, February 24, 2024

In the technology age NHS nurses must be paid more

  •   5 min reads
In the technology age NHS nurses must be paid more

Nursing may be one of the last jobs to be lost to automation, and that is the killer reason why NHS nurses' pay must rise. As for why nursing pay is so low, there is one overriding reason, and it has to do with gender equality.

Should nurses be paid more? The UK government has awarded nurses a  three per cent pay rise, meaning that after allowing for inflation, their wags have actually fallen.

Health and Social Care Secretary Sajid Javid said: "NHS staff are rightly receiving a pay rise this year despite the wider public sector pay pause, in recognition of their extraordinary efforts.

But three per cent, really?  Words and action have to support each other. If I were to say 'I love you' and then promptly hit you in the face, you might be entitled to question the authenticity of my claim

So, what are the arguments for  higher wages for nurses?

Nuance behind the nurse's pay debate

At first glance, the case for higher nurses pay is not clear-cut, but the argument becomes much stronger when you look closer. When you factor in how technology is changing the world, the case for higher nurses pay in the UK becomes overwhelming.

According to The Royal College of Nursing, an NHS Nurse's average annual salary is £33,384.  The median salary across the UK is £31,461. Those who are less sympathetic to the nurse's cause, see how average pay to nurses exceeds the average salary and ask, why the fuss?

There are three fundamental problems with that argument. Firstly, the mean salary across the UK is £36,611, so the average pay for nurses is less than average. Secondly, the only way a nurse can earn the stated average of £33,384 is by doing a lot of overtime, or after seven years experience as a band six, which requires an extra qualification. Band six for a nurse is a junior management position.

The salary pertaining to a band seven or senior charge nurse (in the case of a female, also called a senior sister) peaks at £44,000. This is an important position with considerable responsibility, which is typically only earned after many years of experience and requires additional qualifications.

Even the next tier, band eight, also called matron, only starts at £45,000. To reach this level requires many years of dedicated work, qualifications and several promotions. Most hospitals only have a handful of band eight nurses. A band eight nurse is probably the equivalent of brigadier (or at least a colonel) in the army, and the starting salary is £45,000. (A colonel's starting is £91,900 and. A brigadier's starting salary is £108,00.)

The third reason is the killer argument.

These days, nursing is typically a graduate position. This is changing slightly so that some new nursing positions won't require a degree, but the vast majority of newly qualified nurses have degrees, and that, of course, means, in most cases, student loans to repay.

It is not reasonable to compare nurses salaries with the national average salary because the average working adult doesn't have to repay student loans.

The case for and against a higher minimum wage

Nursing agencies and why the NHS shoots itself in the foot

But when you look closer still, things go from bad to worse, and one can't help feel there is either incompetence or something deliberate going on.

Because of the situation outlined above, each ward in a hospital has a challenge meeting staffing requirements every day. With the ageing of the population, this problem can only become more acute.  As a result, hospital wards have to resort to hiring agency nurses to work for just one shift. One nursing agency pays their nurses an hourly rate ranging from £32 for the equivalent of band four, all the way up to £116 per hour.  Furthermore, when a ward hires an agency nurse, not only do they have to pay the nurses hourly rate, they have to pay a similar amount as a fee to the agency.

The above system would work fine if it was used sparingly, only in emergencies. But because there is a shortage of qualified nurses, which is hardly surprising considering the cost of university education and the pay rates, hospitals are making extensive use of these agencies.

Such is the extent of this usage that it is even possible that the NHS could save money by increasing pay to nurses, thereby increasing the supply of nurses wanting to work for the NHS, reducing the necessity to employ nursing agency staff at a much higher cost.

Lesson from industrial revolution

At this point, we need to take a detour for one paragraph:

During the 18th and 19th centuries, periods of super-rapid innovation, wage increases often lagged behind increases in productivity. One of the reasons for this, according to the economist James Bessen, is that at first, the skills acquired by a worker at one factory were not transferable to other factories. So the employer had a monopolistic wage bargaining position. This changed when technology became more homogeneous, and then, at last, both wages and factory profits began to rise in tandem.

There is a good analogy between the 18th and 19th-century practices in factories and modern nursing in the NHS. Imagine a nurse leaving their position at a hospital to join a nursing home, an agency, or even another hospital in extreme situations. And then say they decide to return to their original employer. In most industries, the returning worker with their new experience and fresh perspective will be welcomed. With the NHS, it is often not like this, instead a nurse will usually be required to re-join the hospital on a lower grade, and even if the grade isn't lower, they often see their wage drop as all their years of experience is no longer factored in.

Just like 18th and 19th-century factory owners, the NHS has a monopolistic wage bargaining position. Not only does this make things harder for nurses, it reduces the flexibility of the labour market, reducing dynamism.


So, why is it so bad?  The problems outlined above are apparent; a cursory examination reveals the absurdity. It is difficult to avoid the conclusion that the very highest level, perhaps government level, is either incompetent or deliberately undermining the NHS, preparing the way for privatisation, a political timebomb.

Why it matters

In the technology age that is approaching, many jobs will be lost to automation. But jobs such as nursing and caring roles will be among the last to be automated, if they ever are. Sure some tasks will be automated, but by definition, human to human contact is not something computers or robots can replace.

In this technology age, how do we want society to be structured? Do we want to increase inequality and increase the gap between technology workers and workers engaged in one-on-one human-to-human interaction?

In any case, nurses literally save lives, every day. As society ages, the demand for healthcare will increase. Do you really want your future healthcare to be reliant on poorly paid workers?

How has it happened?

There is one more question that needs asking. Why is nursing pay so low?

There was a time when people used to talk about the police, teachers, firefighters, doctors and nurses in one sentence, as an example of poorly paid workers.

All of these job functions have seen significant pay rises except for nurses. Why is this?

It is hard not to conclude that the reason why nursing is poorly paid in the UK NHS is because women dominate the profession. A similar problem applies to carers and pharmacy assistants.

Diversity campaigners call for greater gender equality within professions, but they overlook the issue of gender equality across the same professions.

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