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Counting the cost

In a bid to control runaway spending on temporary staff and encourage NHS trusts to employ more permanent nurses, health secretary Jeremy Hunt last month announced the introduction of a pay cap on agency spending.

Picture credit: Alamy

In February, an RCN Frontline First report highlighted a projected NHS spend of a staggering £980 million on agency nursing staff by the end of the financial year, unless rapid action was taken.

A cap on agency spending may be long overdue – it is expected to save the NHS £400 million by the end of the year – but this alone will not solve the chronic shortage of nursing staff in the UK, and it does nothing to tackle one of the root causes: pitifully low salaries.

The freeze on annual pay rises between 2009 and 2013, in addition to the partially resumed 1% annual increase, which is still much lower than the rate of inflation, had a devastating effect on nursing salaries, driving some UK nurses abroad in search of better pay and conditions.

Yet politicians continue to disregard the inadequate wage of the average UK nurse, and this is rapidly becoming the elephant in the room in discussions about the nursing workforce crisis.

Although strategies have been put in place to try and resolve workforce issues – including recruitment campaigns, return-to-practice schemes and increased nurse training places – it will likely be years before the benefits of these are felt. In the meantime, short term, quick fixes are necessary, such as recruiting nurses from overseas.

The rise in international nurse recruitment has been well documented; a report published by the King’s Fund in April revealed that 5,788 nurses were recruited from abroad in the year to September 2014, mostly from Spain, Portugal and the Philippines.

But this quick fix does not necessarily translate into a long-term solution. Research has shown that many NHS trusts fail to keep hold of nurses recruited from abroad, and some lose the majority within a year of hiring them.

Over-reliance on international recruitment is akin to putting a sticking plaster on a gaping wound. Excessive international recruitment could also be compounding the snail’s pace of salary rises, because the overseas nursing supply helps to depress wage growth.

According to research from the Institute for Fiscal Studies, a 10% pay rise for UK nurses – in line with politicians – could increase nurse numbers by around 7% in London, where relatively high numbers of ‘potential’ NHS nurses are in the private sector or non-nursing jobs.

National Health Action Party co-leader Clive Peedell believes the money to cover this 10% increase would not have to come from taxpayers, but could be accrued by reducing NHS waste, including the inefficiencies created by the NHS internal market and private finance initiative loans. This way, the government could find the extra money needed to improve salaries and quality of care without putting more strain on the taxpayer.

Despair and low morale among NHS nurses is at a record high, and this elephant in the room is bigger than we think. Nurses may not join the profession for the salary, but they still deserve to be paid adequately for the increasingly high workloads and the extensive skills and knowledge that come with being a nurse in the UK in 2015.

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