Analysis

Nurse pay: will the ‘clap for carers’ sentiment mean anything come negotiation time?

After months of praise for the ‘NHS heroes’, the government has the chance to reflect the nation’s gratitude in its pay awards

  • Nurses have been praised and applauded during the pandemic, but as pay negotiations loom there have been rumours of a possible public sector pay freeze
  • Unions are calling for a pay rise that recognises nursing as a highly-skilled workforce and addresses the real-terms fall in nurse pay since 2010
  • How the pay review process works and where pay for nurses across the four UK countries stands now
Will the prime minister’s gratitude for nurses extend beyond a round of applause?
Picture: Shutterstock

The COVID-19 crisis has brought the dedication, skill and expertise of the nursing profession into sharp focus like never before.

Clap for our Carers saw people across the UK applauding from their doorsteps, windows and balconies every Thursday night at the height of the pandemic, in support of NHS staff and other key workers.

Heightened appreciation of nurses during the COVID-19 pandemic

Prime minister Boris Johnson publicly thanked nurses for saving his life after he was admitted to intensive care at London’s St Thomas’ Hospital with COVID-19 in April.

Intensive care nurse Luis Pitarma was at the prime minister’s side for three nights, while ward sister Jenny McGee was also singled out in a video message posted after Mr Johnson’s discharge from hospital.

Nurses’ stock may be at an all-time high, but what impact will the pandemic have on future pay?

The current pay deal for nurses comes to an end in April 2021, so the issue will be high on the agenda in the coming months.

April 2021

When the next pay deal for nurses will come into effect

Is the public sector heading for a pay freeze?

Typically, pay talks involve the governments of all four UK countries, employer representatives such as NHS Employers, and submissions from health unions.

But there have already been rumours the public sector could be heading for a pay freeze in the aftermath of the pandemic.

In May, leaked Treasury documents examining the cost of the pandemic suggested a possible two-year pay freeze for public sector workers.

‘The clapping will have long stopped, but unions will ensure the immense effort and dedication shown by NHS staff throughout the pandemic isn’t forgotten’

Sara Gorton, Unison head of health

It wouldn't be the first time the government has made such a move: the NHS has been subject to public pay restraint since 2012, including a pay freeze in 2012 for staff earning more than £21,000, followed by several years of a 1% cap on pay rises.

The government denied the reports, but in the same week health and social care secretary Matt Hancock drew fire from unions when he refused to commit to a pay rise for nurses after the COVID-19 pandemic had passed.

What is the NHS Pay Review Body?

The NHS Pay Review Body is a non-departmental public body that advises on the pay of NHS staff.

  1. It is responsible for making making recommendations on the pay of all staff employed in the NHS and paid under Agenda for Change (AfC), with the exception of doctors, dentists and very senior managers
  2. It conducts research on pay and related matters
  3. It visits trusts and healthcare settings to meet staff and managers to gather information and views on pay and related issues

Source: NHS Pay Review Body

Health and social care secretary ‘will fight to have a fair reward’ for nurses

Speaking at a Downing Street press conference in May, Mr Hancock agreed ‘very strongly’ with the statement that nursing is a highly skilled profession and deserves decent pay, but stopped short of making any promises.

Matt Hancock said nurses should have a ‘fair reward’ for their work during the COVID-19 pandemic Picture: BBC

‘When it comes to how we reward people for their efforts in this crisis what I can tell you is that as the health secretary I will be making sure that we fight to have that fair reward,’ he said.

Unison head of health Sara Gorton argues that the same public who applauded NHS and care staff for weeks on end would ‘take a dim view’ of any attempt at pay freezes or wage caps.

Sara Gorton: ‘The public will take a dim view of pay freezes or wage caps’

‘People will expect the government to show the same gratitude towards nurses and other health professionals when pay talks start later this year,’ she says.

‘The clapping will have long stopped by then, but unions will ensure the immense effort and dedication shown by NHS staff throughout the pandemic isn’t forgotten.’

Nursing care and compassion has been very visible during the pandemic

The RCN believes the government should offer ‘a sizeable pay rise’ for nurses in the next formal pay round.

RCN executive lead for UK pay and director of RCN Wales Helen Whyley believes the public has been touched by nursing’s response to COVID-19.

She says the number of nurses choosing to return to the register and nursing students signing up for paid roles, as well as stories of care and companionship nurses provided for dying patients when hospitals banned visitors, have brought the profession to prominence.

‘Our members don’t just want a pat on the back for their work – this is a historic opportunity for government to right wrongs and value nursing as highly-skilled workforce’

Helen Whyley, RCN executive lead for UK pay and director of RCN Wales

‘UK nursing is very visible at the current time,’ she says.

‘What has touched the public’s heart is the care and compassion of nurses and nursing – they have seen how nurses have stepped up and supported their communities.

‘And what’s really clear is this pandemic has exposed exactly what nurses do – things we already know to be the case – that nursing is highly skilled and worthy of great respect.’

Voices from the front line

When stories of a possible pay freeze emerged, nurses debated the news on Nursing Standard’s Facebook page.

‘I think there would be a lot of backlash from [the] public and public sector if this happens,’ one wrote.

‘Not surprised,’ said another. ‘We will all have to tighten our belts to pay for this crisis whatever our jobs are.’

Another said: ‘How about a pay freeze for the non-essential workers – the politicians?’

A pay deal that values nursing as a highly-skilled workforce

14.9%

The real-terms fall in nurses’ earnings since 2010

Source: RCN labour market review

Ms Whyley adds that long before COVID-19, nurses felt undervalued in their work and mistreated by governments, and says that now is the time to address that.

‘Our members don’t just want a pat on the back for their work – this is a historic opportunity for government to right wrongs and value nursing as highly-skilled workforce.

‘Government should actually show they value nursing and bring in a sizeable pay rise for nurses.

‘When we set out our expectations on pay, we will be showing the level of ambition our members want.’

What do nurses earn now?

Nurses’ wages are set by Agenda for Change (AfC), the national system for NHS pay, terms and conditions, which is broken down into bands.

The starting point for newly qualified nurses is the bottom of band 5. In England in 2020-21, this comes with a salary of £24,907.

Experienced nurses at top of band 5 earn £30,615 a year.

Band 6 starts at £31,365 and band 7 at £38,890.

Do nurses in all four UK countries earn the same?

All four UK countries use their own versions of AfC, so wages can differ between countries.

In England, Scotland and Wales, nurses are all into the third year of their country’s own three-year pay deal.

Pay is traditionally highest in Scotland, the starting point for band 5 in 2020-2021 is £25,100, while in Wales the starting point is £24,907.

In Northern Ireland, nurses start on £22,795, although they are still on the 2018-19 pay bands following three years without government. Work is under way in Northern Ireland to get pay parity with England and Wales after historic industrial action by health and social care staff, and following the restoration of the government.

RCN keen to right the wrongs of the 2018 pay negotiations

Unions will not want to see a return to 1% caps or freezes, and bringing pay into line with inflation is one of their goals – RCN research states average NHS pay has not kept pace with the cost of living since 2010.

In the months after the 2018 deal was made, some nurses complained they had not received the pay rises they had expected and voted for and that aspects of the deal had not been fully understood or communicated accurately.

Helen Whyley: ‘Nurses don’t just want a pat on the back’

The furore resulted in a member’s vote of no confidence in RCN council, after which then general secretary Janet Davies and members of the council stepped down.

‘Obviously we have learned lessons from the 2018 negotiations,’ says Ms Whyley. ‘We are doing our best to make sure the RCN has got its house in order.’

RCN member survey is first step to ensure clarity in pay negotiations

With that in mind, work is currently under way to collect members’ pay ‘expectations and experiences’ with a new RCN member survey. Ms Whyle emphasises that communications on future pay negotiations will be clear.

In May, RCN general secretary Dame Donna Kinnair and chair of RCN council Dee Sissons wrote to Mr Johnson urging him to have an honest discussion about nursing pay after the pandemic.

£688

The gross median weekly full-time earnings for nurses in 2019

Source: RCN labour market review

But for now, the government is remaining tight-lipped on pay matters.

While a Department of Health and Social Care spokesperson told Nursing Standard the government is ‘incredibly proud of our nurses working day and night throughout this pandemic’, pointing out pay rises since 2018, they would not comment on commitments to avoid pay freezes or caps.

The spokesperson added: ‘The independent NHS Pay Review Body makes recommendations to government on pay increases for nurses and will be taking evidence and making recommendations on the next annual pay increase.’

How will nursing pay for 2021-22 be decided? Pay talks explained

Every year, ministers in England, Scotland, Wales and Northern Ireland write to the NHS Pay Review Body (NHSPRB) asking it to make certain recommendations on NHS pay for the next financial year.

This could happen any time between now and the autumn, although it will probably begin after the NHSPRB publishes its 2020-21 report.

After it has received its remit letters, the NHSPRB then calls for evidence from trade unions, such as the RCN, as well as the NHS Staff Council. It will also carry out visits to NHS settings and speak to staff.

The NHSPRB then produces a report with detailed recommendations on Agenda for Change (AfC) pay in the different UK countries.

Governments then decide whether they agree to those recommendations. If they decide to implement a pay rise, the NHS Staff Side Council and employer representatives agree a deal during a series of talks.

Union members are then asked to vote on whether they accept the deal.


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