The government is considering whether to introduce a separate pay scale for nurses in England to help with career progression and retention.
The Department of Health and Social Care has published a call for evidence that seeks to understand whether there is merit in adopting a separate pay structure for nurses currently on the NHS Agenda for Change (AfC) contract, which covers more than one million NHS workers including paramedics, midwives and other non-medical staff.
During negotiations for the 2023-24 pay round, concerns were raised by the Royal College of Nursing about how the AfC pay structure affected career progression and development opportunities for nurses, which was having a direct impact on their recruitment and retention.
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The most common grade for NHS nurses and health visitors is Band 5, which accounts for about 43% of the nurse and health visitor workforce in the NHS in England. This band has an entry pay point of £28,407 a year.
The DHSC says the AfC was introduced in 2004 to harmonise pay and terms and conditions, ensure equal pay for work of equal value, improve job descriptions and facilitate better partnership working. However, after recognising the concerns raised by the RCN, it now wants to understand whether the issues raised are unique to the nursing profession and whether removing nurses from the pay structure would rectify the problems.
Health minister Andrew Stephenson said: “We hugely value the work of nurses, who play a vital role in the NHS. We have listened to union concerns and are launching this call for evidence to explore the risks and benefits of a separate pay structure for nurses.
“I want stakeholders to share their expertise and help us collate feedback from across the healthcare sector, ultimately helping to make the NHS a better place to work.”
The DHSC presents two potential options:
- a separate nursing pay spine within the existing AfC contract, but all staff would remain on the same set of terms and conditions
- a separate nursing pay spine on a new contract or nursing staff, with a wider set of terms and conditions and a new contractual arrangement to ensure pay equity across the NHS workforce.
RCN general secretary and chief executive Pat Cullen said: “The current pay scale turns 20 years old this year and no longer reflects the skills and expertise in nursing today.
“Despite many years of experience, the vast majority of nurses are on the lowest pay bands possible. The current system only rewards people the further away they get from patient care. This approach is poor for patients and works against career progression for a nurse. Automatic pay band progression is afforded to some staff groups and never to nurses – it is unfair and unsustainable.
The current system only rewards people the further away they get from patient care. This approach is poor for patients and works against career progression for a nurse.” – Pat Cullen, RCN
“The genuine advance back in 2004 is ailing the profession today – the pay structure has not kept pace with nursing progress. Our workforce is 90% female and a new structure can remove the gender disadvantages at present and dispel completely the idea that nursing is less skilled, women’s work and worthy of low pay and poor treatment.”
However, Unison acting head of health Helga Pile said that “pitting different groups of staff against each other” would be the wrong approach.
“It would divert time and resources from the real problems, damage team morale and tie employers up in years of equal pay claims,” she said.
“Nurses – along with all other NHS staff – are rightly furious about being underpaid and poorly recognised for the work they do. Instead of creating divisive distractions, ministers should be looking to grade nurses properly, so they’re paid fairly for their skills and training, improve career progression and offer decent overtime rates for all.”
Alice Sorby, director of employment relations at the Royal College of Midwives, said: “The government is clearly deluded if it thinks that separating out one job group is going to help tackle the workforce crisis in the NHS. Never mind a different pay structure, what midwives and the whole of the NHS workforce need is a clear path to tackling the workforce crisis.
“They need urgent and timely investment in their training, and to be paid the wage they deserve. To take one staff group out of the current NHS pay structure risks seriously damaging the morale of midwives, maternity support workers and all other NHS staff who do their best every day to provide care to mothers, babies and their families. Teamwork is the foundation which the NHS is built on and years of experience shows us is the best way to deliver safe high-quality care.”
The survey will run for 12 weeks, until 4 April 2024.
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