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Have nurses ever been paid their due?

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Charting the history of nurse pay since 1948, Emma Vere-Jones discovers that, throughout the years, staff wage packets have always left something to be desired

On 7 August 1948, then NT editor Marjorie Wenger summarised the feelings of the profession on pay – sentiments that many hold true today: ‘That all is not well with the conditions and salaries of nurses in this country, and elsewhere, has been realised by members of the profession for a long time.’

Issues of NT from that year reveal salaries. Female staff nurses on the wards were paid a total of between £240 and £300 a year, while their higher-ranking ward sisters earned between £300 and £380. Their male counterparts earned slightly more, purely because they were men, with a male staff nurse earning from £260 to £312 and a charge nurse earning from £312 to £380 (see box).

Of course, products in those days were also considerably cheaper – a pint of milk cost the equivalent of around 2p in today’s money (see box). The average house price at the time was approximately £1,700 and annual registration with the NMC was half a crown (2/6d) – the equivalent of about £3.25 today.

Margaret Reading, a former nurse who trained in 1953, remembers her salary in the early days: ‘It wasn’t well paid, not even in those days,’ she says. ‘One always got by but, yes, it was hard to make ends meet at times.’

The introduction of the NHS on 5 July 1948 brought with it a new body to decide the way in which nurses should be paid – the Nurses and Midwives Functional Whitley Council. It was made up of a staff side, representative nursing organisations such as the RCN, and the ‘official’ side, which comprised the Department of Health, regional hospital boards and local authority organisations.

It was the first time that representatives of nurses’ unions and professionals met with management in order to negotiate pay structures and agree other terms and conditions of employment. With its introduction came lengthy pay negotiations and the kind of disappointments with which nurses today will be familiar.

The Whitley Council made its first decision on nurse pay in May 1949 after four months of protracted discussions that caused ‘widespread disquiet’ among the nursing profession, NT reported at the time.

The decision brought considerable improvement. Female ward sisters at the top of the pay scale saw their salaries increase from £380 to £500 and the most junior staff nurses saw their income rise from £240 to £315. Furthermore ‘the gap between scales for men and women has been reduced to a minimum’, NT reported but added: ‘The prolonged discussions on the trained nurses’ salaries has given indication of the extensive nature of the problem and the difficulty of reaching agreement between the staff and management sides of the council.’

Such difficulties were only going to become worse. During the 1950s and 1960s there was regular arbitration in the industrial court because of the inability of the Whitley Council to reach a decision. There were low pay increases for a number of years and special reviews had to be carried out to allow nurse pay levels to be improved. However, even after these reviews, nurse pay still remained inferior to that of other public sector occupations.

Independent reviews in the 1970s helped to boost pay but the significant increases they heralded were undermined by pay awards well below inflation in subsequent years.

This boom-and-bust cycle came to an end in 1983 with the introduction of the ‘Review Body’ – an independent body to advise the prime minister on the pay of nurses, midwives and health visitors.

‘The Review Body was seen by nurses at the time as being beneficial because it removed the consideration of nurses’ pay out of the annual “pay conflict” and it fitted in more with other public sector professions such as doctors and dentists,’ says RCN senior employment relations adviser Gerry O’Dwyer.

‘It was seen as an objective process to decide nurses’ pay with the government obliged to follow the review body’s recommendation. The government position was that they would implement the PRB recommendation unless there were compelling reasons to
do otherwise.’

The next milestone was the introduction of clinical grading in 1989. ‘[It] looked to create a more ordered nursing career structure where people could be rewarded for remaining at the bedside,’ explains Mr O’Dwyer.
Clinical grading did initially make improvements to nurse pay but it was marred by ongoing pay disputes relating to the way in which it was used.

The final and most recent milestone in the history of nursing pay is of course the 2003–2004 implementation of Agenda for Change, which was introduced to try to ensure equal pay for work of equal value within the NHS.

So have nurses benefited as much as they had hoped out of AfC? Mr Dwyer believes so.

‘For many nurses they’ve moved into a pay band with a lot more headroom. They may say I’ve only got £3 increase out of AfC on assimilation – but they can receive an extra increment that was not available under the Whitley system, so it’s increased the amount of money that they’re going to be earning over the next few years,’ he says. ‘It’s a system that better reflects the value of jobs that people do in relation to the jobs of others.’

Others are less convinced, however. Donald Nicholson, staff nurse in dermatology at NHS Lothian, says: ‘If Agenda for Change had been applied as it was originally intended, it would have made a difference. It’s supposed to be a way for everyone to move up the ladder, but the only way to get up the ladder is to apply for a new job. There is no way to go further because there is no money.
‘It’s been a massive disappointment. All they’ve done is change the outlines.’

So are nurses better off today than in 1948? Figures from the Office for National Statistics show that the average female salary in 1948 was £190. So in 1948 a female staff nurse on the bottom rung of the scale earned significantly more (£240) than the average working woman. That said, this was still significantly lower than the average male salary in 1948, which stood at £351.

Today the average full-time nurse salary, according to the ONS, is £24,002. However, staff at the bottom of the band 5 scale earn just £19,683, with those at the top of band 5 only just surpassing the national average at £25,424.

It is also interesting to see how nurses’ salaries have changed in the last 60 years when compared with other public-sector workers. Ms Reading recalls that even when she held a senior nursing post within her local region she still fared poorly compared with other sectors.
‘From 1974 onwards, I held a very senior post with a lot of responsibility but my co-workers in teaching, social services and doctors were all paid considerably more than me,’ she recalls.

Today that gap in pay remains. RCN pay evidence for the 2008–2009 round shows the average weekly pay of police officers in 2006 was £668 a week, significantly more than the £436 average earned by nurses. Teachers fared better too, earning an average of £600.
It seems, despite the reviews and planned improvements to the pay structure since the inception of the NHS, nurses still have some way to go before they will be earning what they feel they deserve.

Again it appears that Ms Wenger’s original reflections on the disappointing first Whitley pay award hold equally true today: ‘Nurses will presumably continue to press, through their representative organisations, for what they feel is right, knowing that the nursing service is a most valuable part of the great National Health Service’.

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