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News Focus: The real cost of the pay cap

Exclusive research for Independent Nurse found that the pay cap could be mortally wounding the NHS

It has long been billed as the bitter medicine needed to keep the NHS sustainable in the age of austerity, but exclusive research for Independent Nurse found that the pay cap could be mortally wounding it.

After seven years of pay awards which have lagged behind the rising cost of living, 53% of the respondents stated that they had considered leaving the profession in the last three years. Scores of nurses reported on the impact on their standard of living, and many admitted to have run up credit card bills (30%) or bank loans (15%) to bridge the gap. It is difficult to look at such figures and not share the RCN’s conclusion that ‘the 1% pay cap for NHS staff is unsustainable’.

READ MORE: Lords and midwives join calls to 'scrap the pay cap'

However, perhaps more worrying is the effect it has having on the NHS workforce of the future: 72% of nurses who took the survey stated that their employers were struggling to recruit staff and another 66% believe that the removal of bursaries will deter people from entering the profession. Perhaps even more telling is that 42% admitted to advising others not to enter the profession.

The findings of the survey, carried out by Healthcare Voice with Sapio Research, back up other studies into the NHS’ looming recruitment crisis. Analysis of data from the NMC register between 2012 and 2017, found a 20% increase in leaving the NMC register in 2016-17 compared to those who than joined the first time this has happened in recent history. Looking among UK national nurses – who make up 85% of the register – leavers outnumbered new registrations by 45%, indicating an unprecedented number of nursing staff turning away from the NHS.

Additionally, the pay cap has severely damaged the quality of life for nurses and other NHS staff. The survey found that 52% of respondents had reduced the amount they spent on clothes and going out, while 42% had reduced spending on food. Nurses said that they had been forced to borrow from family, sold personal belongings to meet mortgage payments, and in one case, sell their home.

A recent report found that that nurses were earning median real earnings of £16 an hour in 2005. Despite a rise to £17 an hour in 2010, pay slumped back down to just above £16 by 2015 – showing a minimal rise of 1.4% in nurses’ pay across the 10-year period. The stalling of nurses’ wages has been largely attributed by nursing organisations to the 1% cap on pay rises which has been enforced by the government since 2010.

READ MORE: More nurses left the NHS than joined in past year

‘As a result of below-inflation increases for the past seven years, midwives have seen their pay drop in value by over £6000 since 2010; it is unsustainable for this to continue. The RCM has previously warned that this is a disastrous and unsustainable decision for maternity services and the NHS,’ said Jon Skewes, RCM director for policy, employment relations and communications.

MPs recently rejected a Labour amendment to the Queen’s speech which would have seen the public sector pay cap lifted in a Parliamentary vote on 28 June. Speaking in parliament, Liz Truss, chief secretary to the Treasury said: ‘We all recognise that public sector workers do a fantastic job. Over the past seven years, we have seen major improvements in our public services. Government pay policy is designed to be fair to public sector workers, who work so hard to deliver these strong public services, but we must also ensure that we are able to provide those public services on a sustainable basis for the future.’

However, many MPs, including Conservatives were unsatisfied with the statement. ‘In the NHS half a million staff are at the top of their pay scale and have received a real-terms pay cut over the past few years,’ said Dan Poulter, an NHS doctor and Conservative MP. ‘They work incredibly hard, above and beyond the call of duty. They are the people who gave up their days off to go in when the terrorist attacks happened in London and Manchester. Those people do need a pay rise.’ And the clamour has reached the cabinet. Foreign Secretary Boris Johnson has indicated he believes the cap could be lifted now.

The government’s official line is that it will continue to listen to the recommendations of the NHS Pay Review Body. However, some have suggested that the government has willfully ignored its advice in the past. ‘The PRB clearly stated that the pay cap was not sustainable and the NHS was at risk of a staffing crisis. If ministers were serious about recruiting and retaining staff they would start by ensuring they are paid fairly,’ UNISON head of health Sara Gorton said. ‘By imposing a limit, ministers have denied paramedics, nurses, therapists, catering, cleaning and admin staff the pay rise they deserve.’

‘At a time of increased pressure on the healthcare workforce to deliver quality patient care, we hope our data will provide evidence to support the government and employers to look in detail at how they can reverse this trend,’ said Jackie Smith, chief executive of the NMC.

John Orchard, chief executive of the Cavell Nurses Trust, told Independent Nurse that the charity had received the highest number of requests for financial aid on record, with requests for help rising by 36% in 2016. Additionally, in the first three months of 2017, there was a 56% rise in nursing professionals asking for help from the charity in the first three months, compared to last year.

It has also been suggested that pay restraint is having a direct impact on the health of NHS staff. A full breakdown of sick days taken from 2012 to 2016 revealed in the last year that 16,866,471 sick days were taken in total by NHS staff – up 6% from 15,970,492 in 2012, or an increase of 895,979 days used.

Royal College of Nursing senior employment relations advisor Kim Sunley said: ‘‘Too many feel unsupported, overstretched and are burning-out. The sad consequence is an increase in stress-related illness, which is bad for the nurse and does not help the NHS to provide safe care to patients. This is often compounded by financial worries brought on by years of pay restraint. The best way to reduce this strain is for the government to scrap the pay cap and help recruit and retain enough nurses to deliver safe care.’

READ MORE: 'The time is up': Promises to lift pay cap from Scottish government

The damage to morale, lifestyle and care done by the pay cap is clear. With a weakened government desperately in need of some good press, and a renewed struggle to ’scrap the cap’ (the Royal College of Nursing is organising a ‘series in opposition to the policy), the days of pay restraint for nurses may be numbered. Perhaps the strong and stable thing to do is to take the initiative now.

‘Our members’ Summer of Protest will continue,’ said Janet Davies, chief executive of the RCN. ‘But we also know that a growing number on the Government’s own benches agree the cap should be scrapped. We will continue to build cross-party support this summer. If the Prime Minister intends to address pay in an autumn Budget, she should do so without delay.’