Debate: NHS Pay (MfD)

The NHS Staff Council – in which the RCN plays a central role – is responsible for maintaining the Agenda for Change pay system. It has a UK-wide function and meets regularly, involving representatives from NHS employers and officers and lay representatives from trade unions, as well as government bodies from all four countries.

Agenda for Change covers more than 1 million staff across the UK. Staff Council’s remit includes maintaining the Agenda for Change pay system; negotiating changes in conditions for staff on Agenda for Change and reflecting these in the NHS terms and conditions of service handbook; and providing national support on interpreting the national agreement for employers and trade unions.

Until the Staff Council in 2004, responsibility for determining nurses’ pay and conditions rested with the Nursing and Midwives Whitley Council – one of several negotiating councils within the health sector. However, it attracted criticism due the frequent inability to reach agreement and the absence of a governmental role within the negotiating machinery. As a result, nurses often received below-inflation pay increases. A series of one-off special reviews enabled nurses’ pay to ‘catch-up’, but overall the Whitley Council did not deliver improvements in pay and conditions for nurses in comparison with other occupations. 

In 1983, the government established the Review Body to advise on the pay of nurses and midwives. However, the pay structure still focused only on pay for nurses and midwives and did not consider other roles. This gave rise to a raft of equal pay for equal value claims during the 1980s and 1990s which confirmed male dominated professions enjoyed better terms and conditions than those that were predominately female-dominated.

The RCN lobbied for equal pay with other professions and in 1997 the government, employers and trade unions all agreed that the situation was unsustainable and a better way for deciding pay for nursing and other health care staff was needed. Agenda for Change, as the new harmonised terms and conditions for all NHS staff (with the exception of Doctors, Dentists and very senior managers), was agreed and implemented in 2004 - as the mechanism ensure equal pay for equal work of equal value. Agenda for Change is also underpinned by a job evaluation scheme to ensure equity between similar roles in different roles across the UK.

The NHS Pay Review Body continues to make annual recommendations on pay as requested by governments in the four countries with the decision on any award made by the governments. The RCN, other unions, employers and UK governments submits evidence to the Pay Review Body.

This is usually an annual process. However, in 2010, the government imposed pay freezes and the 1% pay cap on public sector pay meaning that the latitude for the Pay Review to make recommendations on pay awards was restricted. Between 2010 and 2017NHS nursing staff were up to 14% worse off in real terms as a result of the pay cap. In response, the RCN launched the ‘Scrap the Cap’ campaign. In October 2017 the government announced it would lift the 1% pay cap and signalled their intent to negotiate a pay award for NHS staff. Ministers committed £4.2 billion to fund a deal, on the condition that the pay deal increased productivity.

In 2018, three-year NHS pay deals were agreed in England, Scotland and Wales. A key part of the deals included a restructure of Agenda for Change, which reflected the trade union negotiating priorities of ensuring the deletion of pay points as part of a move to increase starting salaries and the reduction in the time it takes to reach the top of most pay bands. This year is the second year of the three-year deal. To date, a deal has not been agreed in Northern Ireland.

Despite the deal being one of the best public sector settlements, it has been argued that the three-year pay deal did not reward the nursing workforce equitably as there was a difference in the percentage increase in reward for nurses at higher and lower pay bands. Those that were lower paid received a greater level of reward in percentage terms. This raises a question as to whether the focus on improving poor pay in lower pay bands will be at the expense of the rest of the workforce, and if so whether this creates a disadvantage for those within nursing.

This discussion by members will inform the RCN’s future pay strategy.