Change unviable

RCN members during the nurses’ pay strike Picture: John Houlihan

Creation of an NHS pay spine just for nurses has been criticised as a pipe dream that would create division and pay inequalities in the service.

The government said it would look into creating a pay scale solely for nursing staff when it made its latest Agenda for Change (AfC) pay offer, on which RCN members in England are now being balloted.

Agenda for Change would be in jeopardy

The college wants to see a nursing-only pay scale, in the face of opposition from other health unions, whose leadership, as well as nurses commenting on social media, insist fragmentation of AfC would create unequal pay in the NHS. Unite’s national officer for health Colenzo Jarrett-Thorpe told Nursing Standard a separate pay spine would destroy AfC.

‘It’s never going to happen, it’s a pipe dream. We’re wholeheartedly against it. Our nurse members aren’t looking for a separate pay spine, it will destroy AfC and cause a lot of “equal pay for equal value” concerns across the NHS. The achievement for AfC was we eliminated unequal pay across the NHS,’ he said.

‘Just separating out pay doesn’t get you any more money or address underlying issues. It will cause division and tensions, and potentially break up the whole AfC structure’

Helga Pile, deputy head of health, Unison

Unison added that while there are issues with nurses’ pay banding and career progression, a separate pay spine would not solve them. Unison deputy head of health Helga Pile said: ‘Just separating out pay doesn’t get you any more money or address those underlying issues. It will cause division and tensions, and potentially break up the whole AfC structure, but not necessarily deliver any more pay for anybody.’

AfC system is trapping too many nurses on Band 5

But in a video message, RCN director of nursing Nicola Ranger said many nurses were stuck at Band 5 and AfC gave them no prospect of pay progression. She said it was important to negotiate pay for nursing staff separately, to help solve the profession’s longstanding recruitment and retention issues.

‘The data we scrutinised showed 62% of people on Band 5 are nurses and too many of those spend their whole career at that level. AfC has trapped many nurses at Band 5 while their roles have evolved and developed, and they’ve become increasingly skilled,’ she added.

There have been calls to review the AfC framework, which set up in 2004 to simplify national pay for non-medical NHS staff groups and ensure fairness, wit some experts suggesting it is no longer fit for purpose. A 2021 report to ministers by the NHS Pay Review Body questioned whether AfC ‘fully reflects the professional demands on nurses and their contribution to the NHS’.

The Scottish government said it would review AfC as part of its pay deal agreed with nurses for 2023-24.

The RCN has been contacted for comment.


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