Annexes

Annex 1 – Summary of data sources used in this report

Data source

Chapter used in

Overview and limitations

NHS Digital: NHS Staff Earnings Estimates

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-staff-earnings-estimates

2: UK nurse pay analysis

NHS Digital provide quarterly data on the average earnings of staff in the NHS Hospital and Community Health Service (HCHS) sector in England.

Limitations of the quarterly data:

  • The data provide only specific estimates of average earnings and do not provide ranges. This does not facilitate analysis of how the earnings distribution for NHS staff may have changed over time.
  • The data go back to 2010 and are not available for previous years as they are derived from the NHS Electronic Staff Record (ESR) and most NHS trusts began using the ESR in 2009.
  • Nurses and health visitors are a combined entity in the data and it is not possible to look at nurses’ or health visitors’ average earnings in isolation.
  • The data do not classify NHS staff by Agenda for Change pay band, so it is not possible to use them to examine the proportion of staff by pay band.
  • The data are not presented for key staff characteristics (eg gender, age band, ethnicity and region of residence), so analysis of subgroups cannot be undertaken.

Office for National Statistics: Annual Survey of Hours and Earnings (ASHE), 1997 onwards

Office for National Statistics: New Earnings Survey (NES), 1973–1996

2: UK nurse pay analysis

The Office for National Statistics provides estimates of the mean gross weekly earnings of UK employees over time, in recent years based on the Standard Occupational Classification 2010 (SOC, 2010).

Limitations:

  • The data provide only specific estimates of average earnings and do not provide ranges. This does not facilitate analysis of how the employee earnings distribution may have changed over time.
  • The data refer to all UK nurses as a combined entity. It is not possible to look at NHS nurses in isolation.
  • The averages are available by gender and separately for full-time and part-time employees but analysis of other employee characteristics such as ethnicity and region of residence cannot be undertaken.

Organisation for Economic Co-operation and Development (OECD) Health Statistics: Remuneration of health professionals

3: International nurse pay comparisons

The OECD provides data on hospital nurses’ remuneration in OECD countries over time. Remuneration is defined as average gross annual income, including social security contributions and income taxes payable by the employee.

Limitations:

  • Remuneration should normally include all extra formal payments, such as bonuses and payments for night shifts and overtime, but some countries are not able to provide data on bonuses and supplemental payments. Further, remuneration data do not account for differences in hours worked and pension payments and so cannot be used to compare total reward packages across countries.
  • The data are for salaried hospital nurses, a category that covers certified/registered nurses actively practising in public hospitals and also in other health care facilities in some countries. In some countries, it includes all qualified nurses, while in others (eg in Canada and the United States) it only includes registered nurses and not licensed practical or vocational nurses.
  • The data relate to nurses working full time, except for Belgium where part-time nurses are also included.

Annex 2 – Brief summary of research on public sector pay in the UK

The debate on public sector pay determination and earnings differentials between the public and private sectors is an old one. Disney and Gosling (1998) provide a snapshot of how earnings distributions differed between the public and private sectors in the UK in the 1980s and 1990s. Bryson and Forth (2017) provide a comprehensive summary of how earnings growth in occupations covered by the pay review bodies (PRBs) compares with comparable other occupations in the economy. Their findings suggest that in the 2005–2015 period, PRB occupations were somewhat insulated from a real-terms earnings decline across the economy. However, there were differences in earnings growth outcomes across PRB occupations, even in cases where the same PRB was responsible. While nurses covered by the NHSPRB registered better earnings growth than those not covered by the NHSPRB, the differential was largely found to be due to differences in occupational workforce composition (such as tenure and age profile variation). On the other hand, PRB nursing auxiliaries enjoyed better earnings growth than their non-PRB counterparts even after accounting for such compositional differences.

In terms of benchmarking public sector pay growth, there are several alternatives:

  • A comprehensive review commissioned by the Office of Manpower Economics (Economic Insight, 2017) noted that there is considerable sectoral variation in the findings of studies looking into the relative value of different workplace rewards. With UK studies tending to focus on doctors and dentists more often than on other health care staff, there is little evidence regarding how different forms of remuneration affect health care workers.
  • As we highlight in Chapter 2, research undertaken by the Institute for Fiscal Studies (2018) has emphasised the relevance of accounting for educational attainment levels.
  • Further, research commissioned by the Office of Manpower Economics on modern pay systems in the private and not-for-profit sectors (PwC, 2016) offers useful insights, with individual job rates, broad banding and narrow banding all found to be quite common. Other research finds evidence of a persistent long-term relationship between public and private sector earnings, with public sector earnings tending to move in line with wage setting in the private sector. At the same time, wage increases in the public sector go hand in hand with significant employment inflows.
  • Another point to consider is regional or local pay variation – the NHSPRB undertook a review of ‘market-facing pay’ in 2012, setting out guidelines that might help to tailor the Agenda for Change framework in line with local labour market characteristics. Research by the Institute for Fiscal Studies in 2015 showed that the wage elasticity of nurse labour supply is likely to be higher in labour markets offering a wider and better array of employment alternatives (such as London).

There remain gaps in our understanding of how different variables affect nurse labour supply, both directly and in interaction with each other. The REAL Centre is undertaking work to develop a nurse supply model that should provide more insights into the drivers of nurse supply in England by the end of this year.

Annex 3 – Additional data on mean gross weekly earnings of nurses and selected other occupational groups

Figure A1: Nominal mean gross weekly pay, male full-time nurses and male full-time employees in selected other occupations in the UK, 1973–2019

Source: ONS Annual Survey of Hours and Earnings and New Earnings Survey Note: The data represent male full-time employees only. 2020 data have not been included as they are provisional and may reflect some impacts of the COVID-19 pandemic. Time-series data for male full-time nurses are available from 1979 onwards. The numbers of male nurses in the UK have historically been small, as a result of which many of the average earnings estimates for male full-time nurses are based on relatively small sample sizes and therefore subject to greater uncertainty, thus we do not analyse this time series in depth.

Figure A2: Index of mean gross weekly earnings of female full-time nurses and selected other occupations in the UK in real terms (after accounting for CPIH inflation), 1999–2019 (1999 = 100)

Figure A3: Index of mean gross weekly earnings of female full-time nurses and selected other occupations in the UK in real terms (after accounting for CPIH inflation), 2009–2019 (2009 = 100)

Source: ONS Annual Survey of Hours and Earnings and New Earnings Survey; ONS CPIH data Note: The data represent female full-time employees only. 2020 data have not been included as they are provisional and may reflect some impacts of the COVID-19 pandemic. Estimates for police officers refer to police officers at sergeant level and below.

Annex 4 – Summary of OECD data on hospital nurses’ earnings in selected OECD countries

Country

Data sources

Methodology

Australia

2018 onwards: Australian Institute of Health and Welfare (AIHW). Hospital resources tables. www.aihw.gov.au/reports-data/myhospitals/content/data-downloads. 2014–2017: Australian Institute of Health and Welfare. Hospital resources: Australian hospital statistics. Canberra: AIHW (and previous issues). Also at www.aihw.gov.au. 2000–2013: Australian Institute of Health and Welfare. Australian hospital statistics. Canberra: AIHW (and previous issues). Also at www.aihw.gov.au.

  • Data cover all levels of nurses.
  • The year reported is the financial year 1 July to 30 June (eg 2016-17 is reported as 2016).
  • Figures include all recurrent expenditure (including payments for overtime) on salaries and wages.
  • Limitations on recurrent expenditure information for public hospitals exist. The collection of staffing categories was not consistent among jurisdictions and in some instances best estimates were reported. See Australian Institute of Health and Welfare, Hospital resources 2016–17: Australian hospital statistics for more information.

Canada

Statistics Canada, Labour Force Survey

  • There is a deviation from the OECD definition in that, until 2014, data refer to both Nurse Supervisors and Registered Nurses (category D1 of the National Occupational Classification: www.statcan.gc.ca/eng/subjects/standard/noc/2011/noc-s2006-noc2011) working both in hospitals and outside hospitals. It was not possible to separate out the remuneration for Registered Nurses and Nurse Supervisors. Only those workers who have either a post-secondary certificate of diploma, University: Bachelor’s degree or a University: Graduate degree have been included.
  • Break in time series in 2015: Starting in 2015, nursing coordinators and supervisors are excluded, in agreement with the OECD definition. However, a deviation from the OECD definition still exists as data still include registered nurses outside hospitals and still exclude licensed practical nurses.
  • Data refer to registered nurses working full time.

New Zealand

District Health Board (DHB) audited financial templates

  • Data for hospital nurse remuneration are direct costs for those staff directly employed by DHB (ie those people with a legal employment relationship). This category therefore excludes contractors.
  • Remuneration is an average accrued cost per FTE (ref: www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/200, Measuring staff resources – counting ‘FTEs’) rather than remuneration to nursing personnel.
  • The following employment categories are included: Nurse Practitioners, Senior Nurses (includes Senior Nurses, Nurse Managers and Nurse Educators), Registered Nurses, Enrolled Nurses, Nursing aids/assistants and care workers who do not have any recognised qualification/certification in nursing, Registered Midwives, Internal Bureau Nurses and Health Assistants.
  • There may be some discrepancies with the OECD definition: in particular, nurses actively practising in private hospitals are excluded.
  • Break in time series in 2015: Up to and including 2014, the data have included employers’ contributions to superannuation schemes. These contributions have been excluded from 2015, resulting in a slight decrease.

United Kingdom

NHS Digital – Electronic Staff Record data (coverage: England only)

  • Data are estimates for the UK based on estimates for NHS hospital nurses in England, up to and including 2019.
  • Payments made to nurses by private sector organisations are not available and therefore not included.
  • Data are provided from 2009 onwards. Data collected prior to 2009 are not consistent with the current definitions and have been excluded.
  • Figures are calculated per person based on a methodology that does not aggregate all additional payments over and above basic salary by FTE, as additional payments are typically made on an individual level basis only not related to FTE. Mean total earnings are calculated by dividing the total amount of pay earned by staff in the group by the total number of staff.
  • Further information: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-staff-earnings-estimates

United States

US Bureau of Labour Statistics, Occupation Employment Statistics (OES) survey. Coverage: Nationally representative sample of the US civilian non-institutionalised population.

  • Deviation from definition: Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs) are not included.
  • Calculation method does not match OECD definition: The estimates shown here are for all hospital-based registered nurses (RNs).
  • Hospital-based RNs based on the North America Industry Classification System Code NAICS 291111 are included.
  • Remuneration of hospital nurses includes RNs working on the NAICS session of Health Care and Social Assistance (62) and limited to General Medical and Surgical Hospitals (622100), Psychiatric and Substance Abuse Hospitals (622200) and Special Nursing and Rehabilitation Care Facilities (622300).
  • Registered nurses may include nurses in training and midwives.
  • Annual wages have been calculated by multiplying the hourly mean wage by 2,080 hours; where an hourly mean wage is not published.
  • Data are available from 2002 and are solely based on the NAICS classification system.
  • Further information: www.bls.gov/oes/

‡‡‡ In some instances, these limitations can be addressed by sending supplementary information requests to NHS Digital.

§§§ These limitations may be addressed by accessing the underlying survey microdata for the ASHE (1997 onwards) and the NES (1973–1996). However, these microdata are not publicly accessible as they are classified as sensitive and controlled data.

¶¶¶ For a more detailed description of this nurse supply model, see www.health.org.uk/what-we-do/real-centre/nurse-supply-model

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