ICN writes to UK Secretary of State for Health: “The road to economic growth is paved by investment in health.”

The International Council of Nurses (ICN) has written an open letter to the UK Secretary of State for Health and Social Care, Steve Barclay setting out the health and economic reasons for investing in nurses’ pay. The Royal College of Nurses (RCN), ICN’s member association in the UK, is – for the first time in its history – considering industrial action following the refusal of UK ministers to discuss the issue of pay.

RCN has written to the UK Prime Minister, Rishi Sunak, calling on him to protect nursing in order to protect the public. ICN has previously warned governments of the impact of an increasing shortage of nurses, and, following the release of the ICN’s 2022 report, Sustain and Retain in 2022 and Beyond, ICN Chief Executive Officer, Howard Catton said, “We can no longer afford to undervalue and underfund the nursing profession, not only for the sake of the health of nurses, but for the protection and sustainability of our entire global health system.”

In June 2022, ICN reported on strike action across the globe, saying “the alarming rise in the number of nurses taking strike action across the world is a direct response to governments’ failure to tackle the root causes of our fragile, severely weakened, and in some cases collapsing healthcare systems”. ICN’s position statement on industrial action can be found here.

ICN’s open letter to Mr Barclay said:

“The COVID-19 pandemic has taught us that we need to be better prepared for future pandemics. It has set us back on the road to Universal Health Coverage. We also know we have issues around noncommunicable diseases, ageing and antimicrobial resistance. For all of those reasons, ICN and WHO have been crystal clear that we need to invest in the nursing workforce.

ICN has worked with WHO to develop the current Global Strategic Directions for Nursing and Midwifery 2021-2025 which was adopted by the World Health Assembly in 2021. The top line message of this report is the need for investment in nursing leadership, education, jobs and service delivery.

ICN has been concerned for number of years about the historic undervaluing of nursing roles in terms of pay which does not reflect the complexity and demands of modern nursing practice. Nurses today are educated to degree level. They are problems solvers, leaders and scientists. Nurses are at the forefront of advancing innovations to improve access to care and creating new models of care. They are a safety critical profession and decades of overwhelming evidence shows that having the right number of experienced and educated nurses leads to better patient outcomes, shorter lengths of hospital stays, lower readmission rates and, most importantly, reduced mortality rates. Nurses are a major part of the solution to meeting the new challenges that the world faces today.

We are also very concerned that the undervaluing of the nursing profession in economic terms is driven by the fact that the majority of nurses are women. Therefore, by investing in nursing, we not only strengthen health systems, but we also address gender equality and equity.

Pay is, without a doubt, an absolutely critical factor in the retention and recruitment of nurses. ICN’s work has shown that, during the global economic downturn, nurses pay around the world stagnated and, now, as we come out of the pandemic, but face the challenge of war in Ukraine and economies struggling, nurses’ pay is falling again in real terms. This is an historically long-term pattern of fall in pay, which not only is making the nursing profession unattractive for people starting careers, but we are also seeing increased quit rates and vacancy rates around the world with people leaving the profession early, leading to a challenge in retention. Increasing pay will help to address recruitment and retention issues and also help reduce England’s reliance on the overseas recruitment of nurses which risks weakening already fragile health systems and widening global inequalities.

We hear governments say that they can’t afford to invest in nursing, but ICN has consistently replied that the world cannot afford not to invest in nursing. Why? Because nurses are the bedrock of strengthening your health systems, of keeping people well and healthy, and having a productive population who can work. There can be no health security without nurses. The road to economic growth is paved by investment in health.

The report of the United Nation’s Commission for Health Employment and Economic Growth showed that new investment in global health workforce will create jobs and drive economic growth. It stated that “Investments in the health system also have multiplier effects that enhance inclusive economic growth, including via the creation of decent jobs.”

A recent World Economic Forum article by Hans Kluge, WHO Regional Director for Europe and Professor Mario Monti, Head of the Pan-European Commission on Health and Sustainable Development, stated “The past three years taught us a fundamental lesson. If we fail to invest in preparing our health systems for unexpected shocks, in this case, a pandemic, but also financial crises or natural disasters, we will pay more in the long run” and “Given that healthcare will always be labour intensive, even if we can harness new technology, we must invest in the health workforce, with measures that attract and retain these essential workers.”

ICN policy supports strike action by nurses around the world. We do see it as a last resort, but it is a right. However, we also encourage – in the strongest possible way – all parties to come together to meaningfully negotiate on pay and working conditions to find a solution. When you invest in nursing, you are investing in the health security and economic prosperity of the people of the UK.

Download the press release here