The relationship between the NHS, the government which funds it, and its staff has recently soured still further with a once unthinkable nursing strike planned across the UK. While it reflects wider dissatisfaction, this was immediately triggered by this year’s pay settlement for Agenda for Change staff. Junior doctors, too, will be voting on strikes “after the government failed to meet the BMA’s demand for pay restoration”.
What is the truth about how much real pay has fallen, or been restored, for different NHS staff groups? To provide answers, we have updated our earlier chart showing staff pay in real terms since 2010. Close followers might notice an improved methodology has produced slightly different results (see the data notes).
Real terms NHS pay by financial year, consumer price index, 2010/11 baseline.
Nuffield Trust analysis of NHS Digital salary data and Annual Survey of Hours and Earnings (ASHE) data for private sector earnings estimates.
These figures show again that NHS staff pay remained lower in real terms in 2021/22 than it was in 2010/11. As we saw in previous years, the drop has been sharpest among the highest paid, with the lowest paid somewhat protected. Doctors, nurses and all staff saw some recovery during 2020/21, with a relatively higher pay settlement and a slowdown in inflation as Covid-19 hit the UK, but this stalled or went into reverse during 2021/22.
For the more clearly defined staffing groups, we also project the effects of the recent pay offers for doctors and other staff into the next financial year. This shows a marked decline for all staff groups, driven by a sharp rise in the price level due to the war in Ukraine and fall in the value of the pound.
Reversing the previous trend, foundation year 1 doctors at the start of their career would be hit especially hard. Their pay would drop from 94% of its 2010/11 level to 87%. Salaries among consultants, nurses and health visitors would drop by another few percentage points.
The starting salary for a nurse joining the NHS was comparatively protected across the period, being only 3% lower last year than in 2010/11. However, it too would be predicted to drop sharply in the current year, by four percentage points.
We also used the Annual Survey of Hours and Earnings to estimate pay in the UK’s private sector for comparison. This takes a snapshot of pay each year in April: for each NHS year, we averaged across the snapshot at roughly the start and end, using mean gross pay for all private sector workers. On this basis, wages in the UK’s private sector have done better across this period than any NHS group. The underlying figures suggest they have now overtaken on average the weekly equivalent of the annual average among nurses.
There is good reason to think that pay is not necessarily the dominant immediate factor driving staff attitudes to working in the NHS. Work-life balance, feeling undervalued, exhaustion and ill health dominate the various – imperfect – measures of why staff leave the service. However, with the difficult current situation in the NHS there is a real risk that these factors too will worsen. We have criticised limited progress in understanding and planning how to keep the workforce in place.
There is a risk that forthcoming strikes and dissent over pay are only a staging point in a darkening relationship with health service staff, to the detriment of the service and its patients.
*Update 16/12/2022: We have now expanded on the above analysis to include other key NHS staff groups. Please see this chart.
We used NHS Digital salary data for hospitals and other trusts to obtain average total pay in NHS financial years, which span from April to March, for different staff groups. We then adjusted this for the average proportion of a full-time role worked by staff and for the average price level over the same year as measured by the Office for National Statistics’ Consumer Price Index.
This shows the goods and services staff could afford with their salaries each year, relative to 2010/11.
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