Chancellor George Osborne’s July budget announcement about four more years of pay constraint for NHS nurses is as much a political calculation as a way of containing public expenditure; the cap on NHS pay increases will probably take us through to the next general election.

A government ideologically committed to the market is more than happy to be interventionist when it comes to holding down nurses’ pay. It is fully aware that nursing shortages would exert an upward pressure on nurses’ pay if there was a free market – the high day rates of London agency nurses is testament to this.

The UK government is faced with trying to meet its population health priorities against a backdrop of a hard-pressed nursing workforce, increasing evidence of skill shortages, and ongoing funding constraints.

Health is a labour intensive sector, and holding down staff numbers, staffpay, or both, will always be the obvious ‘solution’ to cost containment. This has led to the crude ‘if you keep your job you can’t have a pay rise’ narrative that has been a recurring theme in the public sector since the recession hit.

There is a blunt logic to this argument in the short term. Longer term, with the economy improving and skills shortages increasing, it looks increasingly threadbare as a sustainable solution if the NHS is to deliver quality services.

Nurses who have delayed retirement or career changes will move on. NHS nurse vacancies will continue to increase, and the growth in gap-filling international recruitment will continue apace.

NHS nurses’ pay determination should be a lever to improve performance and service delivery. It should also recognise the contribution of staff, and motivate them to continue to contribute. The longer the freeze goes on, the less it delivers on any of these necessary objectives.

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