All participants pointed to the context of the high cost of living in London, in the context of a national decision not to award a 1% pay rise to NHS staff , and in particular the issue of housing affordable to nurses (and other health care staff).
Page 48 of 64 Drennan et al. 2015. Adult Nurse Turnover & Retention: South London Project Report Participants were conscious that remuneration was one factor in the attractiveness or less attractiveness of posts. Most were clear that it was only one factor but an important one. Solutions to problems were often interconnected to the other aspects of nurses working lives such as career development. Under this topic the following were discussed: high cost area supplements, differently graded posts, rates of pay for agency staff. We touch on each of these in turn.
High cost area supplements was one issue discussed. The senior managers described to the
attraction of similar nursing posts in London Trusts that could offer the Inner London high cost area supplement (20% of basic salary subject to a minimum £4117 and maximum £6,342) compared to that for outer London (15% of basic salary subject to a minimum payment of £3,483 and a maximum payment of £4,439) - “yes of course that two thousand pound a year difference means a lot in take home pay when it’s only a short bus ride difference to another hospital up the road“. For those working in designated outer London areas, they were conscious of the draw of a higher supplements but talked of other ways in which to make nursing posts attractive in their Trusts, linked to for example career development. One Trust which had sites which were inside and outside the areas for attracting supplements had taken the decision to give all staff the higher supplement irrespective of place of work (see Box 5.5).
Higher pay for nurse by temporary staffing agencies. A number of participants discussed the
problem of rates of pay for agency nurses as being often higher than those of nurses on permanent contracts and therefore becoming a draw to nurses in their Trust . “So anecdotally we ‘ve heard that the agency nurses come and talk to their colleagues about their pay and are signing up people with the agencies …we have a very good in-house bank for nurses but they’ve seen their numbers drop “. A number of respondents argued that there should be a sector wide agreement on a ceiling to be paid for agency staff to try and manage both the cost but also the pull of such wages. One participant described local HR events modelling the losses in the long term to their staff if they left the NHS to work for agencies e.g. loss of NHS pension over time (see Box 5.5).
Grading of clinical nurse specialist posts. Some reported that clinical nurse specialist posts in some
tertiary specialities were more highly graded in Trusts outside of London or required less evidence of qualifications or expertise than in the London tertiary centres. They reported this pulled nurses away from their London Trusts, particularly those nurses with less experience who might be the ‘supply pipeline’ or successors to those experienced clinical nurse specialists nearing retirement. “ So they are kept at band 5 because they haven’t got all the courses the unit says they have to have for band 6 but they can go out of London and get the same job at band 6 without needing this and that expected here. “ Again solutions were offered linked to career development and being able to offer further training and qualifications.
Grading within band 5 posts. The largest groups of nurses are in the Band 5 salary scale and this is
one group in which senior nurses expected movement as these were those new to nursing and often at early stages of their career. One issue raised was how to differentiate between newly qualified nurses and those who were more competent and capable, both to attract and retain them. One Trust reported that they were one of a number of Trusts, looking at using flexibilities in the Band 5
Page 49 of 64 Drennan et al. 2015. Adult Nurse Turnover & Retention: South London Project Report pay scale to create a differential between newly qualified (and junior) staff nurses from the more capable senior staff nurses. This was described as creating a ‘5.5’ grade (see Box 5.5).
Affordable Housing. Participants pointed to the attractiveness, particularly to those with families
and in mid-career, of moving out of London to work and live in areas of more affordable housing. There was also a view expressed that many younger people come to London to train and work as nurses then move back to their ‘home ‘ region as they get older and that factors such as affordable housing contribute to those decisions. Some Trusts were reported to have single accommodation still to rent to its workforce but it was of small quantities and tenancy was time limited. A view point was put forward that affordable housing for key health service staff was a sector wide issue and solutions went beyond an individual Trust. A suggestion was made that it was an issue for all key staff in any Borough and needed to be raised with Local Authorities and other London wide bodies such as the Greater London Authority.
Ensuring the same high cost area supplements were the same across all Trust sites and not different at different sites. Further information Epsom and St. Helier University Hospital NHS Trust Kevin Croft, Director of People and Organisational Development [email protected]
Creating a 5.5 band staff nurse grade for further information contact Debbie Hutchinson, Assistant Director of Nursing King's College Hospital NHS Foundation Trust Email: [email protected]
Demonstrating the financial and other consequences long term in working for a nursing agency at St. Georges University Hospitals NHS Foundation Trust contact for further information Director of Human Resources Wendy Brewer [email protected].
BOX 5.5.EXAMPLES OF ASPECTS OF REMUNERATION
We turn know to the type of nursing work and progressing nursing career.