Real-terms cuts to NHS wages since 2010/11 have been so severe that hundreds of thousands of nurses are effectively working five days a month for free, as new analysis shows a quarter has been cut from pay packets in the last decade.
The independent analysis into nurse pay in England’s NHS, carried out by London Economics, comes as half (52%) of nursing staff say they are likely or very likely to quit nursing in the next five years due to low pay and cost of living pressures. Over two thirds (68%) admitted to rationing gas and electricity during the last winter.
Since 2010, nursing staff in the NHS in England have received year-on-year below-inflation pay awards from the government, leaving them exposed to the rising cost of living. Comprehensive analysis of pay awards shows that between 2010/11 and 2023/24, a typical, experienced nurse had their pay cut in real terms by 25%.
The analysis also shows how government pay policy has critically undermined the value of a nurse’s work. In England, 248,500 (74%) of the NHS’s 336,900 nurses are in pay bands 5 and 6, earning between £28k and £42k each year. For these nurses, who deliver the largest bulk of patient care, pay erosion since 2010/11 has been so severe that they are now working effectively one week each month for free. This would mean that from Monday 25 March, staff would not be paid for the rest of the work they do that month.
The analysis is released alongside new damning figures from a cost of living survey of almost 11,000 nursing staff. The responses lay bare the human impact of the decade-long attack on pay evidenced by London Economics. The results from the survey also highlight how sustained pay cuts are causing mental and physical stress and forcing nursing staff to consider leaving their jobs.
The findings from the survey reveal a nursing workforce struggling desperately with living costs, with more than three quarters (77%) saying they are financially worse off than 12 months ago. Over two thirds (68%) report rationing gas and electricity and almost half (43%) say financial pressures are having a considerable impact on their mental health.
Over half of the nursing staff (52%) who responded to the survey said they were now likely or very likely to leave nursing in the next five years. The RCN says this raises serious concerns about the ability of the NHS to staff services safely when its workforce is so deeply unhappy with pay. There are currently tens of thousands of unfilled nursing posts in England’s NHS.
Last year, NHS nursing staff received an average pay uplift of 5%, the lowest pay award across the entire public sector. The new analysis from London Economics and the findings from RCN’s major cost of living survey demonstrate how urgent it is for the government to deliver a fair pay award when it is due on 1 April this year.
In its submission to the NHS Pay Review Body, the RCN demanded a ‘substantial and above inflation’ pay rise along with an additional salary top-up worth ‘several thousand pounds’ going to every member of nursing staff. The College says this would help stem the exodus of nursing staff from the NHS and combat chronic workforce shortages.
Other findings from the RCN’s cost of living survey include:
- 85% of respondents said that their current monthly household spending is higher than it was 12 months previously.
- Almost a third (32%) of respondents said that their financial concerns have a considerable or very considerable impact on their physical health.
- 60% said they have used credit or savings for essential living costs within the last 12 months.
- Only 1 in 20 (5%) of respondents said that within the last 12 months they have been able to manage their finances without difficulty.
- 1 in 4 (27%) of respondents said that they are struggling with living costs and increasingly worried about their financial situation.
Professor Pat Cullen, RCN General Secretary and Chief Executive, said:
“This new analysis exposes the scale of the government’s sustained attack on nursing. Over a decade of below inflation pay offers, followed last year by the lowest award in the entire public sector, have caused hardship and forced thousands to consider quitting altogether.
“Today, nursing staff are rationing electricity and gas with financial pressures pushing four in ten into a state of mental distress. Pay has been devalued so much that they are effectively working 5 days or more for free each month. Ministers who once seemed glad to applaud NHS staff should reflect on this terrible state of affairs.
“When nursing pay is deliberately undermined in this way, so too is patient care. There are tens of thousands of nurse vacancies across England’s NHS and yet our most experienced nurses are being forced out of the profession – just when the health service needs them most.
“The next NHS pay award should have been ready for the new and imminent financial year – but our members will be kept in the dark again until the government confirms its plans. Ministers must commit to a substantial pay rise for every member of nursing staff. That’s how to begin delivering pay justice for a profession so routinely undervalued. If they fall short once again, they will be exposing tens of thousands to further hardship and exacerbate an already dangerous staffing crisis.”
Ends
Notes to Editors
The analysis on nursing pay was carried out by London Economics and commissioned by the RCN.
The average real-terms pay cuts calculated refers to Registered Nurses working in the NHS in England band 5 and above on the Agenda for Change pay scales.
Calculations on ‘days worked free’ based on an average month of 22 working days.
NHS Workforce data is from August 2023.
Cost of living survey methodology:
RCN's Cost of Living survey (online) was opened for two weeks (between 8 January and 21 January 2024). There were just under 11,000 respondents from England (10,937), the majority (85%) of whom were registered nurses/health visitors. The remainder were healthcare support workers/HCAs, students, nursing associates (including trainees), and retired nursing staff. The majority of respondents (79%) worked for the NHS.
Topics in the survey covered how much respondents earnt and spent on a range costs such as housing, utilities to food and transportation. It centrally looked at how the cost of living crisis has affected respondents’ financial situations, spending behaviours and their lives.
The RCN’s survey of nursing staff about cost of living pressures was carried out in January 2024. There were 10,937 respondents in England, with 8,294 of those working in the NHS.
