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Nursing strikes have exposed anomalies across the NHS


Industrial action has highlighted frustrations for nurses within the healthcare system, says Marilyn Eveleigh

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 maintained it could not afford an increased NHS pay award. This is madness. While insisting it values nurses, it claimed 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? 

Marilyn Eveleigh is a nurse adviser and independent trainer in East Sussex