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Josie Irwin: Campaign for fair pay is a fight for future of the NHS

The 1% pay cap is causing low morale among nurses, has destabilised the workforce and is now putting patient care at risk, says the RCN’s lead pay negotiator.
Morale and pay

The 1% pay cap is causing low morale among nurses, has destabilised the workforce and is now putting patient care at risk, says the RCNs lead pay negotiator

NHS finances are in a dire state across the UK. Some would say that now is not the time to argue for a pay increase, but the RCN's reasons for asking the Pay Review Body to recommend a 2017 pay award above the 1% limit are compelling.

Nurses have suffered a real terms pay cut of 14% since 2010 and the RCNs 2015 Employment Survey found a third were struggling financially, with more than half relying on working extra hours. Less than half would recommend nursing as a career.

Our evidence is clear: pay policy has taken its toll on morale and commitment.

NHS is its staff

The argument that

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The 1% pay cap is causing low morale among nurses, has destabilised the workforce and is now putting patient care at risk, says the RCN’s lead pay negotiator


Picture: iStock

NHS finances are  in a dire state across the UK. Some would say that now is not the time to argue for a pay increase, but the RCN's reasons for asking the Pay Review Body to recommend a 2017 pay award above the 1% limit are compelling.

Nurses have suffered a real terms pay cut of 14% since 2010 and the RCN’s 2015 Employment Survey found a third were struggling financially, with more than half relying on working extra hours. Less than half would recommend nursing as a career.

Our evidence is clear: pay policy has taken its toll on morale and commitment. 

NHS is its staff

The argument that allocating money for pay takes money from services must be challenged. The NHS is its staff, and when pay policy hurts staff it also hurts patient care.

The government has made significant savings in recent years by preventing NHS pay from keeping pace with the cost of living. As the Migration Advisory Committee commented recently, pay is a factor in the poor retention of nurses in permanent roles in the NHS. Yet evidence consistently shows a strong relationship between registered nurse numbers and good quality care.

The truth is that if pay is not addressed, financial problems will only grow, reinforcing workforce issues that are already putting patient care at risk. Savings from pay restraint create problems that are expensive to fix - vacancy cover from agency staff has already cost billions.

The nursing shortage is set to get worse, with a third of nurses due to retire in the next 10 years. Some 59% of the nursing staff surveyed were too busy to provide the care they would like.

Systemic problem

A long-term solution is required, but where to start? The problem is systemic and tackling one issue is likely to give rise to others. The NHS faces the invidious choice of cutting front line  staff or facing heavier financial penalties. Meanwhile, numbers of patients continue to grow.

This raises the ugly spectre of rationing. If public health and community services were more of a priority, fewer people would end up in emergency departments, but there is even greater financial distress in the social care sector. We want social care providers to pay the living wage, but the cost is forcing them to compromise standards or go to the wall.

The government recognises that staff working in new and creative ways is essential to the long-term sustainability of the NHS, for example, working across acute and community boundaries to keep people out of hospital. For staff to give their best and be creative, they need to feel valued.

Short-term decisions to reduce NHS spending only compound problems: decisions in the recent past to reduce nursing student numbers contributed to the current nurse shortage and related chronic reliance on agencies. The switch from bursaries to loans means future nursing students will have to take on debts while facing the prospect of earning £8,000 less than the median graduate salary on qualification. This makes nursing a less appealing career, creating more uncertainty for the NHS.

A pay award that feels fair would start to fix retention and stabilise the future supply of nursing staff. It could also help release creative energies to find solutions to reduce demand.

No nurse should worry that ending pay restraint would drain funding for patient services. To put things in proportion, a 1% pay increase for a nurse on the top of band 5 is worth just 14.6p an hour. Fighting for fair pay is also a fight for patients and the future of the NHS.


About the author

Josie Irwin is RCN head of employment relations

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