Expert advice

Workforce: What can we learn from the ‘pay pendulum’ of decades ago?

Since the mid-1980s, the Pay Review Body has been fairly successful in keeping nurse pay on an even keel, but it’s clear the system now needs fixing, says workforce expert James Buchan


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As NHS nurses consider their response to the new pay offer, it is worth reflecting on the bad old days of nurses’ pay determination.

Before the Pay Review Body (RB) was established in the mid-1980s, the history of nurses’ pay made for sorry reading.

With negotiations at national level between unions and the Department of Health –and the Treasury playing a shadowy but influential role in holding down pay rises – for many years the process did nurses no favours. The result was frequent recourse to arbitration to settle pay disputes.

There were four one-off reviews of NHS nurses’ pay in the 1960s, and two further independent reviews in the 1970s. These were essentially ‘catch-up’ exercises, with nurses’ pay having fallen behind that of other workers during the periods between the reviews.

Ending the ‘boom and bust’

The history lesson? Any attempt to hold down nurses’ pay rates nationally for too long results in pent-up demand for a substantial increase.

Nurses’ pay falls behind that of other workers, and earnings are eroded by inflation. This leads to increasing pressure for a catch-up award, with this ‘boom and bust’ happening repeatedly in the NHS from the 1950s to the 70s.

One of the reasons for establishing the RB in 1983 was to end this damaging pay pendulum and set up a fairer and more rational approach. Until the pay freeze of recent years, the RB had been fairly successful in keeping nurses’ pay on track. Since the freeze, its independent role has been marginalised.

NHS nurses will, quite rightly, be weighing up the merits of the current catch-up national pay offer.

But we must not lose sight of the fact that the national NHS nurses’ pay system now needs fixing.

Otherwise, we risk falling back into a damaging cycle of pay decline and catch-up.



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

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