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Scotland's pay deal: the beginning of the end for a UK-wide approach?

A better pay rise, retention of the student bursary and a commitment to safe staffing means nurses in Scotland could be leaving their colleagues in England behind

A better pay rise, retention of the student bursary and a commitment to safe staffing means nurses in Scotland could be leaving their colleagues in England behind

Picture: Daniel Mitchell

Union members in Scotland have endorsed a three-year deal that will reportedly see nurses receive a pay rise of at least 9% by April 2021. This includes the 3% increase already received in July, now backdated to 1 April.

The Scottish Government has lost no time in promoting that by 2021, NHS nurses in Scotland will be ‘better paid than NHS staff anywhere else in the UK’.  It claims that by 2020-21, a ward nurse at the top of band 5 will earn £1,030 more than a colleague in England.

Step towards separate pay system

On paper at least, this looks like a better deal than that achieved by unions in England. Factor in the continued confusion about what that English deal actually means for individual NHS staff, and ongoing uncertainty about the future role of the UK-wide NHS Pay Review Body (RB), and nurses in Scotland appear to be on to a relative winner.  

The Scottish deal also marks another significant step in the direction of a separate pay determination system for NHS staff in the country.

In past years the Scottish Government has given separate evidence to the RB, but in 2018 there has been a separate pay process in Scotland, leading to distinct and different outcomes. 

Growing divergence

The nationalist Scottish Government wants to present itself as more responsive to the NHS and its staff than Westminster has been. Many would argue this is no big challenge, given Westminster governments have presided over a seven-year pay freeze, significant increases in nursing vacancies, and continue to ignore demands for a more effective co-ordinated national approach to safe staffing. 

Nursing looks in a better place in Scotland than in England. 

There is also growing divergence between Scotland and England on other aspects of NHS nursing policy. Scotland has, so far at least, retained a bursary model for funding nursing students, and has not seen as rapid a decline in the number of applicants for nurse education as has occurred in England. Unlike England, Scotland has not risked skill mix change by introducing nursing associates. And it is committed to a national safe staffing approach based on mandatory use of workload tools backed up by legislation. 

Nursing looks in a better place in Scotland than in England. Can that continue?  It will depend – on funding and politics. 

Three possibilities 

One of the unions, Unison, has called for the Scottish Government to break away from the RB, and wants to set up direct pay negotiating structures. There are probably three viable options if the main parties involved in determining nurses’ pay in Scotland want to go their own way.  

There could be a continuance of a linked approach, perhaps with a UK-wide RB giving separate assessment to Scotland, or pay determination in Scotland giving consideration to pay levels in the other UK countries while retaining a UK-wide grading structure. This year we reached that point by default. The question is if this year marks an aberration followed by a return to business as usual on nurses' pay, or a step in a new direction. Part of the answer to this question depends on UK-wide decisions on what should be the role, if any, of the RB.

Alternatively, Scotland could run a parallel system, where it sets up its own full pay determination machinery, and does its own thing, while keeping some elements of UK-wide grading, terms and conditions.  

The third, fully autonomous approach, would see Scotland break all links with the NHS pay system, and set up its own purpose-built model. This would require clarity over funding and is the model that would exist if Scotland were independent.

The Scottish Government, with one eye on the next election and the other on a future independence referendum, is no doubt keen to be seen to be doing things differently and positively. It knows that public sector pay is a big ticket item – potentially costly, but also a potential vote winner.

 James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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