Closed call for evidence

Separate pay spine for nursing

Published 11 January 2024

Applies to England

Introduction

Nursing staff have a key role across the NHS workforce; they provide essential clinical expertise to support the delivery of NHS services, and nurses make up a significant proportion of NHS staff.

The government is committed to supporting the recruitment and retention of nurses, to help the NHS to deliver its services effectively and to adapt to the evolving needs of patients. Policies that are in place to support this aim include:

• a target set in 2019, and met in November 2023, to increase the number of nurses in England by 50,000 by the end of this Parliament
• the development and expansion of apprenticeships and new nursing roles to provide a strong talent pipeline into the registered nursing profession
• further ambitious plans to train, retain and reform the nursing workforce in the longer term, as set out in the NHS Long Term Workforce Plan

In May 2023, the government agreed a deal for the Agenda for Change (AfC) workforce through the NHS Staff Council. The deal consisted of additional payments for 2022 to 2023, a pay uplift for 2023 to 2024, and a series of non-pay measures to support the NHS workforce, including nursing staff.

Work to progress these non-pay commitments is ongoing, and includes improving opportunities for nursing career progression, and exploring how outcomes from the nursing and midwifery national job profiles review (currently being conducted through the NHS Staff Council) can be applied fairly and appropriately across the NHS to aid career development.

During negotiations, concerns were raised about how the AfC pay structure is affecting the career progression and professional development of nurses, and the direct impact that this is having on recruitment and retention.

AfC was introduced in 2004 and applies to all members of the non-medical workforce that are directly employed by NHS organisations (apart from very senior managers).

The Royal College of Nursing (RCN) suggested that a new pay spine for nurses, separate to the current pay arrangements used for the rest of the AfC workforce, could address concerns with career progression and professional development of nurses.

The government has published this call for evidence to consider the benefits and challenges of a separate pay spine for nursing staff, and to explore other potential approaches to supporting the career progression and professional development of nurses.

The exploration of a separate nursing pay spine does not form part of the AfC deal that was agreed with the NHS Staff Council.

Aim of the call for evidence

AfC was established following extensive consultation with health trade unions and employers, and to reflect the development of case law, following a number of equal pay claims when professions had their own pay arrangements. It was designed to harmonise pay, terms and conditions and deliver a number of benefits, including:

• equal pay for work of equal value
• improved job descriptions
• better partnership working

Nursing roles in the NHS are covered by AfC arrangements. We are looking for evidence from different perspectives across the health and care system that will inform the government’s consideration of separating nurses pay from other staff under AfC in the NHS in England.

We are specifically looking for evidence that will enable us to:

• identify any issues with nurses’ career progression and professional development under the AfC pay structure, and understand any impacts this is having on recruitment and retention
• assess whether any of the issues identified are unique to the nursing profession
• evaluate whether a separate nursing pay spine would address any issues raised
• understand the impacts of removing nursing staff from the harmonised AfC pay arrangements
• consider alternative solutions that could support any issues that are identified

The government will be considering the legal and equality implications of removing nursing staff from the existing AfC arrangements and we welcome views and evidence from respondents on these matters.

This call for evidence is open to everyone. You can respond:

• on behalf of an organisation
• as an individual member of the health and care workforce
• as an individual that is not a member of the health and care workforce

Each category of respondents will be asked a different set of questions.

Understanding the problems

While the benefits of AfC continue to be realised, concerns have been raised over career progression and professional development for nursing staff in the NHS, and the impact that this is having on the recruitment and retention of nurses.

The government is currently progressing multiple workstreams, in partnership with NHS employers and NHS trade unions, to consider some of these issues as part of the deal agreed with AfC trade unions in May 2023. One of these workstreams is dedicated to improving opportunities for nursing career progression.

This call for evidence is being published to explore the specific concerns that have been raised in relation to the ability of the AfC pay structure (which applies to all non-medical staff in the NHS apart from very senior managers) to support nurses’ career development and to account for the way that the nursing profession has changed over time.

We are looking for any evidence to demonstrate whether the AfC pay structure is creating career progression issues that are specific for nursing staff, and for any evidence to demonstrate the impact of this on the recruitment and retention of nursing staff. We are also looking for evidence regarding the specific features of the pay structure that may be having this impact. This will help government to ensure that its considerations are evidence-based, and that if any further action is taken it would directly address the issues identified.

Questions for organisations

Question

Is there any evidence to suggest that the current AfC pay structure is creating issues for the career progression and professional development of nursing staff in the NHS?

• Yes
• No
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Question

Is there any evidence to demonstrate that issues with career progression and professional development are impacting the recruitment and retention of nursing staff in the NHS?  

• Yes
• No
• Don’t know

Please provide any evidence you have to support your answer. (Maximum 500 words)

Question

To what extent could existing AfC arrangements accommodate changes to the nursing profession, including changing responsibilities within roles and the introduction of new nursing roles?

• Fully
• Partially
• Not at all
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Question

Is there any evidence to suggest that issues with career progression and professional development in the NHS are unique to nursing, and would therefore require a solution that is exclusive to nursing?

• Yes
• No
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Questions for members of the health and care workforce

Question

If you have experienced any barriers to your career progression and/or professional development in the NHS, please indicate which below. (Select the barriers that impact you most - maximum 3)

• Lack of clear career pathways
• Limited availability of training and education courses
• Limited opportunities for promotion
• Insufficient career and development support provided by line managers and team leaders
• Poor organisation or team culture
• Job description (and therefore pay band) not accurately reflecting the work that you do
• Barriers within the AfC pay structure
• Other

Please provide your views, evidence or experience to explain your answer. (Maximum 200 words)

Question

In your view, how important is the AfC pay structure as a factor that impacts your career progression and professional development choices?

Please consider this in relation to the other factors listed in the previous question.

• Not important
• Slightly important
• Moderately important
• Important
• Very important

Please provide your views, evidence or experience to explain your answer. (Maximum 200 words)

Question for individuals outside of the health and care workforce

Question

If you have any evidence or experiences of how the AfC pay structure is affecting the career progression and professional development of nursing staff in the NHS, please outline these below. (Maximum 200 words)

Separate pay arrangements for nursing staff

The RCN has suggested that a separate nursing pay spine could help to address concerns around nursing career progression and professional development under the current AfC arrangements.

Introducing a separate pay spine exclusively for nursing staff would remove these members of the workforce from the single pay structure that is currently provided by AfC.

AfC was introduced following a number of equal pay cases when professions had their own pay arrangements and therefore an important principle of AfC is to ensure that NHS staff receive equal pay for work of equal value.

As the AfC pay system covers a wide variety of NHS roles across multiple professions, and the work required by different roles is not always directly comparable, it is underpinned by the NHS Job Evaluation Scheme (JES). The NHS JES evaluates the skills, responsibility and effort that is required for different AfC jobs. Each job is given a job evaluation score, agreed in partnership between employers and trade unions, and is assigned to a pay band within the AfC pay structure based on this score. The NHS JES is a legally tested scheme that supports pay equity across the AfC workforce.

In exploring a separate pay spine for nursing staff in England, consideration needs to be given to the wider implications of removing nursing staff from the harmonised pay and contractual arrangements provided by AfC, as well as considering the benefits that a separate pay spine may bring to nurses and the nursing profession.

Questions for organisations

Question

Do you think the introduction of a separate nursing pay spine would improve the career progression and professional development of nursing staff?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 1,000 words)

If you answered ‘yes’, please explain how you think a nursing pay spine would achieve this.

If you identified issues for nursing staff in the section ‘Understanding the problems’, please consider whether you think a separate nursing pay spine would directly address these issues and explain the reasons for your view. 

Question

Do you think there are any additional benefits to introducing a separate nursing pay spine that are not directly related to career progression and professional development?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 500 words)

Question

Do you think there would be risks or potential unintended consequences of separating nursing staff from the current AfC pay arrangements?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 1,000 words)

If you are responding as a membership organisation, please include a view of how this would be received by your membership or profession, and any potential consequences of this.

Question

Do you agree or disagree with the principle of introducing a separate pay spine exclusively for nursing staff?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

Questions for members of the health and care workforce

Question

Do you think the introduction of a separate nursing pay spine would improve the career progression and professional development of nursing staff?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 500 words)

If you answered ‘yes’, please explain how you think a nursing pay spine would achieve this.

If you identified issues for nursing staff in the section ‘Understanding the problems’, please consider whether you think a separate nursing pay spine would directly address these issues and explain the reasons for your view. 

Question

Do you think there are any additional benefits to introducing a separate nursing pay spine that are not directly related to career progression and professional development?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 200 words)

Question

Do you think there would be risks or potential unintended consequences of separating nursing staff from the current AfC pay arrangements?

• Yes
• No
• Don’t know

Please share any relevant experiences or evidence to support your views. (Maximum 500 words)

Question

Do you agree or disagree with the principle of introducing a separate pay spine exclusively for nursing staff?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

Question for individuals outside of the health and care workforce

Question

Do you agree or disagree that a separate pay spine should be introduced for nursing staff in the NHS?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

Please explain your answer. (Maximum 200 words)

Design of a separate nursing pay spine

If a separate pay spine for nursing was taken forward, there are 2 ways in which the pay arrangements for nursing staff could be separated from the rest of the AfC workforce.

Option 1 - introduce a separate nursing pay spine within the existing AfC contract

If we introduced a separate nursing pay spine within the existing AfC contract:

• all non-medical staff would remain on the same wider set of terms and conditions (covering matters such as annual leave, sickness absence and pay enhancements)
• there would be 2 pay spines within the AfC contract: one for nursing staff and one for other AfC staff
• the JES would continue to apply to both pay spines, meaning that nursing roles would continue to be evaluated against other AfC roles to ensure that equal pay was maintained
• the NHS Staff Council would retain responsibility for the AfC contract

Option 2 - introduce a separate nursing pay spine as part of a new contract for nursing staff

If we introduced a separate nursing pay spine as part of a new contract for nursing staff:

• a new national contract would be negotiated for nursing staff
• this would include a pay spine, a mechanism for determining levels of pay, as well as a wider set of terms and conditions
• new contractual arrangements would need to ensure that pay equity continued to apply across the NHS workforce, and that there was a robust structure in place to support progression criteria for a new pay spine
• the NHS Staff Council would retain responsibility for the AfC contract, however a new national collective bargaining structure would be needed to take responsibility for the new nursing contract

We are looking for evidence and views on the practical considerations that would be needed to design and implement a separate nursing pay spine. This will help ensure the government’s considerations are evidence based, and that if any further action is taken, it would be operationally possible.

Questions for organisations

Question

What would be the benefits, if any, of option 1? (Maximum 500 words)

Question

What would be the challenges and wider implications, if any, of option 1? (Maximum 500 words)

Question

What practical steps and decisions would be needed to implement option 1? (Maximum 500 words)

Question

What would be the benefits, if any, of option 2? (Maximum 500 words)

Question

What would be the challenges and wider implications, if any, of option 2? (Maximum 500 words)

Question

What practical steps and decisions would be needed to implement option 2? (Maximum 500 words)

Question

If a separate nursing pay spine were introduced, which of the following would you prefer?

• Introduce a separate nursing pay spine within the AfC contract (option 1)
• Introduce a separate nursing pay spine as part of a new contract for nursing staff (option 2)
• No preference - both options would work
• No preference - neither option would work
• Don’t know

Please explain your answer. (Maximum 200 words)

Question

If you have any views on which members of the nursing workforce should be in scope of a separate nursing pay spine, please outline them. (Maximum 500 words)

Please include how your suggested approach would best support the recruitment, retention and development of nursing staff in the NHS.

Question

If you have any views on how nursing roles should be assessed against a separate nursing pay spine, please outline them. (Maximum 500 words)

Please include how your suggested approach would best support the recruitment, retention and development of nursing staff in the NHS.

Question for members of the health and care workforce

Question

If a separate nursing pay spine were introduced, which of the following would you prefer?

• Introduce a separate nursing pay spine within the AfC contract (option 1)
• Introduce a separate nursing pay spine as part of a new contract for nursing staff (option 2)
• No preference - both options would work
• No preference - neither option would work
• Don’t know

Please explain your answer. (Maximum 500 words)

There are no questions in this section for individuals outside of the health and care workforce.

Other approaches

Work is already underway as part of the AfC deal to support different aspects of career progression and professional development for nursing staff, and the recommendations from these pieces of work will be considered through established mechanisms in due course.

This call for evidence has been published to explore the scope of a separate pay spine for nursing staff, as a way to address specific concerns raised about the career progression and professional development of nurses under the AfC pay structure. We are keen to explore other potential approaches to addressing any issues that you have identified in the ‘Understanding the problems’ section of this call for evidence.

Questions for organisations

Question

Are there any adjustments that could be made to the existing AfC pay structure, or any existing flexibilities within AfC that could be used more effectively, to address any issues you have identified in the ‘Understanding the problems’ section?

• Yes
• No
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Question

Are there other measures that could be considered to support any issues you have identified in the ‘Understanding the problems’ section?

• Yes
• No
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Question

Is there evidence of effective solutions that are currently in place within the NHS to support the issues you have identified in the ‘Understanding the problems’ section?

• Yes
• No
• Don’t know

Please explain your answer and provide any evidence you have to support your views. (Maximum 500 words)

Questions for members of the health and care workforce

Question

What changes could be made to better support your career progression and/or professional development in the NHS? (Select up to 3)

• Clearer career pathways
• Improved access to training and education courses
• Increased opportunities for promotion
• More career and development support provided by line mangers and team leaders
• Improved organisation or team culture
• Ensuring your job description (and therefore pay band) accurately reflects the work you do
• Changes to the AfC pay structure
• Other

Please provide your views, evidence or experience to explain your answer. (Maximum 200 words)

Question

Are there any adjustments that could be made to the existing AfC pay structure to better support any issues you have identified in the ‘Understanding the problems’ section?

• Yes
• No
• Don’t know

Please provide your views, evidence or experience to explain your answer. (Maximum 200 words)

Question for individuals outside of the health and care workforce

Question

Please share any views, evidence or experience you have relating to alternative measures to support the career progression and professional development of nursing staff. (Maximum 200 words)

How to respond

This call for evidence closes at 11.59pm on 4 April 2024. You can respond by completing the online survey.

If you have any technical problems with using the online survey, log the issue by emailing nhs_ppandes_services@dhsc.gov.uk. Do not send any personal information to this email address.

Next steps

The government will review all of the evidence that is submitted and will use this to consider its position in relation to supporting nursing recruitment, retention and professional development in the NHS.

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