Last week the government announced that the majority of public sector workers, including doctors, dentists, teachers and police officers, would receive pay rises of at least 6% for 2023-24.
In response, nurse unions and campaigners hit back at the government, accusing it of giving nursing staff the lowest percentage pay rise out of all public sector workers after their 5% deal earlier this year.
Nursing Times has spoken with some of these campaigners, as well as workforce policy experts, about nurse pay frustrations and the wider dangers of implementing below-inflation pay rises across sectors with growing recruitment and retention issues.
“We know that the necessary wealth exists in our society to pay all workers in this country without penalising any section of the workforce”
NHS Workers Say No
Among the public sector workers who last week received a pay rise for 2023-24 were doctors and dentists, who were given 6% in line with the Review Body on Doctors’ and Dentists’ Remuneration’s recommendations.
For junior doctors, they would receive this pay rise plus a consolidated £1,250 – equivalent to a rise of between 8.1% and 10.3% depending on where they are in their training.
Meanwhile the government also accepted recommendations from the pay review bodies for teachers and police officers, awarding them 6.5% and 7% respectively.
In response, the general secretary and chief executive of the Royal College of Nursing, Pat Cullen, argued that nurses had received the lowest pay rise in respect of 2023-24 among public sector workers.
It comes as the RCN was among the unions that rejected the recent pay deal in England for nurses and other staff on Agenda for Change (AfC) contracts, which included a 5% pay rise for 2023-24.
In a letter to the health and social care secretary, Steve Barclay, Ms Cullen said the 2023-24 pay rise which had been implemented appeared “increasingly inadequate” and had “been eclipsed” by subsequent pay awards for other public sector workers.
She said: “This highlights the long-term disparity, pay erosion and disadvantage of the nursing profession and is, frankly, unjust.
“Why does nursing deserve the least? Particularly, given nursing is one of the most diverse and female-dominated professions within the public sector.
“The government has very clearly signalled it does not recognise or value their public service in the NHS compared with other professions.”
Also responding to the announcement, Anthony Johnson, lead organiser at Nurses United, told Nursing Times that the nursing profession had “been conned into accepting a pay cut” even worse than colleagues in education were experiencing.
He said: “This government thinks they can do this because nurses will accept the scraps on the table.
“Our profession needs to make sure that it continues to organise around pay, and bread and butter issues like safe staffing, to ensure that we are able to pass a ballot in the future and protect nursing and our patients.”
Meanwhile the campaign group NHS Workers Say No warned that every single pay offer for public sector workers was “well below inflation” and that this would not nothing to fix recruitment and retention issues across the various professions.
“These deals still amount to real-terms pay cuts rather than the pay restoration we deserve,” they said in a statement published on Twitter.
Because other public sector colleagues received at least a 6% pay increase for 2023-24, NHS Workers Say No questioned why staff on NHS AfC contracts were advised to accept a 5% pay offer as “supposedly the best” that could be achieved.
They said: “We are for the fullest unity across the public sector workforce and beyond.
“We know that the necessary wealth exists in our society to pay all workers in this country without penalising any section of the workforce.”
The group added: “We send our full solidarity to workers fighting for fair pay deals and encourage fellow trade unionists to reject deals that they consider inadequate.
“We will continue to fight for a restorative pay rise for NHS staff and welcome moves by workers in other sectors to do likewise.”
Workforce policy experts have also weighed in on the latest public sector pay awards.
Dr Billy Palmer, a senior fellow of the Nuffield Trust, told Nursing Times that it was difficult to draw conclusions about which profession has been most affected by below-inflation pay rises, as it varies depending on the period that is analysed.
He said: “For this year alone, foundation year doctors get something like 10%, which obviously is more than just the nurses for this year, which is 5%.
“But, of course, nurses did better than junior doctors substantially the previous year.”
The government gave doctors and dentists an average 4.5% pay increase for 2022-23, junior doctors received 2%, while AfC nurses received an average 4.75% increase.
On top of the 4.75% consolidated deal, AfC staff also received a one-off payment – which was awarded in 2023-24 but backdated for 2022-23 – of at least £1,655.
Dr Palmer said that if you analyse the last decade of public sector pay, “doctors real-terms pay was cut more than nurses”, but also noted that this varied depending on the seniority of the role.
“Foundation year doctors actually did a bit better than nurses, but consultants did worse,” he said.
Whatever way you look at it, Dr Palmer said that the way the pay deal was set up for nurses, by including non-consolidated payments, it “possibly leaves [nurses] at a greater risk of having any sort of pay restoration in future years”.
He explained that as non-consolidated payments were one-off and do not affect an individual’s base salary, it “could put [nurses] in a worse place” for future pay negotiations as they would be negotiating from a smaller baseline.
Meanwhile, Professor James Buchan, workforce expert and senior fellow at the Health Foundation, told Nursing Times that offering different awards to staff within the NHS would “do nothing to allay the friction between government and the nursing profession”.
He said: “It’s not going to draw any heat from the current situation of friction, given the comparison nurses will inevitably make with their offer, compared to what has now come through as offers for other groups.”
The Department of Health and Social Care announced last week that pay increases for doctors and dentists would be funded “through prioritisation within existing departmental budgets”, with frontline services being protected.
Conversely, it previously said the AfC pay awards would be funded by a mixture of new money and existing budgets.
Professor Buchan said this showed that all of these offers, irrespective of profession, “do not appear to be fully costed and coming from new money”, which could impact the NHS as a whole.
He said: “There’s a message there for the NHS to look at coming up with roundabout half or more of the total costs of implementing the awards.
“So, we’re obviously then getting into the question of trade-off and what can’t be done without funding if it’s been used to fully fund pay awards.”
Separately, Professor Buchan noted that the differences in pay awards could be a result of the “bigger [and] broader” remit of the NHS Pay Review Body compared to review bodies for other professions.
He said: “The Agenda for Change review body has a much more challenging remit, I think, in terms of trying to balance interests across a really diverse range of occupations.
“I think that raises questions about how we can ensure that there is an effective way of determining NHS staff pay in England as we move forward with the long-term workforce plan.”
When contacted for comment, the Department of Health and Social Care directed Nursing Times to its media fact sheet, where it argued that AfC staff had not received a smaller pay rise.
The fact sheet said: “Agenda for Change staff received a 5% pay rise and two significant non-consolidated awards – worth between 3.5% and 8.2% of 2022-23 basic pay in total – at least £1,655 for full-time staff.
“That came on top of an award of at least £1,400 for full-time staff the year before.
“The deal also included non-pay elements to better support the NHS workforce, including improving opportunities for nursing career progression, reviewing safe staffing guidance and reducing agency spend.”
