Nurse pay progression ‘worse than’ midwives and paramedics
While nurse pay progression has sped up considerably over the last decade in England, it lags behind other professions including midwifery, according to researchers.
For example, their modelling indicated that a midwife was over ten times more likely to be in band 6 or higher two years after qualifying than a nurse.
They also indentified large differences in nurse pay progression between region, type of trust, and the age, gender and ethnicity of nursing staff.
Their report, titled Progression of nurses within the NHS and published by the Institute for Fiscal Studies (IFS), has shone a light on the factors affecting the rate of pay progression for nurses in the NHS.
The IFS said the report also provided “important context” for discussions about NHS pay reform, with the debate about the prospect of a separate pay spine for nurses dividing opinion in the profession.
“Career progression is an important factor for the pay of nurses, likely to impact retention and recruitment, and an important part of workforce development for the NHS as a whole”
IFS report
In its report, the IFS examine the career progression of nurses and other staff groups within the NHS Agenda for Change pay framework in England over the decade between 2012 and 2021.
Specifically, the institute analysed the pay progression of a hypothetical cohort of nurses who became nurses in November 2012, using data from the NHS Electronic Staff Record.
This hypothetical cohort joined the profession on band 5 of the Agenda for Change pay scale – the lowest pay grade for a registered nurse in England.
By August 2021, 39% had quit nursing or no longer worked in the NHS. Of the remainder, 21% were still in band 5 and 26% had progressed to band 6, which in 2021-22 was a wage worth £32,306-£39,027.
A further 14% had progressed to band 7, 8 or 9, the latter of which would have been a wage between £93,735 and £108,075.
The IFS said that, of those who remained working as a nurse in the NHS, 35% were still in band 5, which in that year was an annual wage of between £25,655 and £31,534.
The study further found that nurses who were younger, men, or White were more likely to progress faster to band 6 than older, women or Black or minority ethnic nurses.
In the 2012 cohort, 71% of nurses who started aged 20-24 had reached band 6 or above by August 2021, compared to 45% of those who started aged 45 or over.
Three quarter of men progressed by 2021 compared to 64% of women; 67% of White nurses reached band 6 or above compared to 60% of Black nurses, 52% of Asian nurses and 66% of mixed or ‘other’ ethnicity.
In addition, nurses, the IFS figures showed, progressed beyond band 5 more slowly than some other staffing groups.
The IFS ran a similar simulation for cohorts of midwives, paramedics and allied health professionals starting at band 5 in 2012.
By August 2021, no midwives or paramedics and only 6% of allied health professionals remained in band 5, compared to the 21% of nurses.
Around half (49% and 44%, respectively) of midwives and paramedics had progressed to band 6, and 30% of allied health professionals had done so.
Of those still in the NHS, 25% of midwives, 25% of paramedics, and 39% of allied health professionals had progressed to band 7 or above, with more than half of all three groups progressing to band 6.
The report found further disparities by geography. For example, a nurse in Greater London was 45% more likely to have reached band 6 or above after nine years than one who started in the North East.
Despite the issues highlighted in the report about nurse pay progression, the IFS noted that it had, however, “sped up considerably” over time.
An identical hypothetical cohort of nurses, starting work in 2016, was analysed and found to be one-third more likely to be in band 6 or above after four years than one who started in 2012.
The IFS said, in its concluding remarks of the report, that more research was needed to understand exactly what was driving these inequalities as well as the overall slow rate of nurse pay progression.
The report stated: “Career progression is an important factor for the pay of nurses, likely to impact retention and recruitment, and an important part of workforce development for the NHS as a whole.
“In this report, we have documented the patterns of progression along NHS pay bands for early-career nurses in the NHS and how this compares with potentially similar staff groups.
“Pay bands are an important measure of career progression since they determine the pay that NHS staff receive and they capture changes in job responsibilities.
“But changes in pay bands will not capture all forms of progression, such as movements between job roles on the same pay band.”
The IFS report was commissioned by the National Institute of Health and Care Research (NIHR), which is funded by the Department of Health and Social Care.
It followed a promise by the government to “work with employers and trade unions to improve opportunities for nursing career progression” during the 2023 NHS pay negotiations.
The IFS said its research provided “important context” for how and why career progression for nurses needed reforming.
The profession, however, remains somewhat split on what shape this reform should take, with a consultation into a potential separate pay spine for nurses having recently concluded.
Responses from unions representing non-nurse healthcare staff, as well as those representing nurses, midwives, healthcare assistants, have varied.
Some supported it on the grounds that it could help nurses achieve higher pay quicker, while others worried it could cause divisions within the workforce.
Many were against the prospect, such as Unison, while the Royal College of Nursing (RCN), which propsoed the idea originally, last week published its arguments in favour of a separate pay spine.
