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Low pay is denting nursing staff morale and harming worker retention, warn peers


Ongoing restrictions on pay have led to low morale among nurses and problems retaining staff, a report by peers has concluded, which blames successive governments for failing to plan more carefully for the future of the health and care system.

There is no getting away from the fact “the NHS is in crisis and the adult social care system is on its knees”, stressed the report by the House of Lords select committee on the long-term sustainability of the NHS, which hits out at a “culture of short-sightedness”.

“One area where more spending will be required is on pay for lower paid staff”

Lord Patel

Staffing shortages are among key problems highlighted in the wide-ranging document, which found limits on pay were a major factor in “low levels of morale and significant staff retention problems”.

This was a particular issue for nurses, said the report by the cross-party group of peers, who gathered evidence from a wide range of individuals and organisations.

“We received evidence on the lengthy period of pay restraint experienced by health and care staff and the consequential impact of this pay restraint on morale,” it said. “This was a particular problem for those who were often at the lower end of the pay scale such as nurses.”

This – together with the lure of other opportunities for nursing staff – is driving nurses away from the NHS, the report suggested.

“There were concerns expressed about the capacity of the NHS to retain domestically-trained staff because of low pay and morale and the competitiveness of the international market for scarce clinical skills,” said the report.

“The evidence suggested this was a particular issue in nursing, where the proportion of nurses leaving service increased from 6.8% in 2010-11 to 9.2% in 2014-15,” it stated.

“The loss of the experienced, highly trained staff who are currently leaving the NHS in droves cannot be easily reversed”

Candace Imison

The committee said the government should commission an independent review to examine the impact of pay on morale and retention of health and care staff.

“One area where more spending will be required is on pay for lower paid staff,” said committee chair and cross-bench peer Lord Narendra Patel.

“We are in an increasingly competitive international market for health professionals and a decade of pay constraint in the NHS has damaged morale, and made it difficult to train and recruit the staff we need.”

The report, published today, is scathing about the lack of long-term planning, with a “Department of Health that is unable or unwilling to think beyond the next few years”.

This was true regarding workforce planning, which was resulting in “the biggest internal threat to the sustainability of the NHS”, according to the report.

“Instead of workforce planning which was based on sound demographic data driving expenditure, short-term thinking seemed to be a real driver of supply,” it said.

“The government frequently repeat they have secured 9,500 more doctors and 6,900 more nurses since 2010…but there is no evidence to suggest that these numbers were agreed to meet an identified demand based on specific data or calculations,” said the report.

“It explicitly blames the government’s short-termist pay cap for low morale”

Janet Davies

It highlighted an over-reliance on overseas recruitment when it came to filling vacancies, and said the government needed to set out strategy for ensuring a greater proportion of the health and care workforce were home-grown.

Meanwhile, as the UK prepared for Brexit, the committee said the government should take steps “to reassure and retain overseas-trained staff working in the NHS and adult social care, who are now understandably concerned about their future”.

The report also criticised cuts to public health budgets, describing them as “not only short-sighted but counter-productive”.

“There is a grave risk that the burden of disease will increase if these cuts continue, a trend which is bound to result in a greater strain on all services,” said the report, which called for local and national funding for public health to be ring-fenced for at least the next 10 years.

In total, the report made 34 recommendations, including the creation of a new government Department of Health and Care to ensure better co-ordination and “allow money and resources to be used more effectively”.

“Otherwise, I fear staffing shortages will worsen, morale will continue to fall”

Jon Skewes

It also called for the establishment of a new Independent Office for Health and Care Sustainability to look at health and care needs for the next 15 to 20 years, and report back to parliament.

The report’s conclusions and recommendations have been warmly welcomed by unions, nursing bodies and NHS organisations.

Janet Davies, general secretary and chief executive of the Royal College of Nursing, said the failure to develop a meaningful, long-term nursing workforce plan had allowed “a time-bomb to tick beneath the profession”.

“The government has been warned by this cross-party group to stop reaching for the sticking plasters when it comes to the NHS and social care services,” she added.

“It explicitly blames the government’s short-termist pay cap for low morale in the NHS and the numbers being pushed towards leaving the nursing profession,” noted Ms Davies.

Royal College of Nursing

Pay rise above 1% ‘needed to ease nurse crisis’

Janet Davies

“If ministers want to keep the best nurses working in the NHS, they must fund it properly and end the pay cap,” she added.

The Royal College of Midwives said the report “lays bare some of the issues facing our profession”, and praised the emphasis on pay and damaging cuts to public health.

“If we are to retain the staff and attract more to the profession, they must be rewarded fairly in their pay packet and the value of their work must be recognised by government,” said Jon Skewes, the RCM’s director for policy, employment relations and communications.

“Otherwise, I fear staffing shortages will worsen, morale will continue to fall and the care of women, babies and their families will suffer,” he said.

However, Candace Imison, director of policy at the Nuffield Trust think-tank, warned that solving staffing problems was easier said than done.

“Whereas the financial difficulties can largely be solved by increased funding, the loss of the experienced, highly trained staff who are currently leaving the health service in droves cannot be easily reversed,” she said.

Candace imison6th june 2016 hsj roundtable reducing variation079

Candace imison6th june 2016 hsj roundtable reducing variation079

Candace Imison

She said the committee was right to recognise the impact of long-term pay restraint on the health service’s ability to retain staff.

“We need to bear in mind that a large part of the efficiency savings so far produced by the NHS have come from this continued pay freeze for staff,” she added.

NHS Employers chief executive Danny Mortimer said managing pay costs “remains a key part of meeting the financial and service challenges” facing the health service.

“Employers understand that a continuation of pay restraint over the longer term is of growing concern to our workforce,” said Mr Mortimer.

He said it was “imperative” the health and care sector was able to recruit and retain the right staff, whether that was from the UK or abroad, and said migration policy “must be flexible enough to respond to skills shortages”.

Danny mortimer

Danny mortimer

Danny Mortimer

He also agreed there was a need to give assurances to EU nationals – who make up 6% of the NHS workforce – “that they will be able to remain, as well as encouraging them to do so”.

Government arm’s-length body NHS England said the Lords committee had made a “number of important long-term recommendations”.

However, it noted that the House of Lords report was drawn up before publication of last week’s Next Steps on the Five Year Forward View plan, and “couldn’t take into account its far-reaching contents”.

“The committee makes a number of important long-term recommendations well worth debate and consideration,” said a spokeswoman for the national commissioning body.

Meanwhile, the Department of Health it would respond to the report’s findings “in due course”.

A Department of Health spokesman said: “We are totally committed to an NHS, free at the point of use, providing world-class care – and we agree that means taking decisions to ensure the sustainability of the service in future.

“That’s why we are already expanding the number of medical training places by 25% to ensure we have all the doctors we need, investing in social care and working on a long-term funding solution in a green paper, and putting £325m into local transformation plans to improve services, with more to follow in the autumn,” he said.


Readers' comments (3)

  • I'm fed up with this death by 1000 cuts. This is a deliberate government stealth policy to dismantle "troublesome" professions. No political party is untainted by it in spite of their proclamations. It is happening in teaching, medicine and accountancy so why would we be immune? Nurses are perceived as costing too much and delivering too little and as associates and care assistant roles develop they can take on more responsibilities far more cheaply. Nurses are still mainly non graduates who earn far more than the non degree educated workforce.
    We now have situations where clinical areas are being staffed by one nurse, where CDs are checked with HCAs, where HCAs are doing drug rounds. We have never been able to articulate what it is exactly that we do which distinguishes us from others (at least not without mystical jargon or multiple pages so why should the public care?
    We don't support each other, we bully and bitch at and about each other, we haven't got "time" to teach students and think the problems are all down to university not giving the students what they "really" need but instead teaching them stuff that doesn't matter like social policy, we are well known for eating our own and making life miserable for any team member who doesn't "fit in". We are quick to demonise graduates as not nursing in the real world, we don't understand research far less value it.
    I appreciate this is a generalisation, but I doubt there will be many who don't see echoes of it in practice today.
    What is it that we really want?, because we apparently can't have it all and our unions are too keen to be "good", to just be round the table "influencing" and don't seem to ever be actually delivering the pay, stopping or reversing down banding, winning on working conditions or really being the challenge to regulators we need.

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  • In order to retain the staff, some trusts artificially increase the numbers of band 6s. I like it, it's a clever way of boosting staff morale

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  • So nurses earn far more than the non degree educated work force? This might be true in some parts of the country, but not in the greater London area. I am a band 5 nurse and my hourly rate of pay is not much more than my friend pays her cleaner.

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