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Government must fund a pay rise to avoid ‘difficult trade-offs’, says NHSE

Government must fund a pay rise to avoid ‘difficult trade-offs’, says NHSE

Pay remains a big part of NHS staffing problems, but without government funding any pay rise for nurses would lead to ‘difficult trade-offs’, NHS England has said.

In evidence submitted to the NHS pay review body on January 11th pub released today NHS England (NHSE) said that ‘pay inflation’ represented a ‘significant material cost pressure to the NHS, adding that this pressure would result in ‘difficult trade-offs’ between the NHS’s strategic targets, including reducing the backlog and improving urgent care.

The NHS pay review body (PRB) is the agency responsible for producing a recommendation for the Government on NHS staff’s pay awards for the year.

The evidence submitted by NHSE said: ‘Today’s labour market is increasingly competitive as a result of the lowest rates of unemployment in the country since 1974. Vacancy levels across most staff groups are high, despite the NHS workforce having grown significantly over recent years, with more people employed by the NHS now than at any time in its history.

‘Leaver rates are now climbing, having fallen dramatically during the pandemic. To ensure services remain appropriately staffed and safe, NHS organisations have significantly increased their use of temporary staff, through both bank and agency shifts.’

NHSE noted that, for nurses in particular, ‘significant shortages remain given the increasing demand and significant numbers of nurses leaving the NHS.’

Even though the total number of nurses in NHS workforce has grown by about 11%, the use of temporary staff has also climbed by 22.9%. According to NHSE substantive nursing vacancies stood around 41,500 (full time equivalent) in October 2022.

The NHS staff survey found that pay, for the first time, was now among the top five reasons cited for nurses leaving the NHS. Alongside 40% of nurses reporting feeling burnt out by work as less staff are left to deal with more patients.

However, despite the need to improve retention and recruitment, the NHSE evidence points out that no increase in pay is plausible without additional funding from the Government.

The evidence writes: ‘The 2022/23 pay award for staff was not supported by additional investment from central government, which led to difficult trade-offs within the existing NHS budget, and affected service delivery.’

NHSE continued to say that any additional pay costs ‘if not supported by additional investment, is again likely to result in difficult trade-offs during the year on staffing numbers, initiatives to support staff and the ability of the NHS to deliver on its key strategic priorities – reducing the elective backlog, improving emergency care and improving access to primary care.’

In a tweet, Nick Davies, programme director for the Institute of Government, summarised NHSE’s position as saying: ‘We have serious workforce problems and staff are leaving because of pay but unless govt gives us more money so we can afford suitable wages we can’t do much about backlogs and other problems’.

NHS Employers also made their evidence to the PRB public today, telling the body that employers are ‘increasingly concerned about the impact of the delay of the pay award and the inability to implement this from its effective date of 1 April each year.

This comes after the PRB confirmed that the Department of Health and Social care was delaying the bodies work on a recommendation by missing the required deadline. The DHSC is now over 20 days late to submit evidence to the body.

NHS Employers warned that pay was becoming an increasingly important issue for staff as wages across the NHS fall relative to the private sector, ‘shaping views of staff on the attractiveness of alternative employment offers for working outside of the NHS, even for relatively small and marginal differences. ‘


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