Changes in NHS could put nurses' pay at risk

Improvements in nurses' pay, hard-won in the 1980s, could be lost under the National Health Service changes, an independent study warns today.

Moves to local wage negotiation by self-governing hospital trusts will leave nurses prey to hospital managers keen to cut costs, the report by the King's Fund Institute, a centre for health policy analysis, says.

It warns that wages will be held down because local hospitals tend to be the only major employers and will collude. They may leave many nurses with no option but to accept low rates of pay.

The study predicts industrial strife at local levels if the nurses' national leadership cannot maintain pay levels through 'traditional, non-militant pay bargaining methods'.

The temptation to hold down the wages of Britain's 600,000 qualified nurses is high because their NHS pay bill - at more than pounds 6bn in 1990-91 - represented one quarter of the total NHS expenditure. This was 3 per cent of total government expenditure.

Additionally, nursing is often classified as 'women's work', a factor which some analysts have cited as a factor in the suppression of their wages. More than 90 per cent of NHS qualified nurses are female. One in 20 of the UK female working population is an NHS qualified nurse or auxiliary.

The study says: 'Research from the United States, where pay determination is localised, suggests that employers of nurses often pay below the level which would be dictated by market forces, because there is often limited competition for nursing staff in a labour market, and collusion exists between employers to maintain pay levels.' In 1983, nurses were rewarded with a special pay review body for, in the majority, not taking part in industrial action during the 1982-83 NHS winter of discontent. The Royal College of Nursing, which represents most nurses, has a no-strike policy.

Margaret Thatcher's government promised to 'accept review body recommendations unless there are clear and compelling reasons for not doing so'.

The review body could become a lame duck within a couple of years. By then, the majority of hospitals will be trusts. Such self- governing units can ignore the review body's recommendations for those staff employed since their creation. Rapid staff turn-over means that many nurses will thus not have review body entitlements within a few years.

Local pay awards could be poor in London, where thousands of jobs may be shed in the next decade, provoking downward pressure on pay. Privately, senior NHS managers have argued for more radical measures, namely a wholesale move away from the review body by 1994.

If national pay awards do collapse there would probably be some gainers, the study says - theatre nurses who are in short supply plus ward sisters and managers.

Prospects for Nurses' Pay, Flexibility or Fragmentation; James Buchan, King's Fund Institute; available from the Bournemouth English Book Centre, 9, Albion Close, Parkstone, Poole, Dorset BH12 3LL; pounds 8.95.