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”
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”
“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.