The UK government has today [Wednesday 9 April] been accused of failing nursing, paving the way for recruitment and retention problems in the profession to worsen, after it confirmed it will not pursue long-overdue nursing pay and career reforms.
A government consultation was launched in 2024 into the possibility of a separate nursing pay spine after the ÃÛÌÒÖ±²¥ (RCN) had raised significant concerns about the failure of the current pay structure to recognise and value nursing staff.
Despite the government’s official response confirming that 94% of nursing staff said a separate nursing pay spine would improve career progression and professional development, the proposal has been ruled out by ministers a year after the consultation closed.
The RCN argued that the now 20-year-old Agenda for Change (AfC) pay structure was out of date and did not reflect the skill and responsibility of the modern registered nurse. The College said it was actively harming recruitment and retention in the nursing workforce and that a pay reform strategy was desperately needed.
By refusing to pursue reform, ministers have today “attached themselves to a status quo which is failing nursing, the NHS and patients”, the College says.
The announcement comes as ministers also confirm plans for addressing a series of other ‘non-pay’ issues for staff working in the NHS, including violence, job evaluation and career progression. However, the RCN has warned that the measures come with no evidence of additional funding for delivery, with some matters only supported in principle or devolved to a local level instead.
On nursing career progression, the RCN says the recommendations agreed to by government will do little to address the tens of thousands of nurses ‘trapped’ at band 5, unable to progress in the current AfC structure.
On the failure to pursue a separate nursing pay spine, RCN General Secretary and Chief Executive, Professor Nicola Ranger, said:
"The government had a chance to set nursing on a new path, where it's valued, understood and rewarded fairly. It is now clear that ministers and the government are not in fact “on the side of nurses”. In under a year in power, they have attached themselves to a status quo which is failing nursing, the NHS and patients.
“To achieve the three ‘shifts’ in the forthcoming NHS plan, the government needs a booming nursing profession. It has just taken a large step away from that desired future. A nursing pay spine had excellent patient care at its centre too, with those giving hands-on treatment rewarded for their expertise and wealth of knowledge.
“Nursing has evolved beyond recognition. It is a highly-skilled, safety critical profession and we work autonomously to deliver the vast majority of care. We have modernised and taken on more responsibility but are still forced to contend with a pay and grading structure which traps the majority of nursing professionals on the lowest pay bands possible, only a small minority able to progress by moving away from delivering patient care. This isn’t just demoralising to those currently working in our NHS, but actively harmful to attracting the best nurses of the future to stay.”
On the series of other non-pay measures agreed by government, Professor Ranger said:
“Nursing staff were promised major change, but what has been announced today amounts to little more than tinkering and in no way improves nursing career progression. It has taken almost two years to reach this point, and nursing has waited patiently and has been bitterly let down.”
Ends
Notes to editors:
The government’s found:
• 94% thought that a separate nursing pay spine would improve career progression and professional development for nursing staff;
• 89% thought that a separate nursing pay spine would have additional benefits beyond career progression and professional development.
More than 7,000 RCN members contributed to the government consultation into a separate nursing pay spine. Almost nine in ten (87%) felt their pay band didn’t recognise their knowledge, skills, education and responsibility. In its response, the RCN told government that 3 in 4 of its members are weighted to the bottom of the pay and grading structure in band 5 and band 6.
Job Evaluation workstream - The Department of Health and Social Care (DHSC) accepted the principles but there is no detail provided in what this might look like nor is there any investment except for funding a national digital platform for job evaluation in England. The RCN considers this extremely disappointing given the government has also failed to follow through on the PRB’s recommendation 3 from the last report, staff side had placed great importance on this aspect of the recommendations in particular regarding modernisation and again the government has failed to deliver.
Tackling violence and aggression work stream – This issue appears to have been devolved to local level without an overarching remit for the DHSC or other regulators that had been anticipated.
Improving nursing career progression - The RCN did not agree the recommendations proposed by the working group as we did not believe they went far enough in terms of delivering a pathway for nurse career progression. We suggested the utilisation of annex 20 (automatic progression from band 5 to band 6) but that proposal was rejected.
Deployment model of nursing - Action to determine the required deployment for nursing has also been kicked into the LTWP and a much-delayed CNO professional strategy for nursing.
The reduction in agency spend group could have gone much further in terms of considering bank working and flexible working but those areas were considered out of scope and a valuable opportunity was missed. Compared to other professionals, nurses are not afforded the ability to claim overtime for unmissed breaks and extra hours. The Darzi report for DHSC confirmed nurses give more time for free than any other professional group.
Finally, the DHSC declined to support international nursing and midwifery associations which provide nurse career progression workshops and mentoring programmes for internationally recruited nurses, signifying a lack of respect for a large swathe of the workforce.
