Analysis

Pay rise for nurses: what a new deal might look like

Nurses exhausted by the pandemic could leave in droves unless pay is addressed, unions warn

After a year on the COVID-19 front line, exhausted nurses could leave in droves unless a fair pay deal is negotiated, unions warn

  • With pay talks for NHS staff delayed, the government is facing criticism over its recommendation for a pitiful 1% rise
  • Unions warn that unless a meaningful rise is agreed, many nurses will leave, further exacerbating existing staff shortages and increasing care backlogs
  • What unions have said about possible industriual action, plus the expected timeline for pay negotiations

This article was updated on 23 March 2021

There will be an exodus of exhausted and emotionally drained nurses leaving the profession unless they are granted a significant pay rise

...

After a year on the COVID-19 front line, exhausted nurses could leave in droves unless a fair pay deal is negotiated, unions warn

  • With pay talks for NHS staff delayed, the government is facing criticism over its recommendation for a ‘pitiful‘ 1% rise
  • Unions warn that unless a meaningful rise is agreed, many nurses will leave, further exacerbating existing staff shortages and increasing care backlogs
  • What unions have said about possible industriual action, plus the expected timeline for pay negotiations

This article was updated on 23 March 2021

Picture: iStock

There will be an exodus of ‘exhausted and emotionally drained’ nurses leaving the profession unless they are granted a significant pay rise this year.

That’s the stark message from health unions stepping up calls for a decent pay rise, with the current three-year pay deal for nurses due to come to an end in April. Here, we take a look at what unions are calling for, what the government has said, and how the pay deal could progress.

Government under fire for ‘pitiful’ pay rise suggestion

The government is facing fierce criticism over its suggestion of a 1% pay rise for NHS staff this year. In response, the RCN immediately set up a £35 million strike fund to support members should they take part in any industrial action.

The government made the recommendation in its evidence to the independent NHS Pay Review Body (RB) for the 2021-22 pay round for staff on Agenda for Change (AfC) contracts.

‘The government is dangerously out of touch with nursing staff, NHS workers and the public... Nobody would think that this is fair in the middle of a pandemic’

Dame Donna Kinnair, RCN general secretary

‘This is pitiful and bitterly disappointing,' RCN general secretary Dame Donna Kinnair said of the 1% recommendation. ‘The government is dangerously out of touch with nursing staff, NHS workers and the public.

‘It is not a done deal but the government has revealed its hand for the first time. Nobody would think that is fair in the middle of a pandemic and it will do nothing to prevent the exodus from nursing.

'Nursing staff would feel they are being punished and made to pay for the cost of the pandemic. It is a political decision to underfund and undervalue nursing staff.'

The profession will have to wait until at least the summer to find out what eventual pay rise it can expect.

36%

of nurses are thinking of leaving the profession, with pay the most commonly cited reason
Source: RCN survey

In a break with the usual timetable for the pay round, the RB, which advises the government on pay for AfC staff employed in the NHS, has been asked to report back with its recommendations in early May.

‘Without a significant wage rise, staff will leave the NHS’

However, the government has warned money is tight in light of the pandemic.

Prime minister Boris Johnson defended the 1% recommendation on a visit to a COVID-19 vaccination centre in London on 7 March, saying the government had tried to give staff 'as much as we can at the present time'.

At a Downing Street press briefing on 5 March, health and social care secretary Matt Hancock said: ‘The challenge is that the nation's finances are tight and while everybody else in the public sector is going to have a pay freeze, we are able to propose a pay rise for nurses at 1%.'

Pay has always been a factor in nurse recruitment and retention. But for a workforce that has spent the past year in the eye of the COVID-19 pandemic, a meaningful pay rise is vital, says Professor Kinnair.

‘Nurses and their colleagues are exhausted and emotionally drained,’ adds Unison head of health Sara Gorton. ‘Many no longer think the NHS is for them.

‘Without a significant wage rise that's paid soon, people will leave, and the NHS will struggle to recruit the new staff it needs for the future.’

Why is this year’s pay deal so important?

The Clap for Our Carers initiative during the first wave of the pandemic showed public support for the NHS and other public sector staff has never been stronger.

Dame Donna Kinnair, RCN general secretary
This must be the year the tide turns on pay, says RCN general secretary Dame Donna Kinnair Picture: Justine Desmond

Yet an RCN survey of nearly 42,000 members in May and June 2020, towards the end of the first wave, found 36% were thinking of leaving the profession, with 61% of those citing pay as a reason.

Professor Kinnair has said 2021 must be the year ‘the tide turns’ on pay.

The college argues that chronic staff shortages – an estimated 40,000 vacancies in England alone – have further affected the system’s ability to cope with the pandemic, as well as ongoing service demands.

It also warns that a low-level pay rise similar to that given to other public sector workers last year will not prevent nursing staff leaving after the pandemic, and patients will ‘pay the price’.

The RCN says the pay of an experienced nurse has fallen by 15.3% in real terms over the past ten years, and that the suggested 1% pay rise would mean an experienced nurse taking home just £3.50 a week extra.

Unite has also warned staff will leave unless the pay rise this year is a meaningful one.

‘If NHS staff don’t feel they are being looked after and valued, once the pandemic ends there will be a mass exodus of skilled and experienced staff who will be exhausted and disillusioned,’ a Unite spokesperson says.

What sort of pay rise are the health unions calling for?

All health unions are campaigning for a significant increase for NHS staff:

  • The RCN is calling for a 12.5% increase.
  • Unison wants a pay rise of at least £2,000.
  • Unite is calling for a £3,000 or 15% pay rise, whichever is higher.
  • The GMB is calling for 15%, or £2 extra an hour, whichever is higher.

‘NHS staff are on the edge and need more support - physically, emotionally and financially if they are going to stay working in the health service,’ says GMB national officer Rachel Harrison.

What do nurses get paid?

Nurse salaries are set by Agenda for Change, the national system for NHS pay, terms and conditions, which is broken down into bands.

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

  • The starting point for all newly qualified nurses is the bottom of band 5
  • In England in 2020-21, this comes with a salary of £24,907
  • In Scotland, where pay is traditionally highest, it is is £25,100
  • In Wales in 2020-21 it is £24,907
  • In Northern Ireland it is £24,907

Would industrial action be on the cards if a significant pay rise is not granted?

One possibility is that unions may look to the example set in Northern Ireland, where nurses took part in industrial action in late 2019 and early 2020 over inadequate pay and staffing.

Three one-day walkouts and working to rule eventually led to pay parity with nurses in England and Wales.

RCN South East regional director Patricia Marquis said strike action was ‘certainly’ on the minds of RCN members, but was not the first option.

When asked by Times Radio on 6 March whether nurses would strike during a pandemic, she said: ‘I think the answer to that is no, we are not talking about striking tomorrow. What we are talking about as an organisation is preparing ourselves for what we see will be a few months of opportunities for the government to change its mind and to do something different.

‘But in the meantime we need to prepare ourselves for if they don't change their mind, and we need to take the next steps, which initially will not be strike or industrial action – there is a long way to go before we get to that, but it is certainly in the minds of our members.'

Unite has said it is ‘considering all options, including holding an industrial action ballot’, as its pay campaign continues in the coming weeks.

RCN Northern Ireland director Pat Cullen, centre, on the picket line with nurses

How do pay talks work?

In November’s spending review, Mr Sunak told Parliament the government was ‘committed to providing a pay rise’ for NHS workers.

Once the Pay Review Body submits its recommendations, the government decides whether it agrees to those recommendations. If the government decides 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.

If union members vote to accept the offer, nurses’ pay would be increased and backdated to 1 April 2021.

What is the NHS Pay Review Body?

The NHS Pay Review Body is a non-departmental public body that advises government on the pay of NHS staff, as follows:

  • It is responsible for making recommendations on the pay of all staff employed in the NHS under Agenda for Change contracts, with the exception of doctors, dentists and very senior managers
  • It conducts research on pay and related matters
  • Under normal circumstances, it visits trusts and healthcare settings to meet staff and managers and gather information and views on pay and related issues. However a spokesperson for the review body told Nursing Standard that the COVID-19 pandemic has meant it has switched to virtual staff consultations.

Who submits evidence to the body?

The Department of Health and Social Care and the health departments of the devolved UK nations, trade unions, health service organisations such as NHS England, NHS member organisations such as NHS Employers, and staff groups such as Nurses United.

What happens in the rest of the UK?

Scotland, Wales and Northern Ireland have to wait for a pay deal to be agreed in England before starting their own process of pay negotiations.

This is because funding for pay agreements in the UK is distributed based on a formula used by the UK Treasury to allocate public money to the devolved nations.

April 2021

The current pay deal for NHS nurses is due to end

Once a deal is agreed by the UK government, the governments of the other nations are then free to determine the pay they offer to nurses.

These pay offers are then voted on by union members in the respective countries.

Scotland and Northern Ireland decided to award NHS and social care staff a £500 bonus payment for their work during the COVID-19 pandemic.

Wales announced a £735 payment for its staff, which after tax and national insurance deductions will come to about £500.

The Scottish Government has also announced an interim 1% pay rise for all staff on Agenda for Change contracts, to compensate for the delay in negotiations for the 2021-22 pay deal.

The interim increase is being backdated to 1 December 2020. In addition, the final pay rise negotiated for staff will also be backdated to 1 December 2020, instead of the standard starting date, which would have been 1 April 2021.

These payments are not expected to affect pay negotiations in any way.

How long do pay negotiations usually take?

It is difficult to generalise, but for comparison, pay talks for the last deal took place in March 2018, with union members in England asked to vote on the deal in June. Nurses received the rise from their July pay onwards, backdated to 1 April 2018.

Chancellor Rishi Sunak delivers his spending review
Chancellor Rishi Sunak delivers his spending review Picture: Alamy

What has the government said so far on pay?

The chancellor remained silent on NHS pay in the 3 March budget. This followed his spending review in November 2020, which warned of challenging economic times ahead due to the pandemic, and a growing disparity between private and public sector wages due to the impact of COVID-19.

In the full spending review document, the Treasury cautioned against giving too large a pay rise to NHS staff, saying: ‘In setting the level for these rises, the government will need to take into account the challenging fiscal and economic context.’

This was echoed by health and social care secretary Matt Hancock in a letter to the NHS Pay Review Body in December. ‘The affordability of pay recommendations will have to be considered within the context of the significant financial and economic pressures that have resulted from the COVID-19 pandemic,’ he wrote.

When asked about nurse pay in recent months, prime minister Boris Johnson said that nurses have enjoyed a 12.8% pay rise – but this figure applies solely to newly qualified nurses.

In fact, most nurses saw their salary increase by 6.5% over the course of the current three-year deal, though this came after years of pay restraint and pay freezes.

In response to the prime minister’s comments, Professor Kinnair wrote to Mr Johnson, urging him to reflect the truth. ‘Nursing staff are worse off now than they were in 2010, following years of freezes and awards that were capped below the level of inflation,’ she wrote.

In its evidence to the RB, published on 4 March, the government wrote: ‘The economic outlook for 2021-22 remains uncertain and pay awards must be both fair and affordable. In settling the Department of Health and Social Care and NHS budget, the government assumed a headline pay award of 1% for NHS staff. Anything higher would require reprioritisation.'

The Clap for Carers showed public support is high
The Clap for Carers showed public support is high, but unions argue it is now time for the government to show it values NHS staff Picture: Alamy

Is the public behind a pay rise for nurses and other Agenda for Change staff?

A survey conducted by unions indicates widespread support. A poll of around 2,300 members of the public commissioned by 14 health unions in July 2020 found 86% (1,981) backed a pay rise for NHS staff, with 40% (911) supporting a significant increase.

May 2021

When the NHS Pay Review Body is expected to submit its recommendations to the government

In addition, more than 10,000 people supported the RCN’s Clapped us? Back us campaign, lobbying their MP for a pay rise for nurses.

Is there an economic case for a pay rise?

Unions commissioned policy and economics consultancy London Economics to examine the impact of a pay rise for staff.

The report examines the cost of a theoretical 10% pay rise for NHS staff on Agenda for Change contracts in England for 2021-22, which would cost the government about £3.4 billion.

It argues that the government would be able to recoup 81% (£2.74 billion) of this cost as nurses and other staff would pay more tax, have more disposable income to spend in the private sector and clear student loans sooner.

There would also be savings made from efficiencies due to increased recruitment and retention of staff.


This article was originally published on 24 Febraury 2021 and updated to include the latest developments

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