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Monday, 18 December, 2000, 14:55 GMT
How nurses are paid
nurse graphic
NHS nurse recruitment is a major issue
Nurses have had mixed fortunes in this year's pay round. Senior nurses have benefited from a 5% pay increase.

But staff nurses have seen a 3.7% increase, which nursing leaders say is not enough to attract nurses back to the NHS.

Royal College of Nursing general secretary Christine Hancock said the award was "complex".

She said the government had listened and acted to improve the pay of senior nurses to keep them in the NHS.

"It will be good news for ward sisters, specialist clinical nurses and community nurses who have borne the brunt of pressures and who are key to modernising the health service."

But she said staff nurses would be "disappointed" with their 3.9% rise, and added the RCN would be monitoring the effect of the cost of living supplements, aimed to help nurses living in expensive areas.

"We will watch closely to see how these extra payments work in practice - they may simply shift the problem of nurse shortages from area to area."

Nursing leaders have accused the government of deceiving the public over its promise to expand the nursing workforce by 20,000 by 2004, a charge the government denies.

Current estimates from the professions say there are 22,000 vacant posts.

Career structure

Nurses are currently graded according to their training and experience, though there are plans to radically slim down the number of nurses' grades.

The first three grades are for non-registered nurses, and cover health care assistants and auxiliaries.

Unions have called for their low pay rates to be addressed.

Their work generally consists of jobs such as cleaning bed pans and looking after patients' non-clinical needs.

Within each grade there is a sliding pay scale which matches a person's experience.

Qualified registered nurses, from D grade upwards, carry out basic clinical tasks.

The next step up the career ladder is the post of senior staff nurse, followed by junior sister, then ward sisters, dubbed "modern matrons".

Nurses can specialise within hospitals, or move out into the community and work as a school nurse. practice nurse, district nurse, or do extra training and become a health visitor or midwife.

Midwives can however, have specialist midwife training, and do not need to have trained as a nurse.

At the top end of the nursing pay scale are ward managers, nurses who specialise in a particular field of nursing, ward managers who take on extra responsibilities and senior nurses who have a trust-wide remit.

Bones of contention

The government and nursing unions disagree about how best to reward senior nurses.

The government has created 400 "super-nurse" posts - paying up to 40,000 and involving extra responsibility.

Around half are already in post, but many do not earn the top rate for their grade.

Many more nurses are needed, say unions.

When he announced their introduction, Prime Minister Tony Blair, said they would have "the same status as medical consultants have within their profession".

Christine Hancock, general secretary of the Royal College of Nursing (RCN), welcomed the posts as "long-overdue" recognition that nurses are effectively working like consultants.

But she added: "We must ensure that all nurses are valued properly - in terms of pay, conditions and support."

Nursing unions are also concerned senior nurses are not receiving pay boosts from the discretionary points system, which is aimed at adding to the pay of senior nurses who have reached the top level of their grade.

The government says the extra cash is aimed at rewarding senior nurses for extra work, but unions say because the allocation of the discretionary pay is left up to individual trusts, many of whom do not have the funds, very few of the nurses who could receive the extra payments do so.

Pay system

Under the Conservatives, some health trusts introduced local contracts for health workers and a handful still enforce them.

The government is considering proposals to change the way NHS pay is set which could include more of a local pay element.

Health secretary Alan Milburn complained that the current system was "a muddle of local and national pay which was confusing and divisive".

He called for a clear role for local employers, which some have interpreted as a suggestion that the government is considering promoting local pay contracts - a move which Labour MPs criticised in opposition.

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