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Nursing staff are effectively working one day a week for free after a decade of real-terms pay cuts

Press Release 28/10/2022

  • Experienced nurses’ salary has fallen 20% in real terms since 2010 
  • This means nurses are effectively working unpaid one day a week 
  • Findings come as less than a week to go until ballot of 300,000 RCN members closes 
  • Separately, polling finds people are shunning the NHS amid lengthy delays as waiting lists hit record levels 

The goodwill and expertise of the profession is being exploited by governments across the UK, the RCN says, with new analysis showing that experienced nurses are working one day a week for free because of a decade of real-terms pay cuts.  

Researchers at London Economics, commissioned by the Royal College of Nursing, looked at the pay awards NHS Agenda for Change staff have been given in England, Wales, Scotland and Northern Ireland since 2010. They found that in real terms, based on a five-day week, the salary of an experienced nurse has fallen by 20%. 

This reduction, at a time of a cost-of-living crisis, means nursing staff are facing incredible financial hardship. Governments across the UK are gripped by a workforce crisis, with tens of thousands of posts vacant across the UK making services unsafe. 

It comes as new polling shows nearly half of Britons (46%) have avoided using NHS services in the last 12 months, citing long waits (50%) and the level of pressure on the NHS (42%) amid concerns about lengthy waits for care. Earlier this month (Oct), the waiting list for routine hospital treatment in England topped seven million for the first time. 

RCN General Secretary and Chief Executive, Pat Cullen, said: “This exploitation of nursing staff cannot be tolerated any longer. 

“In the pandemic, the politicians urged the public to clap for carers, but now they are wilfully ignoring nursing’s astonishing efforts and expertise. 

“Ministers have stubbornly resisted the requirement to address the workforce crisis, including paying nursing fairly, instead rejecting any opportunity to act. They have taken advantage of nursing’s goodwill and steadfast determination to act in the interests of their patients. 

“Our members have had enough. Expecting nursing staff to work one day a week for free is totally unacceptable. 

“Patients deserve better from their politicians. Despite nursing staff working increasingly long hours and doing all they can, safe and effective care is being undermined by the failure of governments to act.” 

There are a record 47,000 unfilled registered nurse posts in England’s NHS alone. 


Notes to Editors  

The full report from London Economics is available here.


The London Economics analysis found salaries of NHS Agenda for Change (AfC) nursing staff have not kept up with inflation over the last decade.


 A large proportion of nursing staff are employed at the top spine point of each individual AfC band, with particularly large numbers situated at the top of Bands 4, 5 and 6. For the majority of these nursing staff across all parts of the UK, real terms salaries have declined by as much as 20% since 2010. A 20% real-terms pay cut is the equivalent of working a day a week unpaid, compared to NHS AfC salary levels in 2010. 


This calculation assumes that the pay award committed in Northern Ireland will be implemented, which hasn't happened yet due to the lack of a functioning Executive. Before the pay award is implemented, the true declines in real pay in Northern Ireland are larger than they appear in the figures for England


Polling from YouGov was carried out online. The figures have been weighted to be nationally and politically representative of all GB adults (18+). Total sample size was 1,791 GB adults. Fieldwork was undertaken between 22 - 23 September 2022.When asked if they have avoided using NHS services when they felt unwell, or required treatment in the last 12 months nearly half of respondents (46%) say they have done so once or more.  

  • 11% have avoided NHS care on many occasions 
  • 21% have avoided NHS care on a few occasions  
  • 14% have avoided NHS care once in the last 12 months 

When asked why people chose not to seek care in the NHS, half of respondents avoiding care (50%) felt they would wait too long to be seen; more than one in four (42%) wanted to avoid putting additional pressures on the NHS; and nearly one in 10 (9%) received help from a private health provider.


Separately, in a survey with over 20,000 respondents from nursing and midwifery staff carried out by the RCN in March 2022, respondents were asked to report on staffing levels and their experience of their latest shift. It found that almost two-thirds of respondents worked additional time (63%). Of these, almost eight in 10 (77%) were unpaid for these additional hours.  


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