Expert advice

Upgrading hospitals is pointless if you don’t upgrade nurses’ pay and housing

The government must act fast to help staff who are struggling to make ends meet 
Woman looking at an estate agent's window

The government must act fast to help staff who are struggling to make ends meet

One in four of the 1,400 London-based nurses who responded to a recent RCN survey said they were worried about their finances.

More than half said they wanted to leave London, citing factors such as the high cost of accommodation and transport.

The RCN says this is fuelling recruitment and retention problems in the capital, where one in six nursing posts are unfilled. The college is calling for

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The government must act fast to help staff who are struggling to make ends meet 


The high cost of housing, especially in London, is forcing many people to leave the capital. Picture: Alamy

One in four of the 1,400 London-based nurses who responded to a recent RCN survey said they were worried about their finances.

More than half said they wanted to leave London, citing factors such as the high cost of accommodation and transport.

The RCN says this is fuelling recruitment and retention problems in the capital, where one in six nursing posts are unfilled. The college is calling for free travel on public transport for nurses, rent controls, and the use of surplus NHS land to build affordable key worker homes.

Pay weighting system is not working

Another way of addressing London’s cost of living gap would be to increase the pay of its nurses.

Data from NHS Digital shows that 21% of NHS nurses in England receive some pay enhancement related to geographical allowances.  

Nurses working in central London get paid an additional ‘London weighting’ of 20% of basic salary, with a minimum payment of £4,400.

The problem is that ‘weighting’ is a blunt instrument. It rewards equally a long-established nurse who bought a house in London 30 years ago and now lives in a mortgage-free, million-pound-plus property, and a new nurse who – as the RCN survey shows – is finding it difficult to meet the rent and pay for public transport.

Given the likely cost of an adequate pay rise in London, and the reluctance of the RCN and other unions to look at localised or individualised pay, the blunt pay weighting instrument is likely to stay.

We need a large increase in key worker accommodation

This points to the need for other sharper and more targeted solutions. The government has made promises about funds for hospital infrastructure upgrades, but a hospital without nurses is just an empty building.

Key worker accommodation should be part of the ‘new build’ solution.


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

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