Pay spine plans stopped: government 'failing nursing, the NHS and patients'

A major overhaul of the NHS pay structure to encourage better recruitment and retention of nursing staff has been stopped by the UK government.

Confirmation that a separate pay spine for nursing won’t go ahead is a huge let down for the profession, after nursing staff were promised major change by this UK government.

RCN General Secretary and Chief Executive Professor Nicola Ranger said: "The government had a chance to set nursing on a new path, where it's valued, understood and rewarded fairly. It is now clear that ministers and the government are not in fact ‘on the side of nurses’. In under a year in power, they have attached themselves to a status quo which is failing nursing, the NHS and patients." 

The previous UK government announced it would explore a nursing pay spine as part of the negotiated offer in March 2023.

We conducted research among members with a majority in favour of a separate nursing pay spine. In January 2024, the Conservative government launched a consultation exploring a separate pay structure, also known as a pay spine, for nursing staff working for the NHS in England.

Despite the government’s official response confirming that 94% of nursing staff said a separate nursing pay spine would improve career progression and professional development, the proposal has been ruled out by ministers a year after the consultation closed.

More than 7,000 RCN members working across the NHS and social care helped shape our response to the consultation. Thousands told us their job descriptions don’t match the reality of their work.

In our submission, we told the government that nursing needs a fresh start – it has transformed since the creation of the Agenda for Change (AfC) pay structure more than 20 years ago and doesn’t reflect the skill and responsibility of the modern registered nurse.

We also said it was actively harming recruitment and retention in the nursing workforce and a pay reform strategy was desperately needed.

Nicola said: “To achieve the three ‘shifts’ in the forthcoming NHS plan, the government needs a booming nursing profession. It has just taken a large step away from that desired future. A nursing pay spine had excellent patient care at its centre too, with those giving hands-on treatment rewarded for their expertise and wealth of knowledge. 

“Nursing has evolved beyond recognition. It is a highly skilled, safety-critical profession and we work autonomously to deliver the vast majority of care. We have modernised and taken on more responsibility but are still forced to contend with a pay and grading structure which traps the majority of nursing professionals on the lowest pay bands possible, only a small minority able to progress by moving away from delivering patient care. This isn’t just demoralising to those currently working in our NHS, but actively harmful to attracting the best nurses of the future to stay.”

The pay spine announcement comes as ministers confirmed plans for addressing other issues unrelated to pay for NHS staff, including tackling violence in the workplace, job evaluation and career progression.

However, we warned that the measures come with no evidence of additional funding for delivery.

Meanwhile, on nursing career progression, the recommendations agreed to by the government will do little to address the tens of thousands of nurses “trapped” at band 5, unable to progress in the current AfC structure.

Nicola added: “Nursing staff were promised major change, but what has been announced today amounts to little more than tinkering and in no way improves nursing career progression. It has taken almost two years to reach this point. Nursing has waited patiently and has been bitterly let down.”