Matter for Discussion: Cost of living

The Nursing Associate (NA) England only role was introduced in response to the Shape of Caring Review (Willis, 2015) to help build the capacity of the nursing workforce and the delivery of high-quality care. The role was announced by the Government in 2016 and developed by Health Education England (HEE), who oversaw an initial 35 test sites across England

The rising cost of living across all four countries of the UK, alongside the diminishing spending power of nursing wages and the additional costs many nursing staff face just to support their employment have reached unsustainable levels.

Whichever sector nursing staff work in, they all face the same pressures: rising fuel costs, inadequate mileage rates, parking fees, work-safe footwear, laundry costs, registration fees, eating in work canteens or on the go, childcare and student debt. All contribute to the cost of working.

The challenges facing nursing staff are being compounded by record rises to the cost of living. The average RPI inflation rate for 2022 was 11.2%, with people feeling particular pressures from rising fuel and food prices. On top of these pressures, increases to the cost of borrowing have resulted in higher monthly mortgage and rent payments for many. 

Nursing staff working in the NHS have been subject to a long-term degradation in their wage levels and many have faced increases in pensions contribution. For example, the value of the salary for a Band 5 nurse has dropped by 20% between 2010 and 2022.

The number of staff opting out of the NHS Pension Scheme doubled between 2021 and 2022, with around 550 members of staff opting out every day between April and July 2022. Many staff members said they decided to opt out because of affordability and facing other financial priorities. While 47% said this was a temporary decision the continuing cost-of-living crisis may force many more to leave the scheme.

Pension provision can be poorer in the independent health and care sectors, often creating an even greater problem. The RCN 2019 employment survey of nursing staff found that 81.1% of nursing staff working for an independent sector care home belonged to a pension scheme, compared to 92.5% working for an NHS trust or board.

The RCN 2019 survey showed that 55% of respondents are the primary or main breadwinner in their households, indicating the level of reliance on nursing wages. It is even higher among Black (65%) and Asian nursing staff (61%) showing that real terms pay cuts, added to rising costs of living have a disproportionate impact on many groups of staff.

It is unacceptable that nursing staff, already overworked and facing financial hardship should spend hours of their working week earning the cost of their own employment. 

Reading list for this debate available at rcn.libguides.com/congress2023.

References

Office for National Statistics (2023a) RPI: Percentage change over 12 months - Food and catering (March 2023). Available at: https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/czbj/mm23 (Accessed 27 March 2023).

Office for National Statistics (2023b) RPI: Percentage change over 12 months - Petrol and Oil incl Fuel Oil (22 March). Available at: https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/dogq/mm23/previous (Accessed 27 March 2023).

Royal College of Nursing (2022) Low wages forcing nursing staff to opt out of NHS pensions, 25 October. Available at: https://www.rcn.org.uk/news-and-events/news/uk-low-wages-force-nursing-staff-to-opt-out-of-nhs-pensions-251022 (Accessed 27 March 2023).

NHS Business Services Authority (2022) NHS Pension Scheme member contribution changes October 2022 requirements: revised and updated: 10 November 2022. Available at: https://www.nhsbsa.nhs.uk/sites/default/files/2022-11/MemberContributionChanges_PayrollProviderRequirements_v5.0_20221114.pdf (Accessed 27 March 2023).

Cannings J, Halterbeck M, Conlon G and Guglielmi P (2022) A decade of pay erosion: The destructive effect on UK nursing staff earnings and retention: a report for the Royal College of Nursing. Available at: https://londoneconomics.co.uk/blog/publication/a-decade-of-pay-erosion-the-destructive-effect-on-uk-nursing-staff-earnings-and-retention-october-2022 (Accessed 27 March 2023).

The Royal College of Nursing (2019) RCN Employment Survey 2019, Royal College of Nursing. Available at: https://www.rcn.org.uk/Professional-Development/publications/pub-007927 (Accessed 27 March 2023)