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It's not just Londoners who need help with housing costs

London is by no means the only city in which workers struggle to afford rents or buy their own home. Now NHS employers in property hotspots such as Oxford are considering paying a premium to attract and retain nurses.
housing

London is by no means the only city in which workers struggle to afford rents or buy their own home. Now NHS employers in other property hotspots are considering paying a premium to attract and retain nurses

Nurses working in the London area have benefited from a London weighting for as long as many can remember. It can be the difference between being able to live and work in the capital and being forced to move elsewhere by the high cost of housing.

But do nurses working in other parts of the country also need support? Housing costs have soared in some popular areas that now rival parts of London. Oxford and Cambridge are particularly expensive, as is Brighton and much of the south east and Thames Valley.

Some towns

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London is by no means the only city in which workers struggle to afford rents or buy their own home. Now NHS employers in other property hotspots are considering paying a premium to attract and retain nurses

housing
Housing costs are increasingly becoming an issue for hospitals outside London. 
Picture: Alamy

Nurses working in the London area have benefited from a London ‘weighting’ for as long as many can remember. It can be the difference between being able to live and work in the capital and being forced to move elsewhere by the high cost of housing.

But do nurses working in other parts of the country also need support? Housing costs have soared in some popular areas that now rival parts of London. Oxford and Cambridge are particularly expensive, as is Brighton and much of the south east and Thames Valley.

Some towns and cities further away from the capital can also be pricey – Bournemouth and Bristol are both expensive, whether renting or buying.

Further afield

Hospitals just outside London, which don’t qualify for the high cost area supplement, have always found it a challenge to recruit staff who can earn more in the capital. But now housing costs are becoming an issue for hospitals further afield.

Oxford University Hospitals NHS Foundation Trust has floated the idea that other cities with high housing costs should attract their own weighting. Its board is considering offering an extra 3% non-consolidated allowance for staff on band 5 and below, 2% for bands 6 and 7 and 1% for those on higher bands. 

‘We want to make sure that we have the right support in place to encourage people to stay, as well as to recruit the workforce of the future’

Susan Young

That would cost the trust £7 million a year but is well below London supplements, which range from 20% in inner London to 5% in outlying areas.

The trust's interim director of workforce Susan Young says: ‘We want to make sure that we have the right support in place to encourage people to stay, as well as to recruit the workforce of the future. There are a number of ideas that we are exploring to see how we can improve our recruitment and our retention of staff. No decisions have yet been taken.’

RCN South East region director Patricia Marquis believes the emphasis should be on making sure nurses across the country receive a reasonable salary. She suggests the existing recruitment and retention premia – pay supplements used by employers to give individual jobs or groups of jobs higher than usual salaries – could be used for all nurses.

Rewarding staff

Oxford is already using recruitment and retention premia for specific roles such as critical care nurses.

‘Agenda for Change has the flexibility within it to pay recruitment and retention premia. But what NHS organisations will tell you is that if they decide to do that they don’t get extra money for them,’ Ms Marquis says.

She says some trusts have been looking at the high rates they pay for agency staff and deciding they would be better off using that money to reward permanent staff.

The Oxford weighting idea comes on top of a number of existing initiatives at the trust such as a foundation programme for band 5, more development days for bands 5 and 6, and ‘accelerated advancement’ allowing band 5 nurses to jump two points on the Agenda for Change pay scale when they complete their foundation years.

Massive incentive

The trust has also looked at offering annual bonuses to encourage staff to stay, and is even considering paying undergraduate course fees to compensate for the loss of bursaries. Ms Marquis says: ‘They are investing an awful lot in training and development and that’s a massive incentive for nurses.’

She says more exciting job opportunities, the chance to specialise and being empowered can make a difference to nurses. A planned school of nursing will also drive a sense of identity.

Oxford is not the only trust to think about how to retain nurses in the face of high housing prices and a national shortage of nurses. Brighton and Sussex University Hospitals NHS Trust, for example, has a turnover of 14.9% of its nurses each year and is looking to develop retention incentives for nurses.

Cambridge University Hospitals Foundation Trust has similar issues, though they have been eased by its good reputation – which makes it easier to attract staff – and overseas recruitment. It also tries to ‘grow its own’ by supporting existing employees through flexible routes into nursing.

‘If you are a band 5 nurse then – even if there are two of you – you stand no chance of buying a house in Oxford’

Patricia Marquis

RCN Eastern region senior officer Chris Hill says housing costs are a big issue in Cambridge, as are other related problems such as congestion as people try to drive into the city. But he says local NHS employers are aware of the issues. ‘We are having these conversations with employers and they are looking at options,’ he says.

A challenge for trusts would be making a weighting generous enough to keep staff. Even a 5% weighting for someone on £24,000 would only be £100 a month – and that’s before tax and national insurance are deducted.  

Two-bedroom flats easily cost £1,000 a month to rent in popular cities such as Oxford, Cambridge and Brighton, as well as in many parts of the south east. Nurses further on in their career who want to buy their own home can find that even a small terraced house is out of their price range, unless they are prepared to commute.

Use NHS land

In contrast, Birmingham and Newcastle have two-bedroom flats to let for well under £500 a month, and Liverpool is even cheaper.

Another option could be expansion of affordable housing schemes for NHS staff either to rent or buy – something that has been looked at in the Naylor review of NHS property and estates. It suggested that some spare NHS land could be used for affordable housing for staff – possibly in a way that would give staff long-term leases and a share of the rising value of the house. Some trusts have expressed interest in this idea, but any developments may be some years away. 

Ms Marquis welcomes anything that makes staff feel valued, but adds: ‘If you are a band five nurse then – even if there are two of you – you stand no chance of buying a house in Oxford.’

City of dreaming spires – and sky-high prices

Donna-Sue Wright, a pre-op nurse at Oxford’s Churchill Hospital, says the suggestion of an Oxford weighting is welcome but may not be enough for nurses faced with such high prices. It would be far less than London weightings and might not be guaranteed in the way they are, she says.

‘It is a really good offer,’ she said. ‘But it is a drop in the ocean. People think of Oxford as full of dreaming spires and rich people, but there are many ordinary working people here as well.’

One consequence of such high housing costs is that nurses live in cheaper areas and then have long commutes to get to work. Ms Wright, who lives in Wheatley, about nine miles from the city centre, knows of nurses who travel there from Milton Keynes and Swindon.

‘They can afford to live in these places but they then spend two hours or more travelling to and from Oxford each day,’ she says. This means nurses working a long shift, which is common at Oxford University Hospitals Trust, barely have time to sleep when they get home before they need to get up and leave again. This sort of pressure can affect stress and sickness levels, she says.

Oxford’s economy is relatively thriving and a major redevelopment of its main shopping centre is due to open later this year. Ms Wright suspects that some lower-paid trust staff such as support workers may be drawn to working in shops offering similar wages to the NHS but with less pressure.   

House prices in England

Land Registry figures show the average house price in England in May 2017 was £232,530. Here are some examples of average prices across the country:

  • Oxford £426,393
  • Cambridge £420, 734
  • Brighton £353,176
  • Waltham Forest (outer London) £432,759
  • Camden (inner London) £866,681
  • London overall £471,742
  • Birmingham £165,182
  • Newcastle £151,456

Alison Moore is a freelance health journalist

 

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