Nurses working ‘for free five days a month’ due to poor pay

Under-inflation pay rises over the past decade have left many nurses effectively working five days a month without pay, new analysis suggests, as thousands of nurses say they are poorer than a year ago.

Research conducted by consultancy firm London Economics and commissioned by the Royal College of Nursing (RCN), as well as findings from a new survey of almost 11,000 nurses, were published today.

“This new analysis exposes the scale of the government’s sustained attack on nursing”

Pat Cullen

The two publications found evidence of significant pay degradation since 2010 for NHS nurses, anxiety about finances in the workforce and a surge in nursing staff feeling the pinch of the cost of living crisis.

The London Economics analysis found that, between the 2010-11 and 2023-24 financial year, pay for nurses on Agenda for Change band 5 and above fell by 25% in real terms (adjusted for inflation).

This meant, the RCN said, that nurses on bands 5 and 6, earning between £28,000 and £42,000, are now working “effectively one week each for free”, compared to 2010-11.

Falling pay, together with rises in the cost of essentials including electricity bills, have, according to the RCN’s survey, had a huge “human impact”.

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The vast majority (77%) of respondents to the survey said they were “financially worse off” than they were 12 months ago, with more than two-thirds (68%) rationing gas and electricity.

Nurses told the RCN that they were using credit or savings for essential living costs, and struggling to manage their finances more than they had been previously.

Around a third of survey respondents told the RCN that money worries have had a “considerable or very considerable” impact on their physical health, with many also reporting a fall in their overall mental health.

Just 5% of survey respondents said they have been able to manage finances without difficulty in the last year.

RCN general secretary and chief executive Professor Pat Cullen said a decade of pay degradation had “caused hardship” and the analysis “exposes the scale of the government’s sustained attack on nursing”.

“Today, nursing staff are rationing electricity and gas with financial pressures pushing four in ten into a state of mental distress,” she said.

“Pay has been devalued so much that they are effectively working five days or more for free each month. Ministers, who once seemed glad to applaud NHS staff, should reflect on this terrible state of affairs.”

The analysis and survey results represent the latest salvo in the union’s attempts to gain the best deal it can for 2024-25, via the NHS Pay Review Body.

The RCN recently submitted its evidence for the next NHS pay award. The union demanded an above-inflation pay rise as well as a bonus payment for all nurses as a means to improve retention.

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However, implementation of the pay award for 2024-25 will be delayed beyond April, because the formal process to begin it was started late, during December.

Professor Cullen said: “The next NHS pay award should have been ready for the new and imminent financial year – but our members will be kept in the dark again until the government confirms its plans.

“Ministers must commit to a substantial pay rise for every member of nursing staff,” she said. “That’s how to begin delivering pay justice for a profession so routinely undervalued.”

She added: “If they fall short once again, they will be exposing tens of thousands to further hardship and exacerbate an already dangerous staffing crisis.”

Responding to the RCN, a Department of Health and Social Care spokesperson said: “We hugely value care provided by our fantastic nurses, which is why we negotiated a fair and reasonable deal with the trade unions delivering a 5% pay rise, two additional one-off bonuses equivalent to 6% of pay and a series of non-pay measures to support the NHS workforce.

“There are almost 361,000 nurses working across the NHS – over 60,000 more than in September 2019 and we will continue to grow the workforce through the first ever NHS Long Term Workforce Plan – backed by over £2.4bn.

“The plan commits to doubling training places for adult nurses by 2031 and improving retention with measures around working conditions, flexible working and training,” they said.

For 2022-23, the government gave NHS staff on Agenda for Change contracts in England a 5% pay rise, while an additional one-off bonus of at least £1,655 also provided to top-up the deal.

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The government also made a commitment to the RCN to consider introducing a pay spine just for nurses, which was collectively opposed by the other NHS unions.

The deal eventually came during direct negotiations with health unions, following months of strike action by nurses and other NHS staff.

It was implemented after the majority of health unions voted to accept it, with the exception of members of Unite and the RCN.

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