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Pay restraint: time for action?

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Many nurses are upset about the pay cap Many nurses are upset about the pay cap

Ask any nurse what the worst part of their job is, and you’ll likely get a spread of answers. Some might cite long hours, a lack of resources, or understaffing. However, where the profession will be united nationwide is in their discontent over the continuing pay cap.

In March 2017, the NHS Pay Review Body decided to continue the 1% pay cap for NHS staff in England, leading to outrage in the nursing profession – who constitute the largest workforce in the NHS. According to the Royal College of Nursing (RCN), continuing pay restraint in the NHS has led to a 14% real-terms cut in nurse pay since 2010.

‘This deals a bitter blow to nursing staff across England,’ said Janet Davies, chief executive of the RCN. ‘The nursing profession is rightly held in high regard but kind words don’t pay the bills. With this announcement, the Government will deter new people from joining the nursing profession at the very moment it is failing to retain staff and European colleagues in particular head for the door.’

Nurses, however, have not taking the decision lying down. The RCN recently conducted a ballot on NHS pay. Chair of RCN Council Michael Brown said that the 52 000 members who returned the recent pay poll had sent a strong message to Council.

The results of the three-week poll revealed 91% of members would take industrial action short of strike, with 78% saying they were prepared to strike (roughly 40 560 nurses). According to the union, the unprecedented results show a real appetite for industrial action from RCN members for the first time ever.

Opposition parties have recognised the severity of the situation, with the Lib Dems and Labour both committed to addressing the pay cap. ‘We want nurses to be paid properly,’ said Jeremy Corbyn, speaking at RCN Congress 2017.

‘If you undervalue nurses, don’t be surprised if they leave the profession,’ said Tim Farron, also speaking at the congress. ‘The time to invest in health and care has come and not a moment too soon … If you spend time with health care professionals you understand how utterly dedicated they are to what they do. It’s not a decision you’ve taken lightly. It’s something you do because you have concern for your patients.’

Theresa May declined to speak at the RCN congress, and the Conservative Party manifesto does not include any commitments to improve nurse pay.

‘We will continue to guarantee a living wage for all NHS staff, and maintain our commitment to no compulsory redundancies,’ said Shona Robison, the Scottish health secretary. ‘This underlines the value we place on the hardworking men and women of Scotland’s health service.’

The impact on nurses

The pay situation is not just demoralising – it is having a devastating effect on the lives of many nurses. One nurse, who did not wish to be named, spoke to Independent Nurse about the impact the pay cap was having on her family.

‘My daughter followed me into nursing and now she relies on child tax credits to feed herself and her family,’ she said. ‘She depends on myself and other members of the family to look after her children when she goes to work; if she did not have this supportive network it would be untenable. Many nurses are not so lucky. Even so, if she works about 16 hours each week she loses her eligibility for certain benefits – but if she works less she won’t earn as much, especially with the cap.

‘It’s like the government is trying to keep her on benefits. It limits how much she can work and how far she can progress her own career. She should not have to choose between her family and the job she loves.’

Roaqah Shaher, the lead RCN representative for South Tees NHS Foundation Trust, said that inflation was also cutting into salaries. ‘The problem is that as our pay only goes up 1% each year, so many other things go up in price quicker. Taxes, national insurance, fuel, bills, even the price of food. Benefits we are entitled to are shrinking at a fast rate than our pay rises. The 1% we gain each year disappears in tax.’

The pay cap is also damaging to the work done by nurses. Janette Power Jepson, a retired nurse, told IN that many nurses cannot afford to eat at work – especially if they don’t bring in packed lunches – with hunger being the alternative. ‘Cafés and vendors become a luxury, and nurses opt out of lunch just to save money. They can work 13 hour shifts without any food because they have no time or money to spare on it.’

Janet Marsden, professor in ophthalmology and emergency care at Manchester Metropolitan University, said: ‘I know many colleagues who are not in that position and have many students who are worried about entering nursing because of the limitations on pay.’

Many nurses are now ‘paying to work’, particularly in community and district nursing roles. Marie Rogers, a district nurse in Morcambe Bay) said that 10 years ago, when she was a lower Band 5 nurse, she used to bring home £500 more than she
does now as a Band 6 nurse, due to the costs associated
with her current role.

‘I work about 25 miles from home and it is getting to the point where I am considering taking a different nursing job, which I would be less passionate about, to avoid incurring the costs of travelling around for community work,’ she said. ‘I have three children to look after and we have not been on holiday for years;
I often have to choose between lunch or buying petrol.’

Nurses in Scotland, which also accepted the 1% pay increase recommended by the NHS PRB, are also struggling. Alison Nicole, a district nurse for St Andrews and Fyfe, agreed, saying: ‘We have an allowance for our petrol as community nurses, but this is money we have to spend first to get back at least a month later in expenses. In that time, we have to survive without it, making do on the minimal pay we receive as nurses.

‘I have colleagues working in more remote, wider-ranging areas whose caseload may be lighter but they have to travel longer and further – which their pay and petrol allowance does not reflect. One woman I know had to in one week travel 500 miles in total. These necessities for our jobs are not taken into account when the pay policy is decided.’

The future

If the polls are correct, the situation is unlikely to be remedied by a new government. The RCN, however, seems to be readying to take unprecedented action. ‘The RCN has never gone on strike before,’ said Michael Brown, ‘so balloting our members would be a very significant step. We’ve heard from members that they want to send a much tougher message to government, which is why we will be leading them in a summer of protest activity.

‘The pay situation is also making nursing less attractive as a profession. New figures released by the RCN found
that there are 40,000 unfilled nurse posts in England, with 12,000 more healthcare support worker vacancies. Mental health and community care are experiencing the greatest shortage.

‘Our members have been clear that if the next Government doesn’t respond and lift the unreasonable cap on nursing pay, they want us to ballot on industrial action. It would be the first time RCN members came out and took industrial action in our 100 year history.’

Whatever the future holds, the situation is clearly unsustainable. Ms Rogers articulated the concerns of the profession, saying: ‘It is like they give me just enough to survive, but it is absolutely not enough to live.’

Additional reporting by Rhys Handley

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

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The monumental challenges associated in recruiting, and more importantly, retaining nurses in NHS emergency and urgent care services are in a large part due to the imposed 1% pay cap.

The NHS trains emergency nurses to a very high standard, however the low pay and the pay cap acts as a perverse incentive, these emergency nurses then leave their NHS posts only to return the next day in the capacity of an agency nurse - earning at least double their NHS rate of pay. Why not!

The sensible solution is for the NHS to pay an appropriate salary in the first place and not drive some of our best RNs out. This is reflected across most specialities. Lifting the pay cap immediately might help the haemorrhage of departing RN's. The pay cap represents a titanic false economy.

Mike Paynter
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It is demoralising that we continue to have a pay cap, for the first time in my nursing career I now think strike action indicated.
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