Nursing left behind on pay progression, RCN report warns

An RCN report shows the scale of the problem facing NHS nurses who are struggling to progress in their careers. The Left Behind report shows that too many nurses remain stuck at the entry-level pay band for years, despite often working at a higher level, with serious consequences for staff morale, patient care and the sustainability of the health service.

Across the UK, many nurses are employed at band 5, the band newly registered nurses start at. In England, 44% of nurses are at this level, with similarly high figures in Scotland (53%), Wales (44%) and Northern Ireland (49%).

Compared to other health professions, nurses are falling behind – they are more than twice as likely to remain at band 5 than allied health professionals.

This report outlines the detailed case the RCN has been making to governments. In Scotland, the band 5 nursing roles review was agreed in the review of Agenda for Change, which was part of the 2023-24 pay deal.

The review is already delivering results, with the majority of band 5 nurses who’ve had an outcome from the review being successfully rebanded.

We’re calling on all UK governments to build on this progress, reforming pay structures and processes so nursing staff can progress more fairly and quickly, beginning with band 5 to 6 progression.

Professor Nicola Ranger, RCN General Secretary and Chief Executive, said: “This evidence paints a frustrating picture of stalled careers, inequities and missed opportunities. Nursing is stuck in a bottleneck, with staff waiting years for progression while their responsibilities grow daily. We work with more responsibility and autonomy than ever before, but are not rewarded for it. Nursing is worth more.

“Our evidence also offers a clear path forward. Governments across the UK must improve band 5 to 6 progression, so the NHS can retain skilled nurses, improve patient outcomes and build a fairer, more sustainable workforce.”

More than 56,000 nurses in England have been at band 5 for more than seven years, representing one in seven of all nurses.

This lack of progression is not only demoralising, but also linked to higher turnover, with band 5 nurses an estimated 17% more likely to leave NHS hospital and community services compared to those at band 6.

The report also brings together the significant body of research that shows a range of benefits to staff, services and patients of having more nurses at higher bands, including a recent study that makes a connection with fewer patient deaths.

One in four nurses in England are at band 7 or above, while one in three occupational therapists and nearly one in two physiotherapists and speech and language therapists have reached those higher levels. This disparity means nurses are missing out on opportunities to develop their skills, take on leadership roles and contribute fully to the health service.

Ethnicity plays a role too, with nurses from Asian or Asian British and Black or Black British backgrounds twice as likely to be at band 5 compared to their white colleagues. These disparities raise serious questions about fairness and equity in career progression.

Nicola said: “Career progression is not just a professional issue, but a moral one. This matters not only for staff, but patients too. Nursing staff deserve recognition for their skills and dedication.

“Nursing staff carry all the risk as the 24/7 profession giving the majority of care, but we do not get the right reward, respect or value placed on us. The message is clear: nurses should not be left behind.”