Why Sunak must do a deal with the nurses

Rishi Sunak is missing a trick. The chancellor who made his name with Eat Out to Help Out could so easily turn himself into the Prime Minister who Got the Nurses Back to Work rather than leaving them standing on the picket-line.  

And this is how. He should begin by inviting Pat Cullen, head of the Royal College of Nursing union, Amanda Pritchard, chief executive of NHS England, Philippa Hird, chairman of the NHS England, Wales and Northern Ireland Pay Review Body and Steve Barclay, the health secretary, for an emergency meeting at Number 10 to bang heads to avert next week’s strikes. 

What’s more, they should be locked in the Cabinet room until they come up with a solution. To kick-off the meeting – which should be held this weekend – the Prime Minister should admit that the nurses are quite right in saying they are underpaid, and agree to at least a 10% increase – that’s 5% more than the current offer as recommended by the Pay Review Body. This is not as much as Cullen and the RCN are demanding – which is 19.2% – but would show that the government is serious about paying nurses more and that there will be further reviews.

According to the government, every 1% pay increase for Agenda for Change staff would cost around £700 million per year. Barclay has said the RCN’s demands (19.2% on more recent figures) would cost “£10 billion a year” – so if the government were to pay the extra 5-10% then one assumes adding another 5% will cost £3.5 billion. That seems a reasonable cost for rewarding nurses at such a critical time for the country and could be found out of savings elsewhere in next year’s huge £180 billion budget. More of that later. 

As important – if not more important – as the actual pay award, the PM would find out from meeting Cullen and Pritchard face to face what action is needed to solve the far greater challenge threatening the NHS – how to attract and retain nursing staff. 

More than 40,000 nurses have left the NHS over the last year and, according to Cullen, there are 50,000 current vacancies. Nurses are leaving for a variety of reasons – not just better pay in the private sector but also many claim burnout or exhaustion. More worryingly, around two-thirds of those leaving are under 45.

Such a high attrition rate has a cost in terms of experience lost to the NHS as well as a financial impact. Indeed, the RCN says international recruitment for nurses costs 2.4 times as much as a pay rise of 5% above inflation, according to research done for them by consultants, London Economics. What’s more it’s estimated that each international nurse recruited costs the government £16,900, compared to the £7,100 that it would cost to give a pay rise to a nurse considering leaving the workforce.” 

According to a report, the government spent £4.3bn on agency nurses over the last five-years. 

The NHS, together with Health Education England, are working flat out on their ambition to meet the target of 50,000 more nurses by March 2024 by encouraging more undergraduate nurses, expanding the postgraduate pre-registration entry to nursing, encouraging those who have left to return as well as improving the apprenticeship route into nursing. According to the Pay Review Body, apprenticeship nurses have very low attrition rates and way higher retention levels than other nurses whereas a high proportion of student nurses taking degrees drop out half-way through their courses.  

Is there more that can be done, either for those taking the vocational route or degree level nursing? Better starting salaries would be a good lure for all nurses – particularly apprenticeships – but maybe the profession needs a real boost, a big initiative to improve the mood. How about the  government offering student nurses free tuition fees for the next five years until there is a steady supply coming through? If the labour market isn’t working – and it clearly isn’t – then the market needs to adjust to make nursing more attractive again but also bring back honour to the profession.

No one watching and listening to many of the nurses taking part in their first ever strike being interviewed on TV and the press could doubt their commitment to their work. As one senior nurse explained, on the verge of tears, she had come into nursing to care for patients, to feed them, hold their hand, clean their teeth and even say prayers with them. She couldn’t do that anymore, she explained, because there were only two nurses on the ward.   

What will fix this crisis? Other than a higher pay award, what else is needed to stop next week’s strikes – and restore faith among the 100,000 or so nurses who were prepared against their better nature to walk-out?

That’s what Sunak at the crisis meeting he should hold should be asking the RCN’s Cullen, Pritchard and Hird. He should perhaps also point out to Cullen that her claims that the Pay Review Body is merely an extension of the government and a useful stooge to deflect blame, are unfair. If you read the 188 page report, published by the body in July this year, you will see that its eight members clearly understand the problems of low pay. As the report states: 

“Although the Cost of Living support package will provide support to those who need it most, it is expected that income growth will continue to sit below price growth in a way that severely impacts our remit group. The majority of AfC staff are in Bands 1 – 5, and so the basic hourly pay of most of our remit group is below median hourly earnings across the economy as a whole. Lower income households spend a higher proportion of their incomes on food and non-alcoholic drinks, housing, fuel and power. Thus, much of our remit group is especially vulnerable to current high inflation.”

That doesn’t sound like the output of a stooge. 

But in return for agreeing a 10% pay offer, Sunak should also play hard ball with Pritchard, demand that she and her managers find ways of improving productivity within the health service and make savings or readjustments to next year’s whopping £180 billion budget. As Wes Streeting, Labour’s shadow health secretary, said recently, the NHS is not a shrine but a service. 

It’s become something of an easy trope that the NHS is over-loaded with managers but what is true is that much of the middle management is bloated and of poor quality and needs shaking-up big-time. And there are jobs that can be cut: you only have to look at the page after page of tables in the PRB’s report which show the extraordinary levels of bureaucracy in setting pay grades (cut them down) and the itemising of the percentage of genders and ethnicity of NHS workers to see where the focus needs to shift. Back to paying and training the nurses: they are the glue that holds together our healthcare system.      

Until now, Sunak has taken the party line. He claims the nurses’ pay demands are unaffordable, that they will lead to even higher inflation. Yet that does not have to be the case. As economist Doug McWilliams wrote for us earlier this week, higher public sector pay awards will increase inflation but there is a solution, “which is to pressurise the public sector to get its productivity back at least to the level of three years ago. This would generate some cash which could be used to give higher pay to those for whom it is needed.” 

If Sunak – and his colleagues – also believe that if they sit these strikes out, the public will blame Labour, they are deluded.

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