We've had the biggest financial crash in history, austerity and three years of pay stagnation for nurses. Poverty is an issue for most clinicians – its effects fill waiting rooms. But for some nurses it is now knocking at their own door.
It is a picture at odds with the confident profession of a decade ago. Over the past 15 years, nursing has moved to a graduate intake, become responsible for prescribing medicines and had its pay, terms and conditions reassessed under Agenda for Change.
Nevertheless, charities and union benevolent funds have seen a steady increase in nurses seeking financial aid and even help with basic necessities in recent years. 'A lot of our band 6 workers are only one pay cheque away from poverty. If they miss a mortgage or direct debit payment, their credit rating is gone,' says Mike Travis, RCN council member for the North West.
Mr Travis told the RCN Congress in June: 'I know nurses who at the end of the month are on food banks to feed their families until their next pay cheque, who are using their credit cards to feed their families until the next pay cheque, and all the time there is a slow descent into poverty.'
More seek help
The RCN Foundation awarded £120,000 in grants to nurses in financial hardship in 2012-3, a 17 per cent increase on the previous year.
'We are receiving an increasing number of applications from nurses and HCAs on a full salary than we were three years ago,' said grants officer Lewis Allett. 'I'd link this to the rising cost of living. 'Often it's because they can't afford to replace an essential item like a washing machine.'
Similarly, Unison saw a 75 per cent leap in emergency grants for members in financial hardship between 2011 and 2013, when it paid out £12,300.
Nurses who work in the community are especially vulnerable. A charity that once assisted mostly retired district nurses is receiving more requests from younger, working nurses asking for help. 'A worrying thing is people coming for financial help for car repairs as they need their own car to do their job as a community nurse, or they need the car to apply for a job,' said Jean Bailey, a trustee of the 1930 Fund for District Nurses.
'To work as a community nurse many of them have to have their own car, and some of them are running into problems to keep their car on the road and come for help with repairs.
'In the last year people have asked for specific things to help them with their job which I would have thought was the employer's responsibility. One was doing research on behalf of their employer and needed a laptop and software. One would have expected the employer to pay for that.'
Others seeking help have been hit by family break-ups or chronic health conditions, says Bailey. 'Some nurses who would have retired are trying to work beyond their retirement date when physically they are not fit to do it,' she adds.
'There's an increasing trend of hardship affecting individuals,' said Jean Hayes of the Edith Cavell Nurses' Trust , the largest benevolent fund for nurses. 'A big issue for us is who cares for the carers? Nurses and midwives are not very good at asking for help for themselves – they are used to giving the care.
'Sometimes people get used to pay enhancements and rely on them, but then can't cope if they lose them. We also have a number of private sector nurses who don't have a sick pay scheme or holiday entitlement.
'We certainly have been referring more people to food banks, but that is also tied up with the fact that food banks are now more widely available.'
Food banks have spread like wildfire in the past year, with a 163 per cent increase in emergency three-day food aid given by the largest chain, the Trussell Trust which handed out 900,000 food parcels in 2013-14. The charity says that only part of that increase was due to its own expansion.
Why are more nurses having to rely on charity?
Nursing unions estimate that nurses' purchasing power has diminished by around a tenth since 2010 due to pay freezes or below-inflationary settlements.1
And as NHS budgets shrink, whatever benefits Agenda for Change may have brought are being ground away.
In 2012 the European Federation of Nurses reported that in the UK: 'Employers have attempted to erode national terms and conditions locally by asking their employees to work one day for free in order to deliver cost-savings.'2
There are also increased professional costs. The NMC registration fee rose to £100 and will jump again to £120 in March 2015. There are also increased NHS pension costs, with a 0.3 per cent rise in contributions.
Obi Amadi, professional officer for the CPHVA, said the NMC fee increase was affecting student health visitors. 'We are hearing reports of student health visitors who have had to let their NMC registration lapse temporarily due to the cost. The consequences of this can be devastating. If they get found out they could get thrown off of the course.'
The rise of bank nursing, meanwhile, has proved a double-edged sword. While it is often valued as delivering flexibility for working parents, some have described it as the casualisation of nursing, allowing an influx of zero-hours contracts.
In a recent RCN survey, more than a third of respondents said they had worked under a zero-hours contract.3
Two years ago, the Labour Party highlighted a rise in zero- hours contracts for clinicians in the NHS. 'A distinction must be made between NHS staff who join a hospital's bank for extra hours or increased inflexibility, and situations where staff are expected to be on call without payment and are unable to turn down a shift offered,' its report noted. 'Labour's concern is that the NHS is increasingly favouring casual contracts over offering permanent roles.'
In June this year, the business secretary Vince Cable vowed to crack down on 'exclusivity clauses' in such contracts, which restrict workers to only one employer but offer no guarantee of work.
Meanwhile, anger over nurses' pay looks set to explode as NHS unions ballot for industrial action. This September, 350,000 Unison health service members voted two to one in favour of strike action over the government's decision to ignore the pay review body's recommended rise of one per cent. The Royal College of Midwives voted to join strike action for the first time in its 133 year history. The RCN decided not to ballot but urged members to join protest rallies on 30 November.
|After working as a children's nurse and Army medic, Paul Cater suffered a series of financial blows and found himself dependent upon charity and food banks.
Mr Cater spent 13 years in the Army before retraining as a children's nurse, which he did for 25 years. When workplace stress took its toll he went part-time, taking on a second part-time job in a private hospital to make ends meet. The Inland Revenue classed this as a second job and taxed him at 40 per cent.
He took retirement at 52, and is living on two small pensions from the Army and the NHS. But debts have accumulated, including rent and council tax arrears. 'Once I have paid off all the debts, the money is gone by the second week of the month,' he said. 'I'm using a food bank at a local independent church, although I'm only allowed to use it three times a year because they are overwhelmed.'
After turning to the Citizens Advice Bureau, Mr Cater received assistance from the Edith Cavell Nurses' Trust, a charity which helps nurses and midwives in financial difficulties.
'I have worked all my life so it makes it even more frustrating to find myself in this position. It's a terrible thing when people can't sleep at night because of worries over debt and stress.'
|Relying on food banks|
|With almost three weeks to go until payday, children's nurse Jane Mills* has just £15 left to live on. 'I'm living on jam butties 10 days before the end of the month,' she said. 'I have been selling things on e-bay to pay for food. This month I'm going to go to a food bank for the first time. The cupboards are bare.'
A back injury sustained at the hospital she works in north west England forced Ms Mills to go on sick leave earlier this year. The problem is her sick pay is just her basic salary without enhancements. 'I'm down £300 a month,' she said. 'Before we became a Foundation Trust you got your enhancements with sick pay, but now they've cut them.'
As a result, she has missed payments on her mortgage, gas and electricity bills and installments for a car she bought before the injury. 'I had to get a payday loan to cover my NMC registration fee, and also to pay the bills and for food. I have got myself into a lot of arrears.'
In the meantime, the RCN has taken up her case and is arranging a solicitor.
Loss of her enhancements could not have come at a worse time. 'We have had six years of austerity, two to three years of no pay increases, and now I'm paying £30 a month for my pension too,' said Ms Mills. 'Nurses got a one per cent pay increase in April, whereas MPs got 10 per cent this year and 11 per cent last year.'
Ms Mills now has to decide whether she is able to return to work in October, when her sick pay goes to half pay. 'I feel I am being punished for something that wasn't my fault. Being off sick is stressful enough, but it's even more stressful when you have no money.'
*Name changed on request
1. Staff Side Evidence to the NHS Pay Review Body 2014-15.
2. European Federation of Nurses. Report of the Impact of the Financial Cris on Nurses and Nursing. http://www.efnweb.be/wp- content/uploads/2012/05/EFN-Report-on-the-Impact-of-the-Financial-Crisis-on-Nurses-and-Nursing-January-20122.pdf
3. RCN Response to Consultation on Zero Hours Employment Contracts. https://www.rcn.org.uk/__data/assets/pdf_file/0006/565314/1.14_RCN_Response_Zero_hours_employment_contracts.pdf
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