14 | Nursing in Practice | Spring 2023
COLUMNIST
Nursing strikes have exposed
anomalies across the NHS
Marilyn Eveleigh says ongoing industrial action has highlighted frustrations within the healthcare system
Marilyn Eveleigh , nurse adviser and independent trainer in East Sussex
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I suspect everyone in the profession has been following the nurses ’ strikes , regardless of your stance on the matter . From my point of view , the dispute has highlighted anomalies about our healthcare system that frustrate me – as a nurse , a patient and a taxpayer .
First , the Government is the NHS paymaster but not the employer . The NHS trust is the employer , required to ensure all its employed staff are qualified , safe and supported to deliver services . The trust bears the burden of staff absences and vacancies plus the consequent cancelled services and struggles to sustain standards of care . So why can ’ t trusts have the flexibility and freedom to pay nurses according to the needs of the service ? Shortages in specific clinical areas would attract higher remuneration – and where there were geographical shortages , improved pay and conditions could be offered to attract nursing staff .
Second , why aren ’ t NHS nurses paid at their market value ? In fact , trusts are employing nurses at a competitive market rate to cover the 48,000 nurse vacancies – but they are from nursing agencies where pay is almost two-thirds more than an NHS nurse . The Government pay-cap agreement for agency nurses is regularly breached by trusts who have no choice as they need to meet safe staffing levels .
A 2018 report estimated the billions spent on agency and bank staff to plug nurse gaps that year could have financed 66,000 Band 5 nurses . Now , according to a Labour Party analysis , year-on-year agency staff costs have increased by a staggering 20 %. As taxpayers , we now pay more than £ 800m every year on agency nursing fees yet NHS nursing pay has seen a 10 % decline .
I think the public would like to see their taxes fund an NHS nursing pay increase , eroding the need for agency staff .
The Government maintains it cannot afford
Why can ’ t trusts be free to pay nurses according to the needs of the service ?
an increased NHS pay award . This is madness . While insisting it values nurses , it claims all NHS staff would need a rise . But why should an award for nurses require one across the whole workforce ? Yes , there is a blanket Agenda for Change contract for all NHS staff but I think funds should be targeted at the greatest need . The 2022 NHS Staff Survey indicated 72 % of registered nurses were ‘ most dissatisfied ’. For every 10 NHS vacancies , four are for a registered nurse – that directly and significantly impacts on the seven million patients on the waiting list . Needs must : be selective and improve remuneration to retain nurses . And finally , general practice nurses are not under AfC terms and conditions . They may be in the NHS Pension Scheme and earn AfC pay rates but they are employed by independent contractor GPs and can negotiate their own pay and terms . Although there are frustrations , GPN job satisfaction is generally high and turnover is low , with a good work-life balance offered by small , flexible employers .
Perhaps the NHS should learn from GP nursing , which is now the largest nursing group and of course the jewel of primary care .
These are just some of the organisational issues now vexing me . What bugs you ?