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The housing crisis for health staff

Low pay and soaring accomodation costs could trigger a workforce crisis. Alex Turnbull investigates

It is worth remembering that the original title of the health secretary was the minister for housing and health. It may be time to restore it, for the sake of patients and nurses.

Housing has once again become a public health issue, and it has also emerged as a problem for NHS staff. While pay for nurses has risen by 1%, barely above the official rate of inflation at 0.5%, house prices and rental costs in some areas have risen by more than 30 times this.

A survey carried out by Independent Nurse last month found 90% of respondents experienced problems with money, and 62% said they were short each month. Over a quarter said that every week they felt like they were struggling for money.

A recent report by the Public Accounts Committee,1 Managing the supply of NHS clinical staff in England, cited the lack of affordable homes as a major impediment to the supply of permanent key workers in the NHS, particularly in areas where it is expensive to rent and buy property.

‘We concluded that ultimately, until the NHS solves its workforce planning issues, including the lack of affordable homes for NHS staff, it will not solve the problem of reliance on agency staff,’ said the report.

According to research by the RCN,2 high costs combined with sluggish growth in pay are creating a recruitment crisis in London nursing. Nearly three quarters said government decisions on nurses’ pay have made it more difficult for them to live in London, and 76% said housing costs take up a bigger share of their income than five years ago.

‘We know NHS staff are moving further away from where they work. Housing costs are outstripping what the NHS can afford to pay for its staff putting the staffing of London’s NHS hospitals and services at risk,’ said Danny Mortimer, chief executive of NHS Employers. ‘We know increased travel costs is also an issue.’

Claire Cannings, the RCN’s senior welfare adviser, says that its service has ‘absolutely seen a rise in nurses looking for help with debt and money troubles in the last few years. We see such a high percentage of those living in high cost areas spending half of their income on their housing costs, basic rent and council tax,
and that really gets disproportionately high and therefore, it means that other things are impacted.’

Shockingly, more than three quarters of respondents to the Independent Nurse survey reported that more than 75% of their salary went towards basic living costs, with 8% reporting that more than 100% of their salary was used on living costs. Something as small as a broken washing machine or an MOT could disrupt to a nurses’ life and career.

The survey revealed that nurses are increasingly having to find other ways to make ends meet. Nearly four out of five respondents said that they had to borrow money, from family members, while 60% resorted to bank loans.

‘Quite often, nurses take out credit to meet their day-to-day living expenses. When you factor in credit payments, which they then can’t afford, they get into a spiral of unaffordable debt. It only takes something very small to change, shift patterns or a period of illness where you can’t do any overtime.’ says Ms Cannings.

Even more worrying is that a small but significant number (16%) of respondents said they are forced to take out pay-day loans, which can quickly become financially crippling. Most alarmingly, 5% of respondents said they had used food banks at least once. Others said they had maxed out their credit cards or had to contact debt restructuring services just to get by. One respondent reported that they worked three jobs and 80 hours each week.

One nurse who knows this danger all too well is Joan Pons Laplana, a telehealth nurse in Chesterfield. After Mr Laplana separated from his wife, he quickly found his salary was becoming insufficient to cover his bills.

‘When I was married, we had two incomes. But when we separated, the bills did not halve. I suddenly had to pay rent, council tax and maintenance for my two children. I only had around £100 a month to feed myself and buy any clothing and also to see my children. Then I got a bill for six months of utilities, meaning that suddenly I became a month on arrears on my flat, and that put me under a lot of pressure. Whatever I was doing, I was not catching up.’

With only 28 days to pay off his increasing debts, Mr Pons Laplana found himself breaking down at work due to the pressure, and the fear of homelessness. This lead to a ward sister informing him about the RCN’s benevolent fund.

Mr Pons Laplana was helped immediately by the fund, but high demand is causing severe delays. One respondent to the Independent Nurse survey said: ‘When I called the RCN, they said it would take over a month to process. I didn’t have a month, so I had to borrow money off of my family.’

The RCN endeavour to help all its members, but rising demand has lead to increased waiting times. ‘We’re only a small service, and the waiting times are quite long as demand increases,’ says Ms Cannings.

Recently, Mr Pons Laplana ran the Liverpool marathon to raise money for the Cavell Trust, which helps nurses who find themselves in a similar situation.

Independent Nurse survey into financial hardship

Independent Nurse ran a survey between 18 and 24 May 2016, to look into the impact of high housing and other living costs on the workforce.

  • There were 430 the survey, which found that nurses are struggling with finances.
  • Three quarters said that their financial situation had declined in the last five years. compared to 6% who said their finances had improved.
  • Of the respondents, 19% were based in the Midlands, while 18% lived or worked in London. A further 15% said they were in the South East.

Impact on the nursing workforce
The situation raises a serious question about the workforce’s future – how many nurses will be able to afford to continue nursing? Two thirds of respondents told Independent Nurse that they were considering leaving the profession because of financial concerns.

One nurse stated: ‘If I had a better option I would [leave nursing], but I’m a nurse, that’s what I’m qualified to do. However, I have considered leaving the NHS and taking up agency nursing.’ Another stated that without subsidised childcare, they would be earning less than a supermarket worker. Others said they work additional jobs (‘I have to work extra hours to meet my bills and this means that I am always tired’), or simply do without leisure activites to balance their budget.

Ultimately, financial concerns for nurses will be detrimental to healthcare services and patient care. Half of those surveyed said that their financial situation was affecting their professional role. One respondent said: ‘The daily stress is costing me energy and concentration,’ while another said that their pay was making them ‘feel sad, undervalued and exhausted by overtime’.

The situation in London
For years, house prices and rent in the capital have been soaring. While nurse pay in London has risen by an average of 3.5% between 2010 and 2015, house prices have risen by 37% and rents by 30%, leaving stable accommodation out of reach of most nurses in the city.3 With a population of 8.6million, and 16% of the country’s nursing workforce, the city is increasingly becoming a region that many nurses struggle to afford to work in London faces a critical shortage of registered nursing staff, with research showing around 10,000 vacant nursing posts in London, a rate of around 17%, according to NHS Employers.

NHS Improvement announced plans to build sites specifically for healthcare worker housing, but these proposals are still undergoing consultation.

Where you can go for help
There are a variety of outlets available for nurses, past and present, who are experiencing financial hardship. In the Independent Nurse survey, over 90% of respondents said they were unaware of help. Most unions offer a benevolent fund to help with financial struggles.

Another option is the Cavell Nurses’ Trust. The charity helps nurses undergoing hardship with short-term help, advice, and counselling.

A spokesperson for the Trust said: ‘Nursing is a challenging career and we appreciate the many pressures under which nurses work each day. That’s why we focus our efforts where they can make a difference: by giving practical help and support to nurses, midwives and healthcare assistants facing hardship – whatever the cause. We are here for nurses.’

But nurses, dedicated professionals who devote hundreds of hours of their lives for others, shouldn’t have to rely on benevolent funds, or credit cards, or even pay day loans just to have a roof over their head. If nurses are priced out of working in certain areas, the whole country will be poorer.


1. Public Accounts Committee. Managing the supply of NHS clinical staff in England.

2. RCN. RCN London Housing Survey 2016.

3. NHS Employers. London life for NHS workers.