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Nurses’ pay over the long term: what next?

November 2021

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Key points

  • The NHS Pay Review Body (NHSPRB) approach has underpinned several major changes in the overall NHS pay structure since it was established in 1983. However, it is more than 15 years since the Agenda for Change reform, the last significant restructure which gave nurses a substantial pay boost.
  • NHS nurses’ basic earnings grew by 13% in nominal terms between March 2011 and March 2021. However, after accounting for consumer price inflation, this amounts to a 5% reduction in real terms. 
  • The NHSPRB plays a vital role in providing independent evidence-based assessment of nurses’ pay, an issue that is often contested and controversial with significant public funding implications. However, the success of the NHSPRB relies on governments accepting, fully implementing and fully funding its recommendations, which has not always been the case.
  • The government-imposed 7-year public sector pay cap, which ended in 2017, led to a significant drop in nurses’ pay compared to overall average earnings across the wider economy. The current pay system was emerging from the pay cap at a time of significant nurse shortages and the pandemic has further heightened concerns about workload, retention, motivation and the longer term supply of nurses.
  • After inflation, since 1989, female full-time nurses’ average weekly gross earnings have grown more rapidly than comparable public sector occupations such as police officers and secondary teachers, including in the last decade with its public sector pay cap period.
  • On average, hospital nurses’ earnings in the UK are lower than in comparable countries such as Australia, Canada, New Zealand and the United States – both in absolute terms (when comparing nurses’ pay across countries adjusted for the cost of living in each country) and in relative terms (when comparing nurse wages to the average wage of all workers in each country).
  • As the NHS focuses on how to ‘build back better’ from the pandemic, there are five key areas where the system could be improved:
  1. Pay progression mechanisms could be improved to better recognise staff with high levels of skills, experience and advanced practice contributions.
  2. Pay supplements should be targeted at hard-to-fill posts or high cost of living areas.
  3. There needs to be an assessment of how the current pay system supports pay equity. 
  4. Further flexibilities in pension contribution and payments could encourage more nurses to remain in work or return to work.
  5. There is a need to address the issue of emerging divergence in NHS pay processes across the four UK countries.

Our report looks at long-term trends in pay for UK nurses since the establishment of the NHS Pay Review Body in 1983 to the present day.

It explores changes over time, how nurses’ pay has changed relative to other public sector workers, and how pay for UK nurses compares to other countries.

As the NHS focuses on how to ‘build back better’ from the pandemic, the report explores whether the current NHS pay system remains fit for purpose. It highlights five key areas where the system could be improved to better address critical nurse shortages and support the future sustainability of the NHS more broadly.

The report underscores the urgent need for a comprehensive NHS workforce strategy which acknowledges pay as a powerful driver of nurse motivation and retention, and places nurse pay at the front and centre of policies to support the NHS’s post-COVID recovery.

Cite this publication

Buchan J, Shembavnekar N, Bazeer N. Nurses’ pay over the long term: what next? The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-RC19).

Related downloads

Nurses' pay report - datasheet (3.38 MB)
Slide deck (PPT) (4.71 MB)
Slide deck (PDF) (1.16 MB)

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