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Nurse pay restraint not 'immutable fact', says government advisory body


Pay restraint for NHS nurses has been wrongly presented as an “immutable fact”, according to an advisory body that has criticised employers and the government for failing to investigate whether wage increases would improve recruitment and retention.

The Migration Advisory Committee was asked by the government to review whether nurses should remain on the shortage occupation list, after they were temporarily placed on it last year following national recruitment problems.

In its latest report, the committee recommended “reluctantly” that the profession be retained on the list, a move that will make it easier for trusts to employ nurses from outside of Europe.

But it also strongly criticised national workforce planning and a failure by both the health and care sectors to look at how pay could be used to attract and retain nurses to the profession, instead of using migrant staff to plug gaps.

It said both sectors had an “unrealistic view” that the role of pay in recruitment and retention is “only weak”.

The committee was told by employers across both sectors that salary levels were not a major factor in recruiting and holding on to staff, stated the report.

“All parties seemed able to understand how their employees left for higher salaries available through agency work”

MAC report

This was despite employers “bemoaning” the loss of nurses to agencies for better pay and working conditions, it said, which indicated they understood wages were in fact an issue.

Meanwhile, it noted that, according to the Department of Health, financial incentives available to NHS trusts under  Agenda for Change – such as high cost area supplements and recruitment and retention premia – were not being widely used.

The advisory committee also criticised the DH, stating it should “at least explore whether higher pay would improve retention”.

It noted there was evidence to suggest some areas – such as London – were particularly sensitive to pay incentives.



Median pay for a full-time nurse in the UK was currently £31,500, around £7,500 below the median pay in other graduate occupations, noted the report.

Previous periods of nursing shortages in the 1990s resulted in the NHS increasing wages by 4.7% in 1999, alongside a 12% increase for newly qualified nurses.

But in recent years, despite a national nurse shortage, the government has either frozen nurse wages or restrained increases to an annual uplift of 1% – as is the case until 2020.

“The restraint on nurses’ pay instituted by the government was presented to us, and in the evidence to the pay review bodies, as an immutable fact. It is not. It is a choice,” said the advisory committee.

It added: “There was insufficient curiosity across both the health and care sector about the extent to which pay might be responsible for, and might help alleviate, present recruitment difficulties.

“The restraint on nurses’ pay instituted by the government was presented to us as an immutable fact. It is not. It is a choice”

MAC report

“By contrast, all parties seemed able to understand how their employees left for higher salaries available through agency work,” it said.

However, employers – particularly in the NHS – told the advisory committee that pay was not a “readily available tool” to influence the supply of nurses.

The DH maintained that other issues – such as organisation commitment, and dissatisfaction with promotion and training opportunities – had more of an impact on nurse turnover, noted the report.

“We accept that the decision to become a nurse may not be entirely driven by pay for most people. But that is not the same as saying that pay is not a factor in the decisions nurses and potential nurses make,” said the report.

“For some, the relatively low pay may put them off nursing as a career,” it said. “Others may choose to train as a nurse but leave the profession later in their career when pay becomes a more important factor in their decision-making. Alternatively, a nurse may choose to retire early because the pay is not sufficient for them to remain working.”

The advisory committee added that it was “vital” nurse pay and conditions kept pace with those available in other occupations which compete for labour with the profession.

It also expressed “concern” that pay for nurses employed from outside of Europe was undercutting domestic wages, after it found evidence that overseas nurses were being paid around £6,000 less than the average salary for UK workers of similar age.

Data from the Home Office showed that non-European Union nurses were very often recruited at the lowest point on band 5 of the Agenda for Change scale, irrespective of their level of knowledge and experience.


Readers' comments (14)

  • Recruiting is one thing,retention is another.
    Are they to go along together?

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  • I'm quite surprised the average annual income for nurses is stated as £31,000. According to RCN, the majority of nurses are band 5, I would have assumed the average income would be around £25,000-£27,000, which is quite different from £31,000.

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  • I, for one, am considering leaving the profession due to pay. To do this demanding, draining, stressful job and not have sufficient financial reward makes me feel unvalued and is not a place I want to stay for long. It's a joke.

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  • there is a suggestion by Frederick Herzberg that rather than being a motivator, salary is in fact neutral at best and can be a demotivator. His argument is that everyone has an idea of what they are worth; if their salary is less than this and they subsequently receive a rise that takes them to their perceived value they see this as correcting a wrong and the employee is neither motivated or demotivated. Subsequent rises do little to motivate. Herzberg suggests that achievement, responsibility and growth amongst others are motivators; with management and working conditions being amongst the demotivating factors. Average should never be used, they should refer to the median ( the fiftieth percentile)

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  • the wages will be cut even further as hca are cheap to employ, why pay more for a trained nurse- it is not like we need nurses do we? we need more bankers don't we?

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  • Of course no one goes into nursing expecting to be well off. But the least we should expect is for our pay to keep pace with inflation. How anyone can fail to understand this is beyond me. After 30 years in nursing, my pay has significantly reduced in real terms since the "pay restraints" began. lt is this that is causing experienced nurses to leave in droves. lf you kick people in the teeth enough times, eventually they wake up and leave!

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  • Pay is a major factor; not getting a decent pay rise speaks volumes, it shows how much nurses are valued. I love nursing I was aware that nursing was not going to make me a rich, because I wanted to be a nurse. Now nursing is very much a thankless profession, where critism is at all levels.

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  • Unfortunately the Government have done little to investigate this issue as they have had a plan to cap Agency Nurses pay recently. This has been an attempt to push Nurses int permenNt employment however will only work in a few instances. Nurses do not have progression plans as front line staff don't have time to complete extra training and Trusts don't have funding to support Nurses into personal development.
    Going back to the main point Nurse will follow Doctors eventually or resist over doing and using their goodwill and strike also as time is running out along with good will. We are caring people and came to this profession to give of ourselves however we are tired of Government cutting and expecting more for less.

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  • With the national living wage now in place and after 40 years of nursing, I now earn £7.10 an hour more than someone over the age of 25 who works at McDonalds. Valued? I think not.

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  • Then of course, there are the politicians: Politicians are in line for a 1.3% increase from April - just nine months after receiving a backdated boost to £74,000, up from £67,060. 'All in this together?' I think not!

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