Pay: why this year's salary increase may depend on where you live

The final article in our series on the 2018 negotiations on nurses’ pay examines some of the variations across the four countries of the UK

The final article in our series on the 2018 negotiations on nurses’ pay examines some of the variations across the four countries of the UK

  • Nurses hoping for an award that makes up earnings lost due to pay restraint
  • NHS staff unions also seek to iron out discrepancies in AfC structure
  • NHS Pay Review Body’s recommendation is expected in April
  • Links to the rest of our pay series - examining the attempt to link pay to 'productivity' and changes to the Agenda for Change structure - are at the end of this article

Picture: iStock

Pay and staffing dominate nursing workforce debate across the four countries of the UK, so how does the picture differ in England, Wales, Scotland and Northern Ireland as the prospect of a new pay deal looms?

The NHS Pay Review Body (RB), which makes recommendations on pay for all Agenda for Change (AfC) staff in the UK, is currently considering evidence from staff side unions, the government and NHS Employers.

Agreed priorities

The RB is expected to report in April, after which Westminster and the devolved administrations will consider whether to make a pay award to staff in each country in line with its recommendation.

At the same time, talks are under way between all key parties to try to reach agreement on changes to the AfC pay structure.

1.5 million

The number of people the NHS employs, putting it in the top five largest workforces in the world, along with the US Department of Defense, McDonald’s, Walmart and the Chinese People’s Liberation Army

Lead staff side negotiator Sara Gorton says the unions are using the talks to focus on agreed priorities such as addressing low pay.

Ms Gorton says: ‘We do not have direct control over whether and how any outcome from the current talks would be implemented in Scotland, Wales or Northern Ireland.

‘We’re working on the assumption that if there were to be an injection of funding from Whitehall into staffing budgets this would flow through to these countries. However, this is by no means guaranteed.

‘The devolution legislation means that if this were the case, there would be room for decision-making at country level about the practicalities.’


  • The NHS in England employs 1.2 million staff in 152 acute trusts, 54 mental health trusts, 35 community providers and 7,454 GP practices.
  • Since 2013, nurses in England have been subject to a 1% cap on pay.
  • There were 35,835 nursing vacancies in the October-December quarter of 2017.
  • In the year ended last April a total of 33,000 nurses left the NHS in England, 52% of whom were under 40.

Jeremy Hunt signalled the end of
the pay cap. Picture: Terence Philips

Last October, health and social care secretary Jeremy Hunt announced an end to the controversial 1% cap on NHS pay.

This followed a determined campaign by the RCN and other health unions, which had raised the possibility of a ballot on industrial action.

In the November budget, chancellor Philip Hammond promised to fund a pay rise provided that talks on wider NHS contract and productivity reforms proved fruitful.

Imperative outcome

Unison deputy head for health Helga Pile says: ‘The severe nursing shortages in England, plus the fact that rates in England lag behind those in Scotland and Wales, mean it’s imperative that staff get a decent pay rise for 2018.

‘Any pay package will need to address the problems at both ends of the staffing pipeline.’

Ms Pile says that ‘getting pay right’ for new starters is crucial to attract new nurses and healthcare assistants to the NHS.

‘We also need to stop more experienced staff leaving because they feel undervalued.’



  • NHS Scotland employs around 160,000 staff who work in 14 regional NHS boards, seven special NHS boards and one public health body.
  • The Scottish Government spends around £11.7 billion annually on providing healthcare.
  • In December, Scotland’s finance secretary Derek Mackay said nurses will receive a pay rise of 2-3% this year depending on their earnings.
  • The Scottish Government has reaffirmed a commitment that there will be no compulsory redundancies for public sector workers.

Last autumn, Scotland announced it would be the first of the UK countries to lift the 1% pay cap.

Norman Provan says anything less
than an above-inflation pay rise
would be another pay cut.

Mr Mackay said nurses earning £36,500 or less would receive a 3% pay rise, while those earning below £80,000 would receive a 2% rise.

Rises for the highest earners will be capped at £1,600.

Less than inflation

RCN Scotland associate director Norman Provan says: ‘That is the minimum award they would make. However, it's still below inflation, and anything less than an above-inflation pay rise is another pay cut.'

Mr Provan believes the government would make a higher percentage award if the RB recommended one.

On the pledge made by the Scottish Government, he said: ‘It’s more generous than others have offered in the past, but it’s still not a pay rise.’


  • NHS Wales employs up to 89,000 people, making it the biggest employer in the country.
  • The Welsh Government invests £6 billion a year on health, 40% of its budget.
  • Since 2013, nurses in Wales have been subject to the 1% pay cap.

A 2013-17 agreement that applied only to Wales, affecting some terms and conditions for NHS staff, has just come to an end.

£437 million

The NHS budget when launched in 1948, roughly £15 billion at today’s value. By comparison, the annual budget for NHS England alone is now more than £120 billion.

The agreement saw the staff side accept some less favourable terms and conditions related to sick pay and career progression as part of a contribution to austerity measures being taken across the public sector.

Discussions on alternative arrangements on these issues continue outside of the current pay discussions.

Collective terms

RCN Wales associate director employment relations Helen Whyley says this is an example of how devolution has allowed the country to do things differently from Westminster.

Ms Whyley says: ‘We’ve had a small number of Wales-only negotiations.’

Helen Whyley says the safe
staffing law is groundbreaking.

She says that in current pay talks the RCN would like to continue with collective UK terms and conditions where possible.

‘In the past, the Welsh government has supported the approach of a UK NHS Pay Review Body and has implemented its recommendations.

‘Sometimes this has been in line with the rest of the UK, and sometimes it hasn’t.’

Another issue to watch will be safe staffing levels for nurses, which become mandatory in some Welsh hospital wards from April.

The new safe staffing law is the first of its kind in Europe.

‘It’s a groundbreaking piece of legislation,’ Ms Whyley says. ‘But we've got challenges around nurse recruitment, so it could be tricky to ensure hospitals comply with the duty.’

Northern Ireland

  • Since the collapse of the devolved government a year ago there has been no Northern Ireland executive or assembly to make decisions about the country’s health service.
  • The political crisis has seen nurses’ pay fall behind that in the other UK countries. It took until December 2017 for a 1% pay rise which had been agreed for 2017-18 to be released by the finance secretary.
  • The Health and Social Care in Northern Ireland workforce is made up of 64,000 NHS staff, of which nurses and midwives constitute around a quarter.

NHS staff in Northern Ireland have been left in ‘an unacceptable position’ in the current financial year, the staff side unions say in evidence for the pay review.


The minimum pay rise that unions have called for to address the estimated 14% real-terms pay cut nurses have experienced since pay restraint began.

Despite ministers having issued a remit to the RB on a 1% pay award, the collapse of the executive led to the finance secretary refusing to implement the pay award, saying it was beyond his powers.

This led to a campaign by NHS trade unions in the country, and in December the decision was reversed.

The effective pay freeze meant Northern Ireland NHS pay rates for some AfC staff fell below the legal minimum wage.

Garrett Martin says nurses are
going above the call of duty.

RCN Northern Ireland deputy director Garrett Martin says the political situation is contributing to a crisis in the health service and nurses’ pay has fallen behind that in the other UK countries.

‘It’s certainly not helpful that there is no leadership or accountability for decisions that need to be made,’ he says.

Call of duty

‘Health and social care has to be delivered, patients are still in need of healthcare and nurses are continually going above the call of duty to make sure that happens.’

Mr Martin says there is anecdotal evidence that some nurses living on the border with the Republic of Ireland are leaving the Northern Ireland workforce for jobs in the republic, where pay is improving.



More from this series:


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