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The state of nursing in the NHS today

The state of nursing in the NHS today

So, I was on the news recently. As in, BBC News. I was giving my opinion on the Budget in which Philip – owner of private care home developer Castlemead – Hammond stated that IF talks with pay reviews went ahead and IF they bear fruit then MAYBE nurses will get a bit of a pay rise. Since then, the severely-hated-in-NHS-circles Jeremy – received £30,000 from private healthcare providers – Hunt has stated there will be changes to contracts in order to finance pay rises. And of course, in the following few days, it’s been hinted that nurses will see weekend and night enhancements scrapped in favour of a modest pay rise for all.

So, why are nurses so keen on getting a pay rise? What’s all this Scrap the Cap malarkey? Why did the junior doctors end up striking? And will nurses do the same?

Why nurses are asking for a pay rise

Agenda for Change

As a newly qualified nurse (NQN) in the NHS, I’ll be paid based on the Agenda for Change pay banding system. This means that I’ll start at the bottom of Band 5, where all NQNs start and earn £22,128, about £1,500 per month. Why so low? Well, because when I start I’ll be on a preceptorship and won’t have the skills or knowledge to manage patients without that extra guidance from other nurses. As my skills progress over the years, I’ll work my way up the ladder eventually getting to the top of the band, £28,746, or just over £1,800 per month. And there I’ll stay unless I decide to take the jump up to a more senior managerial role.

The issue for nurses is that once you’re at the top of the band, the only option is essentialy to leave your job, and apply for a role that takes you away from patients but puts your skills to use managing bays and nurses and transfers and all the other boring stuff nurses hate. Some nurses, such as myself, just don’t want that. Which means that they’re indefinitely stuck at only ever – note this, ONLY EVER – earning £28,462. There’s literally no way a Band 5 nurse can earn more. Think about that: nurses who’ve endured decades of shift work, abuse at the hands of patients, and are responsible for the lives of thousands will only ever earn £80 a day as a Band 5.

Because of the 1% pay cap.

Tories love spouting that Agenda for Change means nurses get pay rises all the time. This simply isn’t true. A nurse will start at the bottom and work to the top, being remunerated according to skill, until they cannot progress any further.

Scrap the Cap

Over the last decade, these pay bands haven’t increased in line with the cost of living, with workers in the NHS only getting a 1% upscale of wages thanks to a pay cap that was instated during the coalition government. This pay cap has remained in place despite an increase in the cost of living slash inflation, which has risen to almost 4% according to the Retail Price Index. Factor in the increasing cost of rent, bills, food, shopping and imports, and of course the impact Brexit’s had on the pound, and it’s all looking rather dire.

After the police received a 2% pay rise and prison officers 1.7%, 14 unions, including the Royal College of Nursing, demanded a 3.9% pay rise and £800 bonus for NHS staff. Considering nurses have suffered a real-time pay cut of about £6,000 thanks to the pay cap over the past seven years, savings the government have made, it’s not too much to ask.

At RCN Congress earlier this year, a motion was passed to pressurise the government into scrapping the 1% pay cap to ensure nurses remained in post and filled the tens of thousands of vacancies in the community and hospitals nationwide. If the cap wasn’t lifted then nurses would strike.

But didn’t Jeremy Hunt say the cap was scrapped?

Technically, yes. And isn’t it typical that a politician isn’t more specific? On the 9th October, Jeremy Hunt hinted the end of the pay cap thanks to pressure placed on the government following a summer of protest activity. Nurses were waiting with bated breath during the budget to see what the new pay rise would be, only to be given a pat on the back and the promise that pay will be reviewed and if stuff happens then maybe a pay rise is on the cards. No specific amount was given. Typical, and not surprising.

The RCN has somewhat celebrated this news, which has only angered nurses more – this is in no way a win or the result we were asking for. The pay cap has been lifted but without specifics, this could mean a 1.1% pay rise. Useless. Therefore, many nurses are pressuring the RCN (in particular) to ballot for strike action.

Why strike action?

Remember when the junior doctors went on strike for five days? That was after amends were made to their contracts that saw each doctor – who despite the junior in their title are all doctors under the level of consultant – worse off financially and opened up patients to unsafe staffing levels. Weekend pay was to be reduced as well as pay for part-time workers, the majority of whom are women.

It was considered the biggest walkout in the history of the NHS, and the government’s abysmal record of NHS management is only battered further by nurses en masse calling for strike action, the first time in over fifty years.

Don’t people have a calling to become a nurse? Why focus on money?

Put simply: if a nurse needs to choose between eating and being a nurse, or leaving the profession and having enough money to pay their rent, most will choose the option that doesn’t involve starvation and eviction. I know it might sound glib, but the reason nurses are leaving the NHS en masse, the reason nurses are retiring early, and the reason many nurses are leaving the profession entirely is due to the simple fact the wage even at the top of the band doesn’t befit the level of stress the role brings with it.

Think about this – a nurse looking after your gran when she’s had a fall, you after a drunken night out, your best friend when she has a baby, earns AT THE VERY MOST £80 a day as a Band 5. A nurse a few years into the role gets about £70. Is that worth being spat at? Being attacked by patients? Managing a bay of 12 patients because someone didn’t turn up for their shift and the hospital won’t get a bank nurse to cover?

No way.

Not when a private hospital offers £120 a day with a free lunch thrown in, gym membership, and private healthcare to boot.

The government hates the NHS

Working as a student nurse, it’s easy for me to see this.

The government now forces student nurses to pay for their education, with a student leaving their university course having worked 2,500 hours for the NHS over three years and a £30,000 debt to pay off at the minimum. Surprisingly, this means many would-be nurses aren’t too fussed about entering a profession that’ll see them earning a ridiculously low wage with student loans to pay off until they die.

So, point one: we have a reduction in nurses entering the profession.

Thanks to low pay, many nurses due for retirement are taking their last paycheck and leaving their posts with nary a second thought. Which means, coupled with record low student intakes, in 2020 there’s going to be a HUGE shortfall of nurses overall.

Point two: Reduction of nurses entering the profession + record numbers of experienced nurses retiring = mass deficit of nurses.

There are an estimated 40,000 vacancies in the UK, which hospitals just can’t afford to fill. And you know what’s cheaper than a Band 5 nurse? A band 4 semi-nurse. Healthcare assistants are seconded by their trusts to learn the role of a nurse, just without the medication side of things. Which, while they are excellent at what they do, is unsafe. Evidence shows a degree-educated nurse reduces the risk of patient mortality and anything else only means more deaths. We’re seeing Band 4 almost-nurses take up Band 5 posts, because of those juicy cost-saving implications.

Point three: Unsafe nursing levels are being filled on the cheap by nursing assistants who, while helpful, aren’t as qualified as a degree-educated nurse.

Brexit has seen nurses from the EU, who are trained at far, far superior levels than British nurses are in my opinion, avoid the UK when considering leaving their home countries. I mean, could you blame them? Patients refusing service from international nurses is horrifyingly happening on our wards even in this day and age, with some whispering in corners about THAT nurse being FORRIN. Intolerance is rife, and streams of highly-qualified EU nurses aren’t even bothering to renew their nursing PIN, leaving our shores for those that are a bit more tolerant.

Point four: Staff shortages thanks to low student numbers, retiring and leaving nurses, low EU applicants coupled with posts for nurses being filled by non-nurses create long waits, unsafe practice, stressed out teams and, essentially, patient deaths.

Note how nothing was said in the budget about social care? Well, they’re pretty damn important to nurses. Heard of ‘bed blocking’ where patients are waiting to go home but can’t? The term is pretty derogatory considering the reason these patients can’t go home is that it’s unsafe. Why? Perhaps they’re an elderly patient who isn’t as mobile as they were when they arrived at hospital. Now they need a nurse to visit them at home twice daily.

But wait, didn’t we just say there were record levels of nurses leaving the profession? Sorry Marge, but no one can visit you at home as your community service can’t overload any more of their nurses and care teams with new patients. Which means doctors can’t discharge Marge home. And as there are so few beds in smaller, cottage hospitals (which are usually demolished and turned into luxury flats *cough* Brentwood *cough*) there’s nothing for Marge to do but wait.

Point five: With no increases to social care provision even hinted at in the Budget, the NHS selling off cottage hospitals, no spaces in care homes, and no home visit teams, patients end up stuck at hospital while others wait for their beds to become free.

By restraining pay under the guise of ‘budget saving measures,’ the government forces nurses into unsafe working practices. We all need to pay our rent and eat. So nurses will take extra shifts at nights and weekends, when pay increases, to make sure there’s enough cash left at the end of the month. This means a tired, overstretched workforce. And when a nurse is tired, mistakes are made.

If nurses were given a 3.9% pay rise, it would solve huge issues within the profession. The same old problems with patient overload and stress of the job would still be there, of course. But it would halt the tide of nurses leaving, and hopefully attract enough students to cover their loss. It would mean nurses could worry about their patients rather than covering extra shifts to make ends meet.

The state of nursing in the NHS is dire right now. If you’re a nurse reading this, dammit get involved with your union and start planning to make a change.

If you’re a reader interested in what’s happening, the government is not working for anyone’s interests other than their own. They want to sell off contracts to their friends for them to profit from the ill health of the nation. We see this with Virgincare (think your GP practice is part of the NHS? Oh you sweet summer child…) and we see this with the lists of MPs who have shares in private healthcare companies, who are wined and dined by fatcat healthcare executives, and who are sent gifts aplenty from directors keen to get a slice of the NHS pie.

If nurses strike, you bet they’ll spin it to ensure the Daily Mail gets their readers in a tizzy about nurses affording LUXURIES like M&S meals and holidays abroad. Do your research, and remember, once the NHS is gone, it’s gone.

All images via Shutterstock.com


  • Thank you for sharing this, it’s such a valuable (if rage-inducing) insight into what’s going on. I hope nurses do get the pay rise and I fully get why a strike might be needed.

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