The cost of denying NHS staff fair pay

By Amanda Hunter (Staff Writer)

Energy coursed through my body during Cathy Warwick's opening address at the Royal College of Midwives (RCM) Conference in November 2014. In her speech, Warwick (the Chief Executive of the RCM) criticised the UK government for its decision to deny NHS midwives the 1% pay increase that had been recommended for NHS staff, while increasing pay for MPs by 10%[1]. In addition to midwives, this issue affects nurses, porters, paramedics, occupational therapists, cleaners, receptionists and other staff who work for the NHS.

During her RCM address, Warwick also shared an anecdote about questioning a government official regarding the pay increase for MPs. The government official told Warwick that this increase was recommended by an independent review panel in order to attract the best MPs. The room buzzed as Warwick then pointed out that attracting the best midwifery staff was also important and that their pay increase had also been the suggestion of an independent review panel (the NHS Pay Review Body). Indeed, one may wish to question whether they want the best MPs or the best healthcare staff to be employed in the area where they live. It is also important to consider the government’s ability to fund a pay increase for MPs and the implications for NHS staff and patients when denying workers fair pay.

The government's ability to fund a pay increase for MPs, while justifying the denial of a pay increase for NHS staff, may be indicative of conflicting government priorities rather than a need to make the NHS more sustainable or because of insufficient government funds[2]. Despite the purported lack of funding for the recommended NHS pay increase, government spending on a confusing and unnecessary restructure of NHS England in 2012/2013 was expected to cost £3 billion[3] [4]. Unfortunately, I was unable to find the actual costs of this restructure at the time of publication. Additionally, George Osborne, The Chancellor of the Exchequer for the British government, has recently found the resources to pledge £50 million in a bid to make the English national football team “the best in the world”[5].   

Meanwhile, it has been discovered that NHS staff are working longer hours to compensate for staff shortages while being underpaid for their work[6]. Significantly, a lack of investment in staff could actually be costing the NHS more than it saves. In 2012-2013, a 0.12% increase in staff sickness cost the NHS approximately £44 million more than in 2011-2012 (this is the equivalent of 386,520 days) and is thought to be partly reflective of the restructure and subsequent pressures on staff[7].

A UNISON flyer handed to me by striking NHS staff in central London on October 13 contained the following statement regarding their pay being frozen for the fifth year in a row:

“Like so many people we are faced with another year of worrying about bills, keeping a roof over our head and putting food on the table. One more year of sleepless nights because we want to care for our families and can’t see how we can make ends meet. … That worry doesn’t go away when we are at work – it’s always there. And that affects you as the evidence shows that when staff are motivated and feel valued and respected, the results for patients and their families improve.”

In addition to the effects on staff, almost two-thirds of NHS staff are concerned about patient safety as a result of staffing issues [8]. Research has found that NHS staff well-being has an effect on the quality of care received by patients[9]. Staffing issues and pressures on health care staff are amongst the matters cited by this research regarding how poor NHS healthcare staff morale is negatively experienced by patients during care[10]. Additionally, the Francis Report, which examined the Mid Staffordshire NHS Foundation Trust in light of its high mortality rates, found that the working environment for staff was not supportive and that low morale existed amongst staff[11].

Despite the evidence regarding the effects of poor healthcare staff morale on care, Edwina Currie, former Minister of Health and panelist in a session at the 2014 RCM Conference, was outraged by the recent strike action of midwives on October 13th which she described as “disgraceful”[12]. On the panel, Currie claimed that midwives should not receive a pay increase while the stillbirth rate remains high in the UK. While the UK stillbirth rate was found to be the highest amongst high income countries, with a relatively slow rate of decline in recent years, in the Lancet stillbirth series[13], Currie was perhaps missing how investing in midwives and issues around understaffing and poor morale may improve maternity care (and potentially the stillbirth rate in the UK). Indeed, a midwifery staff shortage of approximately 2300 midwives in the UK has led to low morale resulting from pressure on staff, while there has been an 80% increase of clinical negligence payments for maternity cases in the last 5 years[14]. Surely, low morale amongst midwives created by a pay freeze will not help this situation.

As I write this post, I think back to a trip that I made to an A&E department at a large hospital in central London in October 2014. At around 2am, I started speaking to an elderly man with mobility issues in the waiting area. He had been waiting for hours and needed help accessing the toilet as his catheter bag was full. With his permission, I informed the receptionist of his need. However, after waiting 20 minutes for a healthcare professional to assist him with this task, I helped him to the toilet.

When he was ready to emerge from the toilet, the nurse had finally arrived. However, rather than help him exit the washroom, she barely took notice of him (despite being informed that he was in there) and left him to struggle on his own. While I was happy to help him, I’m sure that this task was in her remit. What if a bystander hadn't been available or willing to assist this man? What would have happened? Would he have fallen over? Would his catheter bag have leaked and caused him embarrassment? Then I started to think about that nurse and the largely uninterested receptionist and wondered what their nights had been like to cause them to take such little notice of this man and his need for support.

To avoid such poor quality care for NHS patients, we need to think about the sustainability of the NHS in terms of more than just the immediate financial costs of providing fair pay for NHS staff. Following the NHS staff strike on November 24th, the hope is that the government will start thinking about the quality of life and morale costs for NHS staff and patients in addition to finances. The evidence to support improving healthcare staff morale, recent MP support to repeal the bill that would allow for the privatisation of the NHS[15] [16] and public support for the NHS strike[17] [18] will hopefully pave the way for the government to reconsider allocating funds to increase the wages of NHS staff and improve their quality of life and patient care.


Any views or opinions presented in this blog post are solely those of the author.

[1] Royal College of Midwives. UK top midwife slams Government over NHS pay in conference speech. RCM News. November 11, 2014: (accessed 23 November 2014).

[2] ibid

[3] Murphy-Lawless, J. Anything but simple. AIMS Journal 2014; 26: 6-11.

[4] Smith, R. NHS reforms will cost £3bn and will not work: academic. Telegraph, July 17, 2010: (accessed 25 November 2014).

[5] Crtichlow, A. George Osborne pledges £50m to make England football team 'best in the world.' The Telegraph, Finance, Economics, December 8, 2014: (accessed 16 December 2014).

[6] UNISON. UNISON survey shows NHS staff are overworked and underpaid. November 23, 2014: (accessed 23 November 2014).

[7] NHS Employers. 2012-13 NHS staff sickness figures released. Latest News, July 23, 2013: (accessed 25 November 2014).

[8] UNISON. UNISON survey shows NHS staff are overworked and underpaid. November 23, 2014: (accessed 23 November 2014).

[9] Maben, J. How NHS staff wellbeing affects patient care. HSJ. April 29, 2013: (accessed 25 November 2014).

[10] Ibid.

[11] Francis, R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. London: The Stationery Office, 2013. (accessed 25 November 2014).

[12] Royal College of Midwives. Edwina says strike was wrong. RCM News, November 12, 2014: (accessed 23 November 2014).

[13] Bowdler, N. UK stillbirth rates amongst highest of rich nations. BBC News, Health, April 11, 2011: (accessed 25 November 2014).

[14] Commons Select Committee. NHS midwives shortage remains despite increasing numbers., January 31, 2014: (accessed 25 November 2014).

[15] UNISON. UNISON hails victory as MPs overwhelmingly back bill to stop privatisation. News, November 21, 2014: (accessed 25 November 2014).

[16] BBC News. MPs back bill designed to limit NHS ‘privatisation.’ BBC News, Health, November 21, 2014: (accessed 25 November 2014).

[17] UNISON. Huge mobilisation and tremendous public support for the NHS strikers says UNISON. News, November 24, 2014: (accessed 25 November 2014).

[18] Press Association. NHS workers to stage four-hour strike as pay dispute continues. The Guardian, November 24, 2014: (accessed 25 November 2014).