On 30 October, the Chancellor of the Exchequer delivered the autumn budget, setting out how government money will be spent in the coming year. This included funds to repair buildings affected by RAAC, promises to increase the number of hospital beds and diagnostic tests, but no mention of ways to fix the staffing crisis.
Ahead of the budget, we sent the treasury our view on England’s health and care services – and spelled out what needs to happen for them to thrive.
The nation’s health is faltering, putting the NHS and wider care systems under more pressure than ever. The government must act now to protect the nation’s health and the wellbeing of those working in health care.
Our health and care services have been chronically underfunded. Nursing staff are vital to these services, but with widespread staff shortages, there are not enough resources to meet the people’s health needs. This budget was a chance to change that.
Responding to the chancellor’s plans, RCN General Secretary and Chief Executive Nicola Ranger said: “The chancellor’s task was difficult, but the crisis in nursing remains unresolved. Thousands of staff continue to leave the profession, whilst new nurse numbers have collapsed. We are a safety-critical profession, worthy of infrastructure-style investment. This would make the NHS safer, local communities healthier and boost the economy.
“A depleted, worn-out and undervalued profession can’t bring down waiting lists and transform care. Nursing is crying out for change and will become increasingly restless without it.”
As the government gets ready to publish its 10 Year Health Plan in spring 2025, we say nursing must be at the heart of any plan to fix health and social care. Here are the big issues facing nursing, and the solutions we want to see from the government.
An important note on nations
In this article we’ll specify wherever possible if a subject is relevant for England, Wales, Northern Ireland, Scotland, or the whole of the UK. You’ll also find a dedicated section on the issue of funding for all 4 nations.
Training
The issue? We need more nursing staff in the right places. But recent figures show that the number of people studying nursing fell by up to 40% in parts of England between 2020 and 2023. Changes made in 2016 saw bursaries for nurse education scrapped, meaning students now pay more than £9,000 per year to train, while also working unpaid placements. We need a long-term plan to train nursing staff and fix the workforce crisis.
The solution? The government should fund tuition fees and living costs for nursing and midwifery students. Plus, fees should be reimbursed, or current debt forgiven for graduates affected by the removal of commissioned degrees in 2017.
The government must also provide funding to ensure all nursing courses are protected from university cuts, so they can continue to train the next generation of nursing staff.
Fair pay for nursing
The issue? Nursing pay has fallen by 25% in real terms over the last decade. Nursing staff leaving the profession cite low pay as a top reason.
The solution? The recent NHS pay awards do not close the real-terms pay gap, so the government must set out long-term plans to improve NHS pay, providing additional funding for a fair pay rise. The Agenda for Change pay structure must be reformed – many nursing staff are in a pay band that does not match their skills and experience.
The government must invest in the general practice workforce too: ringfencing funds for practice nursing pay and CPD that at least matches NHS conditions. Pay for nursing staff, in all settings and sectors, must make up for the years of underfunding they’ve experienced.
Retaining nursing staff
The issue? Nursing staff are leaving the profession in vast numbers. In a recent survey, more than half of respondents said they are likely or very likely to quit nursing in the next 5 years – thanks to a combination of low pay, workplace pressures, and mental health issues.
The solution? Fair pay for nursing. Fund Continuing Professional Development (CPD) for all registered nurses and nursing support workers. Fund mental health support for all nursing staff. And ensure free car parking for NHS staff in England, and sustainable travel options across the UK.
Safe staffing
The issue? Health and care services across the UK are often dangerously understaffed. In a recent RCN survey, 80% of respondents said there aren't sufficient nurses to meet the needs of patients safely.
The solution? The government must regularly calculate the size of the health and care workforce needed to meet the needs of the UK population, and reduce demand for acute care. These calculations must be published and used to inform workforce planning and the funding made available for nursing pay.
Legally enforceable nurse-to-patient ratios must be implemented for all health and care settings, to protect patient and staff safety. Nursing staff raising concerns about unsafe staffing must be legally protected.
Social care
The issue? Lack of funding and staffing in social care means we don’t have the services needed to care for the UK population. Patients are often unnecessarily stranded in hospital, because there is no social care available to them.
The solution? The government must provide long-term funding for social care services in England, based on our population’s health needs. This funding must provide social care nursing staff with fair pay and conditions – at least on par with NHS colleagues.
Mental health
The issue? Mental health services are not equipped to meet the needs of the UK population – this has a knock-on effect on other health services, as people in crisis are forced to turn to A&E.
The solution? We need significant funding to meet the mental health needs of the population. This must include funding to increase the mental health nursing workforce. This must be a separate, fully funded plan for England.
Corridor care
The issue? Corridor care has become normalised in many settings. In a recent survey, 37% of nursing staff working in a typical hospital setting told us that they had to deliver care in a corridor or other inappropriate setting on their last shift. It’s unsafe, undignified and unacceptable.
The solution? The government must provide funding to create additional clinical spaces, and the staff needed to work in them. Investment in social care is vital too – allowing patients to receive care in the community, and leave hospital sooner.
As part of the investigation commissioned by Health Secretary Wes Streeting and led by Lord Darzi to assess the state of the NHS in England, our evidence asked to eradicate corridor care, with mandatory reporting on each instance through the NHS Standard Contract.
Public health
The issue? People across the country are suffering from poor health and lowered life expectancy. Local authorities have less money to spend per person, and health inequalities have massively widened, disproportionately affecting people in the most deprived areas. If the government is serious about creating the healthiest generation of children, improving life expectancy, and growing the economy, it must address this.
The solution? Local authority public health budgets in England need long-term investment now. Funding should be decided based on what’s needed to prevent health issues and reduce health inequalities.
Global health
The issue? There is a global nursing workforce shortage, which the UK is exacerbating in some countries by relying on overseas recruitment to solve our own workforce crisis.
The solution? The government must recognise the importance of global health and the international nursing community by reinstating the Official Development Assistance budget to 0.7% of Gross National Income, to bring the UK back in line with the United Nations target.
Funding for Scotland, Wales and Northern Ireland
The issue? Nursing staff in every nation deserve fair pay. Patients in every nation deserve safe care. But often, areas have been left behind. Nursing staff in Northern Ireland, for example, have had to wait for pay offers time and time again.
The solution? We need greater transparency from the UK government around funding for devolved administrations, which have a responsibility for health and social care services. Central funding from the UK government must accurately reflect the level of investment needed to deliver safe and effective care in every nation.
Find out more
- Discover how to get involved and fight for the change that nursing needs right now.
- Read about RCN members making positive changes in their workplaces.
