Hospitals in England that do not adequately increase nurses’ pay to reflect their responsibilities risk industrial action, according to the Royal College of Nursing (RCN). The union has warned that some National Health Service (NHS) trusts may face strikes if they fail to properly re-band band five nurses, the entry-level grade under the NHS Agenda for Change pay system.

Band five nurses currently earn around £32,000 annually, with additional payments for overtime and unsocial hours. Despite the role being considered entry level, the RCN has highlighted that many staff remain at this band for decades, even when their duties and skills justify progression to higher bands. The union argues that this undervaluation does not reflect the true contribution of nursing professionals.

General Secretary Professor Nicola Ranger, who also serves as the RCN’s chief executive, described the Government’s current review of all band five nursing roles as the most significant opportunity to elevate nursing standards in decades. The review, announced in February, seeks to assess roles and shift nurses to higher bands where appropriate, potentially leading to pay increases. Funding for the salary uplifts is to be provided by the Government to NHS employers.

While Prof Ranger expressed optimism about the forthcoming changes, she cautioned that some NHS trusts may resist re-banding and fair remuneration. She emphasized that the union would be prepared to take strong and targeted action, including strikes, against these “outlier” trusts if necessary. Nonetheless, she noted that the union was not currently seeking an immediate industrial ballot and encouraged members to engage positively with the process, stressing that nurses do not want to lose pay or disrupt patient care. However, she underscored that the profession was ready to act if fair pay adjustments are not implemented.

The union’s position includes a long-term expectation that the staff nurse role will eventually be classified at band six, reflecting a higher level of responsibility and skills. Prof Ranger also highlighted broader external pressures on nursing staff, including the cost-of-living crisis and global issues such as the conflict in Iran, which affect the wellbeing of healthcare workers.

The Department of Health and Social Care responded by pointing to recent improvements, noting that newly qualified nurses entering the profession now receive 18.6 percent more in basic pay compared to four years ago. The department also cited a range of measures it has introduced to support the nursing workforce and ensure they receive appropriate pay and support.

As the detailed rollout plan for re-banding is expected in the coming weeks, both sides appear to be positioning themselves carefully ahead of potential disputes. The situation underscores ongoing tensions over nurse pay and recognition within the NHS, a critical element given the role nurses play in the healthcare system.