Late NHS pay letter sparks fresh nurse strike warnings

Nursing unions are threatening fresh strikes in the new year as the NHS Pay Review Body (PRB) process begins too late for any new pay offer to be awarded on time – and a significant improvement in pay looks unlikely.

Recently-appointed UK health and social care secretary Victoria Atkins published her 2024-25 remit letter to the PRB yesterday (20 December).

The letter kickstarts the next NHS pay round and is supposed to be published in the autumn each year so a pay offer can be outlined in the UK Government’s spring budget and delivered by April.

However, Ms Atkins’ letter, addressed to interim PRB chair Stephen Boyle, asked the group to have its report ready for May 2024 – already a month after any deal should be implemented.

The health and social care secretary told the PRB to ensure its recommendations were “affordable”.

She wrote: “It is vital that the pay review bodies consider the historic nature of the 2023 to 2024 awards and the government’s affordability position that will be set out further in written evidence.

“As always, while your remit covers the whole of the United Kingdom, it is for each administration to make its own decisions on its approach to this year’s pay round and to communicate this to you directly.”

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The unions criticised Ms Atkins for the late publication of the letter, meaning a pay award will not be implemented in time for the start of the 2024-25 financial year. Any pay rise will be backdated, however.

They also suggested the PRB was being steered by the government into recommending a sub-par pay offer for nurses and other Agenda for Change staff.

Royal College of Nursing leader Pat Cullen being interviewed. She is wearing a blazer and shirt.

Pat Cullen

Royal College of Nursing (RCN) general secretary and chief executive Pat Cullen said her union’s pay dispute with the government remained “unresolved” and suggested more strikes could come in 2024.

“Once again, the supposedly independent process has its wings clipped when the health secretary writes about keeping costs down,” said Ms Cullen.

“By suppressing NHS wages, her predecessors have added to the shortage of nursing staff and falling care standards.

“The new approach must be to invest in nursing professionals as part of a commitment to patient safety. Repeating the mistakes of recent years would raise the prospect of more strike action.”

Ms Cullen referenced a recent poll which found that two-thirds of the public would support further industrial action by nurses over pay, and added: “RCN is already consulting our members working in the NHS in England about what they may be prepared to do in the new year.

“In an election year, no political party can yet be confident it has the ability to stave off more industrial action by nurses.”

She said the letter contained “no evidence” the government had honoured a commitment from the 2023-24 pay deal to improve the PRB process following longstanding concerns about its independence.

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The deal promised “a review into the timing and appointment process of the NHS PRB to ensure that the pay-setting process and the NHS PRB operates effectively”. 

At RCN Congress in May, nursing members of the college expressed their desire to withdraw from the PRB and for the unions to negotiate directly with the government instead.

Similarly, Unison members voted to “call time” on the PRB at their annual health conference in April.

Responding to the remit letter, Unison acting head of health Helga Pile demanded direct talks with Ms Atkins early in the new year.

“The deal to resolve the recent dispute included a government commitment to review the failing process for setting pay,” she said.

“Falling back on the same discredited system won’t give staff confidence that ministers are taking any of the huge problems affecting the NHS seriously.

“There simply isn’t time to allow the long-winded pay review body process to run its course, especially when everyone knows ministers are calling the shots.”

Helga Pile

Ms Pile said Ms Atkins was in danger of “ignoring the lessons” of the past year’s industrial action, adding: “In the summer of last year, health unions had called for pay talks as the only way to avoid industrial action. Ministers refused, so strikes took place across the NHS.

“But improving wages across the health service is key to solving the staffing crisis affecting every part of the NHS.

“Victoria Atkins must do the right thing for NHS staff and patients by holding proper pay talks early in the new year.

“Otherwise, there’s a risk of a repeat of the disruption that affected so much of the NHS last winter.”

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Ms Pile also highlighted the situation facing nurses in Northern Ireland, who remain without a 2023-24 pay offer due to political turbulence in the country.

She said: “As a matter of urgency, the government must deliver the funding to cover this year’s pay rise in Northern Ireland.

“Then struggling health workers there can catch up and further strikes can be avoided.”

Rachel Harrison, national secretary of GMB, which also represents some nursing staff, said it was “farcical” for the government to pretend the PRB is independent.

She accused the government of “tying” the hands of PRB members before they even began examining evidence for a new pay award.

“GMB has repeatedly said we won’t engage with the NHS Pay Review Body process until it’s significantly reformed,” she said.

“Today’s tardy letter from the [Department of Health and Social Care] shows exactly why.”

A spokesperson for the Department of Health and Social Care said, in response to the unions: “We hugely value the hard work of NHS nurses and that is why we provided a 5% pay rise and two significant non-consolidated awards – which for nurses at the top of band 5 was over £2,000, equivalent to 6.1% of their basic pay.

“This deal was accepted by the NHS Staff Council, and pay for 2023-24 is therefore settled.

“We continue to work collaboratively with unions, including the RCN, to deliver a series of reforms to improve working conditions that were agreed as part of the deal.

“We have asked the independent pay review body to make recommendations on pay for 2024-25.”

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