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OPINION

'We firmly believe regional pay would destabilise the entire NHS'

The pay review body report published in March 2012 has accepted the second year of the government’s public sector pay freeze, along with recommendations to implement regional pay for nurses and NHS staff.

It outlines the case for making pay more market-facing in local areas and, let’s be quite clear on this issue, regional pay is not about enhancing the pay of nurses but a cynical move to dismantle national pay and national bargaining. So how could this impact on nurses across the UK?

Evidence extracted from pay surveys in the private sector points to lower levels of pay in the North of England in comparison with the South, with significant differences between the South West and the North West. If this was implemented across the NHS then a nurse in Blackburn could be earning a lot less than her counterpart in Bristol. This surely would undermine the whole infrastructure of Agenda for Change and create damaging competition between employers. It is likely that rates of pay would be maintained and perhaps enhanced in the form of high cost area supplements in “hotspots” such as London and Bristol, at the expense of other areas. This would mean nurses elsewhere facing the potential of continuing pay freezes or, even worse, a series of cuts in pay.

Regional pay cuts will deal a fierce blow in the hard-pressed communities already hit by job losses and cutbacks. Pay inequality will be a real issue - the foundations of Agenda for Change and national bargaining will be rocked to the core. The reason nurses covered by the Agenda for Change national pay agreement are currently paid the same in Blackburn and Bristol is the commitment to equality and equal pay for equal work. Pay drift would rapidly be followed by job drift with nurses migrating to the higher-paid localities. The impact on service provision and the delivery of healthcare in lower-paid and deprived areas would be huge.

Medical and dental staff are unlikely to be included in these proposals so, again, it is the nursing profession that will bear the brunt of this attack on pay and conditions.

There is also the question of how NHS employers would negotiate regional pay and whether they have the capacity to manage such a process. Some have already expressed concern at increased administration burdens that might be placed on the service. We firmly believe the NHS could be destabilised by local pay as the service struggles to deal with cuts, restructuring and the impact of the Health and Social Care Act.

There is no indication that governments in Scotland, Wales and Northern Ireland would embrace market-facing pay; as such acute recruitment and retention problems could emerge in English regions bordering Scotland and Wales, with the devolved countries potentially retaining higher levels of pay.

Unite has always opposed local pay bargaining in the NHS. Previous attempts to implement such a strategy proved disastrous across the board and took many years to unravel. There are existing mechanisms for dealing with the cost of living encapsulated within Agenda for Change. These include allowances and recruitment and retention premia, which are agreed through the national framework. There is no requirement to introduce regional pay with ill-defined regions and zones; Unite sees this proposal as yet another “quick fix” for the government to raise revenue from hard-pressed nurses to repay the national budget deficit.

Enough is enough, the proposals for regional pay must be vigorously opposed. One option is to contact your MP and ask how they would react if regional pay was imposed on members of parliament.

Fiona Farmer is national officer, Unite the Union.

Readers' comments (20)

  • I would be quite happy to go over to regional pay - when the politicians do the same. Medical and dental staff will not be included - this is discrimination, plain and simple. I would urge everyone to contact their MP. Equality? You must be joking!

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  • Has Ms Farmer seen the difference in the cost of living between the North and the South? At the moment, staff in the North are being paid a lot more in relative terms than those in the South. Is that not inherently unfair?

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  • I agree that the current proposal is an effort to cut wages and I think it should be opposed on that basis.

    However, in the longer run I think regional pay is a much fairer way to go. Nurses in, for example, the North East are not currently getting equal pay with nurses in Bristol. They receive the same wage but the buying power of the wage is much higher in one area than another.

    It is always important to remember that the pay you recive is equal to the buying power of the wage you are given. The money itself is just paper.

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  • John Spashett,Mickey Rich, my daughter is finishing her degree in Middlesbrough next month,thankfully not in nursing. We occasionally visit her and when we do we buy her food. We may possibly be shopping in the wrong places but the price of food in her local Sainsbury's doesn't seem any cheaper than our local one in Lincoln. Petrol is a penny or so more expensive a litre up there and electricity and gas appears to cost her the same as us. The only thing that is cheaper than down South is housing. People choose to work down South in the knowledge that it's going to be expensive.It's the reason why I don't work there.Finally it will be interesting to note, if, when this exercise is finished, as it surely will be, will they then bring in regionalised pay for the Police,Fire and Army or God forbid M.P's?

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  • Anonymous | 24-Apr-2012 6:20 pm

    I agree, regional pay should be across the board for every single job/profession that exists, if they do bring it in for nurses....and they will, because they do as they like with us and we quietly accept everything that is thrown at us.

    Interesting point that petrol is more expensive up North....

    We should look more closely at many of the government proposals and their hidden agendas of divide and rule, we seem to be falling for it

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  • totally against the whole idea, along with London councils moving tenants out because housing benefit doesn't cover their rent, paying us lower wages up North, shipping our water down South-sounds like the plan is to create an England toally split on wealth/poverty.
    And if this goes ahead I think the government should be obliged to put itself and all its departments in the cheaper North to save taxpayers' money, after all in this electronic age there is no need for government to be based in an overpriced, overwaged capital city-Some chance of that happening.

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  • It's time our weak and compliant unions and governing body stopped bowing down to the edicts of the Government and self-serving NHS managers who want to bankroll the country on the back of hard-working nurses.
    I don't know many colleagues who don't already work pool shifts to supplement their pay. Driving down pay will result in a huge recruitment and retention crisis in already struggling areas, leading to spiralling inequality of care. This will knock back the nursing profession and nursing care by decades.

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  • In reply to the anonymous comment mentioning Middlesbrough.

    Although I work in the South I'm actually from Middlesbrough (and i'd love to go back to the north east). I agree that things like food are the same price but as you say, housing is cheaper. Indeed housing is massively cheaper and I think that would probably have to be the basis for regional pay.

    For the cost of my London flat I could rent two houses in Doggie (or one nice one on the Linthorpe road).

    Surely it can't be equal for a nurse on the south to have to live in much worse conditions than one in the north whilst doing the same job.

    As before, I don't believe the current reforms are being done for the right reasons nd so oppose then but I do think this needs to be looked at in the future.

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  • Florence

    No other profession would allow this to happen. We have to be proactive and oppose this. As mentioned in an earlier comment, MP'S wouldn't stand for it. As Nurses we can be our own worst enemy at times.We have the ability to oppose this through the voices of our unions and as individual Nurses we have to start valuing ourselves more as the professionals that we are.

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  • Splitting us already, eh. John Spashett, you do get extra pay for working in London, don't you? Every nurse in Middlesborough ( or anywhere outside of London) has a mortgage on a lovely big house with a 3 car garage and 200ft long gardens that can be paid off in 5 years as the cost of housing is soooo low and our wages are soooo high?
    If conditions in London are really that bad (it's grim down south tha knows)perhaps you should move back North and get some mushy peas in you, the Southerners have obviously turned you a bit Bertie!

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  • Am i losing the plot here but I thought nurses down south have always been paid more that us nurses up north due to the cost of living

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  • I wouldn't oppose this if it meant an increase in wages for those nurses living in high cost of living areas, but I doubt that pay would be increased in these area's, just cut in lower cost area's. It'd be no more than a race to the bottom.

    I live in Middlesbrough, and nothing is cheaper apart from my rent. If I had to take a pay cut then I honestly couldn't make ends meet. I do feel for those living in area's like London or Bristol, and I do wonder how they manage, when I struggle in a low cost area.

    If these changes are enacted, the economic effect in my corner of the NE would be catastrophic, in my opinion. The NHS is the biggest employer here, and regional pay would lead to mass exodus of nurses to better paying area's of the country. This is in addition to the year on year decline in the NE population in general. The NE needs a stable pool of nurses to care for an aging population in increasingly poor health.

    The fact that these changes would not apply to our medical and dental colleagues is grossly unfair, especially as in this region the medical profression makes up 10% of the workforce, but accounts for nearly 30% of the pay bill.

    It seems like this government is hell bent on widening the North/South divide, creating inequality and pockets of poverty and ill health. All very sad.

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  • The intention is noy to raise pay in more expensive areas of the country by any meaningful amount, but to drive down the pay in the areas where housing is cheaper than London.

    First they will target pay. Next will be reduction of annual leave - so that it is 'market facing', or put another way, about 4 weeks.

    Just watch....

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  • I am totaly against this hairbrained proposal and agree with other comments that it is divisory and discriminatory. It will further highlight the north south divide and drive highly qualified nurses out of the profession. As a learning disability nurse, we have faced recruitment issues as a consequence of the changing landscape of this branch of nursing, how are we going to encourage others into small speciality areas like this, with an agenda that is so unfair?
    Is this just going to affect nursing staff or what about allied professions? Obviously it is not including medics and dentists for some reason that seems unfathomable.
    As a nurse with 28yrs experience I would have to give serious thought to the future. As a single parent I cannot afford to be paid less because some faceless burocrat thinks I can provide for my children onm less, it is bad enough with the pay freeze and the run on our pensions as it is. Have they not heard of loyalty? They need to spend years dedicated to a difficult job like nursing and find out.

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  • Regarding all the Middlesborough posts.

    I've said several times that I oppose the current scheme from the government because it is clearly a thinly veiled attempt to 'do over' hard working nurses. My point on the regional pay is that nurses should be able to have a reasonable quality of life regardless of where they live. At the moment that is more difficult for those working in the more expensive south who are having to either live in shared accomodation, commute a long distance or pay a small fortune in rent (never buy).

    Lets get this idiot government scheme out of the way but lets not throw the baby out with the bathwater. Regional pay *may* have a place in a decent accounting for nurses in the future.

    As for our unions. Does the recent 15% turnout at the strike vote suggest Nursing has got the union it deserves? If we dont like the job they're doing why dont we vote with our feet?

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  • I am already an economic refugee who moved north in the 80s as property prices rocketed in the south east. The only disparity in pricing is in housing - and that divide isn't as huge as it used to be - anyway wasn't it Thatcher who wanted us to own our homes? Are PoshBoy and LapDog suggesting that this is now an outdated view?

    Fuel may be a penny or two a litre cheaper if you shop around, so on that basis I'll reluctantly accept a paycut of 1p an hour which reflects the amount of money I save.

    Of course the potential knock on effect of this is that spending in the Regions will be next, so perhaps eventually we will see those Regions forming Regional Assemblies and who knows succumbing to some kind of feudalism or demanding independence?

    I'll get me coat.........

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  • ok so regional pay is being looked at, i work in the north, i do not get the extra 5,000 per year to make up the difference between the cost of living in the north and south. so if i am to recieve lower wages for working the same as those in the south, why is that fair. i work just as hard as those in the south same hours, same skills.
    maybe the cost of living in the south should be looked at. reducing house prices etc. but that will not be looked into will it as it will make those wealthier people worse off and that will cost this joke of a government lose votes

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  • Make no mistake. There is a (not so secret) agenda targeting staff employed on AfC terms and conditions of employment.

    Nurses form the vast majority of this group of NHS employees. The proposals are actively supported by Trust Chief Executives and their sycophant Directors of Nursing. Some Chief Executives are attempting to "force the pace", outside any Nation negotiating process, by forming Regional Consortia.

    The threat is not just associated with basic pay but includes issues involving sick pay, unsocial hours payments, annual leave entitlement, pay scale progression, grade mix, working hours etc.

    Can you imagine the size of the Bonus Awards which any group of Senior Managers will receive as a reward for achieving the objective of destroying the Nationally agreed AfC ?

    These proposals affect every Nurse,Midwife and Health Visitor, EXCEPT Directors of Nursing who can be expected to fully support the proposals.

    Unless you all give 100% support(up to and including strike action) to your Trade Unions/Professorial organisations you can expect to be faced with a Fait Accompli which will ensure not only personal loss but an even lower standard of patient care.

    Apologies for posting anonymously !

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  • Anonymous | 4-Aug-2012 8:23 am


    "Apologies for posting anonymously !"

    why do you apologise for posting anonymously? It is one of the options offered here which many choose to use. Posting under a pseudonym is also anonymous!

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  • NHS nurses are by far and away the largest workforces in the UK and most probably in Europe as well. Isn't this the whole problem? Isn't it far too large and costly to manage successfully and would this not be the reason why nurses are treated the way they are? Is there a fear of a force which is too powerful to be 'managed' by others when they should be managing themselves and costing more than can possibly be afforded. Could this be what this is all about - political issues, which influence the negative media reports, which influence public opinion, which ultimately impacts on the demoralised attitudes of the staff, staffing levels and the quality of patient care they are able to provide?

    It seems to follow that a sufficient level of well qualified and happy staff because they have excellent working conditions and encouragement and motivation in career progression and supportive management and a collegial working environment would reflect in the quality of care they provide. This has been the case in the past and needs somehow to be restored in the near future.

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