Nursing academics have painted a gloomy picture for the profession over the next five years, in the wake of the general election, including further pay restraint, pressure and organisational change.
In particular, they claimed the Tory government would continue to try and hold down public sector wages as the economy struggled to improve.
“I think nursing is going to be under a huge amount of pressure”
Anne Marie Rafferty
One academic also warned that pledges to grow the community nursing workforce may be met by supplementing the figures with larger numbers of support posts and predicted that nurses would find it increasingly difficult to carry out the “pastoral side” to their role.
The academics called on the profession to continue its fight for fair pay, adding that it needed to become more involved with policy making decisions at a commissioning level and must ensure future organisational change was driven by patient outcomes.
Anne Marie Rafferty, professor of nursing policy at King’s College London, claimed the economic challenges still facing the country painted a “pretty bleak” picture for public sector workers under the new government.
“Whether by stealth or other means I think nursing is going to be under a huge amount of pressure….The downward pressure is going to be on salaries and probably headcount,” she told Nursing Times.
Her comments follow last year’s dispute between the coalition and unions, after ministers refused the 1% blanket pay rise recommended by the independent NHS pay review body.
“The nursing profession needs to not have a closed mind to change”
Ahead of the election, the Conservative party made no pledges to commit to pay rises, even those at least in line with inflation.
Professor Rafferty said: “Pay is certainly not going to rise. Who knows, I’m not predicting this, but could we end up in a position where pay declines?
“As in [the case of] Ireland and Spain and many countries impacted by austerity where actual salaries are cuts. How else do you pay the bills,” she said.
“You either raise taxes – which this government doesn’t seem to be keen to do – or you’ve got to find savings from other areas. And given salaries is one of the biggest areas, do you start to saw away at public sector salaries,” she asked.
Professor Rafferty added that she believed nurses would be able to tolerate pay restraint more easily if the government applied it an “equitable and transparent manner”.
She pointed to the better deals received by other professions, such as doctors and dentists, that sit outside the Agenda for Change pay framework.
Professor Fiona Ross, research professor at Kingston University and St George’s, University of London, said she also did not expect nurses’ pay to rise under the new government.
“The time for nurses to do the pastoral part of their role is going to get more and more difficult”
She said nurses must use their “power and contribution [to the NHS]” to fight for better wages over the coming years.
Professor Ross also predicted there would be a “rapid” move towards NHS services being provided by private companies, but that nurses should not automatically resist this.
“The nursing profession needs to not have a closed mind to change, but to be really clear that when change is proposed that the outcomes will benefit patients and [to ensure] that the outcomes won’t increase the gap in equality that we have,” she said.
Referring to the Conservative’s plan to improve access to primary care and the move towards better integration of services, Professor Ross predicted this would inevitably involve hospital closures.
She said nurses should embrace this if it benefited patients and “mustn’t fall into the trap of always trying to save bricks and mortar”.
Meanwhile, Professor Carol Haigh, professor of nursing at Manchester Metropolitan University, cautioned that the Conservative pledge to boost the community nursing workforce may not necessarily result in a significant increase for registrant posts.
“Until we know what they mean by nurse, we can’t comment that that’s a good thing,” she said. “[This] could mean anything from a healthcare assistant to someone with a master’s in nursing.”
“You can’t just talk numbers, you have to talk education, skill mix, occupational level and the expertise of these nurses,” she told Nursing Times.
Professor Haigh also predicted frontline nurses and managers would also have to deal with increasing demand to offer advice and support to patients.
She said Tory austerity measures meant charities – often the first point of contact for patients – were under pressure, meaning patients would come to rely on nurses even more.
“As we become increasingly target-driven, the time for nurses to do the pastoral part of their role is going to get more and more difficult,” she warned.
In response, a Department of Health spokeswoman said NHS staff “are our greatest asset and we know they are working extremely hard”.
“That’s why, despite tough financial times, we will increase the NHS budget by £8bn in real terms and over a million NHS staff, including nurses, will get a pay rise this year with a better deal for the lowest paid,” she said.
She added that the Conservative party had committed to health service leader’s five-year plan for the NHS – the Five-Year Forward View – which suggested NHS pay will need to stay “broadly in line with private sector wages”.
The spokeswoman said official NHS accounts show the use of the private sector was six pence in every pound the NHS spends, an increase of one penny since May 2010.
“We will continue to make sure we have enough nurses and other NHS staff to meet patients’ needs and further consider how best to recognise and reward high performance,” she added.